Incontinence during and after pregnancy

Causes: why is my baby pressing on my bladder?

Let us look first at the pelvic floor muscles that support the organs in the lower abdomen. These ensure, together with other muscle bundles, that the bladder does not release urine, even when under stress.

To enable the child to grow and to prepare for birth, the pelvic floor muscles must now become considerably stretchier and softer. This is ensured in part by the increase in the hormone progesterone.2 These changes to the pelvic floor muscles make the birthing process easier but increase pressure on the bladder. It now has less support from the muscles in the pelvic floor and can no longer reliably withstand the pressure that develops with stresses such as coughing, sneezing, jumping or lifting heavy loads. The blood supply in the pelvic space of pregnant women also becomes much greater. This means that the kidneys produce more urine.

If and how severely a mother-to-be is affected by bladder weakness depends primarily on how strong her pelvic floor muscles are. The strength of these muscles declines with age and is also genetically predetermined to a certain degree. In general, physically active and slim women tend to have a stronger pelvic floor.

 

Symptoms of bladder weakness during pregnancy

The loss of urine during pregnancy is quite normal. Since there are many changes taking place in the female body, it is sensible to check with a doctor if it happens too often or for no apparent reason.

First three months of pregnancy, you can expect to have symptoms like frequent urination and pelvic pressure. In the second trimester, these symptoms will likely decrease as your uterus grows, creating more space in your abdomen, and as your hormones begin to stabilize..

However, in the last three months of pregnancy the baby’s head presses down directly onto the bladder and bladder weakness increases again. The muscles in the pelvic floor also relax more and more in preparation for the birth, symptoms of incontinence can easily be managed with incontinence pads for women.

Incontinence shortly before the due date

As the due date approaches, it is important to be sure that any unwanted loss of fluid is not due to waters breaking early. In most cases the outflow of the amniotic fluid can be easily differentiated from urine, simply due to the sudden and surge-like flow, but a steady dribble of amniotic fluid is also possible. If you are not entirely sure, there are special test strips that stain purple with amniotic fluid and dark green with urine. If the waters breaking are associated with the first contractions, this is an unmistakeable sign that you will very soon be holding a new life in your hands.

 

Uterine prolapse and incontinence

The uterus is held in position by a range of ligaments and muscles, including the pelvic floor muscles. If these muscles become weaker, for example, with age or after vaginal birth, the uterus can drop. This happens in about 30% - 50 % of women over the course of their lives.

Only in very extreme cases is this drop so severe that it is associated with symptoms and needs to be treated. For example, pain in the lower abdomen or back and a feeling of a foreign object in the vagina can indicate uterine prolapse.

 

A prolapsed uterus can also place more pressure on the bladder, which can lead to pain when going to the toilet, a weak urine stream and frequent urinating with a small volume of urine. Because the pelvic floor with its sphincter muscle system is weakened with uterine prolapse, this disorder is commonly associated with stress incontinence. Urine is typically lost with physical exertion such as jumping, sneezing or laughing. If the uterus slips downwards and backwards, this can lead to constipation, pain when defecating or even faecal incontinence. We wrote a post about urge incontinence. Click here to read more

 

Risk factors include:

• Hard physical work that stresses the pelvic floor.
• Medical conditions such as chronic bronchitis or constipation.
• Excess kilos on the scales because more weight places stress on the pelvic floor.
• A congenital or age-related connective tissue weakness.
• One or more births. Vaginal injuries and high birth weight for the baby increase the likelihood of uterine prolapse. However, a temporary uterine prolapse usually regresses soon after the birth.

If you suspect that your uterus may have prolapsed, contact your gynaecologist as soon as possible. Therapy differs depending on the severity of the symptoms and ranges from pelvic floor exercises to treatment with a hormonal cream during perimenopause to surgery.

 

Prevention and follow-up care with pelvic floor exercises

Fortunately, the pelvic floor muscles, like many other muscles in our bodies, have the big advantage that we can specifically train them and thus strengthen them. Regardless of which trimester of pregnancy you are in or even if you are still planning to become pregnant: it is never too early or too late for pelvic floor training. Ideally, start with a course run by a specialist who can take you through the exercises because it is not that easy to identify and then train the right muscles. In addition, biofeedback and electrostimulation can also provide support. Then continue your training at home.

You can find some simple exercises for a strong pelvic floor that you can easily integrate into your everyday life. Pilates and yoga are also known for their positive effect on the muscles in our pelvis. The best exercises are those that make you feel good and that you can do regularly. Read more about sport and incontinence in our new article. Click here Sports like swimming or cycling also naturally strengthen the pelvic floor along with the back. Regardless of whether alone or together with friends or family, there are types of movement that feel good in any stage of pregnancy and strengthen your muscles.

 

Summary: incontinence during pregnancy

We know that having a baby is a time of change; it is a time of growth and development. Becoming a mother is an exciting and rewarding transition in life. Unfortunately, new mothers also have to deal with a full range of common yet embarrassing symptoms. Experiencing bladder weakness while having a baby is not a reason to worry. The symptoms disappear in most cases in the first year after the birth and you can also take countermeasures from the very first weeks of pregnancy with regular pelvic floor training. To avoid embarrassing moments and to enjoy your pregnancy to its fullest, just reach for mild or light incontinence products.