Incontinence during pregnancy: What to do? (Tips)

incontinence during pregnancy

Urgent cravings, urination Frequently et leaks urinary on exertion or at rest, urinary symptoms are common during pregnancy.

It is estimated that between 30 and 50% of pregnant women have leaks urinary. Generally during efforts increasing intra-abdominal pressure (sport, carