Although many pregnant women experience stress incontinence during the latter trimester of their pregnancies when the fetus begins to weigh heavier and drops into the pelvic cavity, there is no way to predict who will experience postpartum incontinence. In some cases, during the pushing stage of a vaginal delivery, the pelvic-floor muscles are damaged causing the bladder and bladder neck to drop, which in turn makes it harder to retain urine postpartum. More than the pain and discomfort that people suffering from urinary incontinence endure is the dreadful embarrassment over frequent nocturnal visits to the bathroom while traveling and staying over at friends' homes, urine leakage during sex, and work disruption or limited sports team involvement.
Keeping a Bladder Diary
Duration and difficulty of labor and the size of the baby are among the contributing factors that influence the outcome after childbirth.
Do you answer "yes" do any of these questions:
- Do you ever leak urine when you cough, laugh, or sneeze?
- Do you ever leak urine on your way to the bathroom?
- Do you need to use pads or extra cloth in your underwear to catch urine?
In order to diagnose the problem, your doctor will need to ask you about any symptoms you may be experiencing and take your medical history. Aside from interviewing you about your condition, your doctor will recommend that you keep a personal journal known as a uro log or simply, a "bladder diary." The log should list all the times in a day that you void, your liquid intake prior to voiding, leakage amount (normal urine should be about 400 ml or the equivalent of two cups of fluid), whether or not you had the urge to urinate, and what you were doing before you voided. This week-long diary will help your urologist or urogynecologist track your leaking pattern and determine whether you simply need to limit your liquid intake or need more serious medical attention.
Bladder Training Exercises
While pregnant women are already advised to stay away from bowel and bladder irritants such as alcohol and caffeine-powered drinks, those suffering from urinary incontinence are usually given the same prescriptive warning, adding carbonated drinks, citrus drinks, and diuretics such as tea. Aside from reducing or eliminating certain liquid intake, women must undergo some other lifestyle changes like incorporating smoking cessation programs and bladder retraining remedies into their daily routine. Behavioral treatment may include developing a voiding habit known as timed voiding -- making a point to use the bathroom at timed intervals. As you gain more control over your voiding pattern, you then try to extend the length of time between trips to the bathroom.
In addition to controlling when you need to make a trip to the bathroom, Kegel exercises are highly recommended for strengthening the pelvic-floor muscles. Named after the gynecologist that developed a specific set of exercises targeted at a specific set of muscles, Kegel aims to help women who develop bladder control problems after giving birth. This involves contracting the pubococcygeal (PC) muscles, the ones you use when you try to stop the flow of urination. Try doing 15 to 20 contractions (holding each for about three seconds) three times a day. This is an exercise that can be done anywhere -- while standing in line at the bank, at a grocery checkout line, working at your computer, or even sitting in traffic.
Learning about your body, the muscles that make up the pelvic floor and abdomen, and the optimal posture to help support your pelvic floor is a very important step to feeling 'in control' of your body and your continence. Consistent pelvic floor exercise including tightening your sphincter muscles as if to stop the flow of urine and elevating your pelvic floor muscles up into your pelvic outlet, has been shown to effectively reduce if not eliminate many cases of incontinence. It takes a little bit of time and consistency but pelvic floor strengthening should be a first line of defense.
While Kegel exercises can help to a certain degree, they do not effectively target the entire set of relevant muscles.