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Managing Incontinence During pregnancy


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Pregnancy can be a beautiful time in a woman’s life, but there isn’t much beauty in the bladder or bowel problems that sometimes come along with it. Because so many of the physical changes that occur during and after pregnancy impact the same organs and tissues that are involved with bathroom functions, it shouldn’t be surprising that pregnancy and childbirth can lead to temporary or more lasting cases of incontinence.

Some of the most common forms of incontinence associated with pregnancy include:

  • Urinary Incontinence – UI affects 30-50% of all childbearing women by age 40. In fact, more than 60% of women with stress incontinence report that their problem began during or after pregnancy.
  • Fecal Incontinence – Up to 25% of childbearing women experience fecal incontinence, also called “Accidental Bowel Leakage,” often as a result of injury during birth.
  • Pelvic Organ Prolapse – This occurs when there’s weakening around the vagina, uterus and pelvic floor, causing one or more of your pelvic floor organs to collapse into the vaginal canal or anus. Common types include cystocele (dropped bladder), rectocele (bulging rectum), and uterine prolapse (dropped uterus).

The following information is intended to help you learn more about your physiology and how to maintain it, so you can be better prepared for a healthier pregnancy and recovery.

Understanding Your Anatomy

There’s a lot going on down there when you’re pregnant, but when it comes to the way pregnancy can affect your continence, the most important part of your anatomy to consider is the pelvic floor.

The pelvic floor is a web of muscles that runs like a hammock from your public bone to your tailbone and serves as the base of your pelvis. It’s made up of layers of tissue and muscle, and these play a role in a number of areas:

  • Supporting critical organs – Your pelvic floor muscles ensure that things stay where they’re supposed to, including abdominal organs, the urethra and bladder, the rectum and the vagina, among others.
  • Maintaining bladder and bowel function – The anatomical features supported by the pelvic floor muscles are essential in controlling bladder and anal sphincter function, allowing for normal waste elimination.
  • Supporting sexual function – In women, pelvic floor muscle contractions are important for arousal and orgasm.
  • Promoting stability – Your pelvic floor muscles are part of a larger system that helps stabilize your torso and pelvis while you move, and they provide support to your core.

There’s a lot more going on with your pelvic floor than just this, and learning more about how it works and how you can keep it in good shape can really make a difference in your long-term well-being. For more information, visit our Pelvic Floor Health center by clicking here.

Incontinence-Related Changes During Pregnancy

There are countless amazing changes that happen to your body when you’re expecting, and while they’re all helpful for your developing baby, they can produce some unexpected – and sometimes unwelcome – effects.

Take hormones, for one. We’re all familiar with the way that hormone changes can influence things as diverse as mood, skin tone, and more, but there are other hormonal changes that you might not be aware of.

For example, hormones can weaken ligaments, which may lead to instability in the hips and pelvis. They can cause frequent urination (especially because your growing uterus is pushing on your bladder, which may result in occasional leaking). And they can also produce constipation, which you should try to avoid because of the strain it can put on your pelvic floor.

In fact, the general strain and pressure that pregnancy creates in your pelvic floor region can be a big factor where incontinence is concerned. Your baby doesn’t particularly care if you wet yourself when you bend over or sneeze, but as we discuss later, there are some steps you can take to help minimize the frequency of these episodes.

Some of the most common changes to watch out for – many of which are directly related to incontinence – include:

● Tiredness (your body is working hard!)
● Morning Sickness
● Visible Veins
● Moodiness
● Stretch marks on stomach, breasts, and thighs
● Dry, itchy skin
● Muscle cramps in your legs
● Hemorrhoids
● Heartburn
● Sudden groin pain
● Shortness of breath
● Difficulty sleeping
● Increased need to urinate

How Does Your Pelvic floor Change During Pregnancy?

When you see just how much a woman can grow when she’s carrying a baby, it’s no wonder that her pelvic floor muscles can be pushed to their limit. Pelvic floor muscles can be stretched and weakened from constant pressure, and bladder leakage is sometimes the result.

The type of incontinence most often experienced by pregnant women is called Stress Urinary Incontinence, or SUI. This occurs when enough stress is placed on your bladder that you accidentally release urine.

When you’re pregnant, don’t be surprised if you find yourself leaking between trips to the bathroom, when you laugh or sneeze, bend over or lift, exercise, or otherwise put more pressure on your body than your bladder can handle at the moment.

Also, keep in mind that your bladder rests right under your uterus. As your baby develops, the bladder gets compressed – really, flattened – which leaves less space for urine. What that means is that you may find that you feel the need to go more frequently than normal.

Bladder And Bowel Tips For Pregnant Women

Let’s be honest: It’s not always possible to avoid leaks during pregnancy, and you shouldn’t get particularly concerned or embarrassed when episodes happen. But that doesn’t mean there aren’t things you can do to reduce the number of episodes you have or how severe they are. Here are a few tips to help you manage:

  • Exercise your pelvic floor. Keeping your pelvic floor in shape can help ward off bladder leaks. A great place to start is with Kegel exercises because they’re the gold standard when it comes to working the muscles that matter most. There are other exercises you can do, too – click here to see for yourself – and what’s great is that they’re easy, quick, and don’t require any expensive equipment or gym membership. Of course, you should discuss your workout plans with your doctor first, and consider talking with a physical therapist for more ways you can improve the health of your pelvic floor.
  • Avoid constipation. Constipation can put increased pressure on your bladder, and it can also cause you to strain when having a bowel movement, and that can really do a number on your pelvic floor. Avoid this by staying hydrated and by eating healthy foods with lots of fiber.
  • Maintain a healthy weight. It’s not always easy to fight off the cravings, and you’re naturally going to gain weight during pregnancy. But by making healthy choices and staying within the weight range your doctor advises, you’ll be doing your part to reduce any unnecessary additional strain on your pelvic floor and your bladder.
  • Avoid bladder irritants. You’re already probably watching what you eat more carefully than ever before, but when you make your food choices, try to avoid those things that can irritate your bladder and make leaks more likely. Common triggers include caffeine, sugar, artificial sweeteners, acidic foods, and spicy foods. (See a full list of common bladder irritants here.)
  • Track your episodes. Keeping a bladder diary can be a great way to identify the trends behind your leaks – are there certain foods, behaviors, or times of day, for example, that tend to be associated more often than not with episodes of wetness? Click here for your free bladder diary – it’s quick, easy, and remarkably helpful.
  • Use absorbent products.  When leaks are light – especially earlier in pregnancy, when there’s more of a bump than a belly – many women find that their usual hygiene products are perfectly adequate to handle things (though you should read “Why you Shouldn’t Use A Maxi-Pad for Incontinence” to see why that’s not always a great idea). But by the time the third trimester comes around, your everyday pads may not be up to the task. Instead, pick up some adult absorbent pads – they’ll give you peace of mind knowing that you’re protected because this is the job they were designed to do.

Exercises For Pregnancy

Being pregnant is hard work – your growing baby is putting a lot more stress on your joints, muscles, heart and lungs than you’re used to, and your hormone changes can affect you in profound ways, too. Healthy exercise is one of the best ways to help your body handle the strain and stay in great shape for your benefit and your baby’s well-being, too.

That includes more than just pelvic floor exercises – there are all sorts of movements and activities you can do that can improve your overall fitness as well as help in the fight against incontinence. Exercise is a great way to address back pain and cramping, enhance muscle tone, prevent constipation, improve sleep, reduce anxiety, minimize excessive weight gain, lower blood pressure, boost your mood and even fight Type 2 diabetes. Plus, you’ll be doing a great job of keeping yourself in shape for the big event: giving birth to your baby.

Before you start…
Before you hop on that exercise bike or jump in the pool, remember that pregnant women need to take more precautions than normal – you’ll want to check with your doctor first to make sure that the exercises you’re planning on doing are safe for your particular condition.

Your current stamina, fitness and activity level will probably have an impact on what you can or can’t do, and you should make sure to check in with your doctor as your pregnancy progresses – what’s helpful at one stage along the way may not be recommended at another. For example, you’ll probably be told that you should avoid performing exercises on your back after 16 weeks of pregnancy, and there may be other surprising directions for you to follow, too.

You should also be careful that you don’t take on more than you can handle. Pregnancy hormones can weaken your joints and ligaments, and that can lead to injury. This only increases as your pregnancy goes on, and there’s no shame in reducing your amount of activity in later months. Stretching should be done with caution, and you’ll certainly want to avoid contact sports and other highly physical activities any time after your first trimester.

No matter when you exercise or how, it’s especially important to maintain good form – watch your posture, brace your abdominal muscles and don’t over-tax your back. In fact, it’s a good idea to do this even when you’re not exercising. When standing or walking, hold yourself tall, keep your shoulders back and gently draw in your abs.

Great exercises for uncomplicated pregnancies

  • Walking
  • Light/low-impact aerobics
  • Stationary cycling
  • Freestyle swimming and water aerobics
  • Light weight training

Exercises to avoid

  • Heavy weights/weight lifting
  • Sit ups and other exercises that cause abdominal strain
  • Exercises that require bouncing, jerking or twisting
  • Exercises that extend the curve in your lower back
  • Balance exercises, particularly if you have to stand on one leg for a period of time
  • Hip abduction exercises (lifting your hip to the side when on your hands and knees)
  • Contact sports and high-impact activities
  • HIIT (High Intensity Interval Training) and other activities that require sudden changes in intensity or direction
  • Swimming strokes like the breaststroke and butterfly, because they put excess strain on your pelvis
  • Pushing off the wall in the pool with one leg
  • Exercises that require holding your breath

This list is far from exhaustive. As we mentioned earlier, you should always consult with a medical professional when considering your exercises – this is absolutely one of those “better safe than sorry” situations.

Important Notes of Caution
When you’re pregnant, make sure to exercise gently. Anything that causes pain should be avoided.

Immediately stop exercising and consult with your doctor if you experience:

  • Dizziness/faintness/blurred vision
  • Headaches
  • Nausea/vomiting
  • Numbness
  • Pain of any kind
  • Discomfort or excessive tiredness following exercise
  • Vaginal bleeding
  • Contractions
  • Discharge
  • Reduced movements of your baby

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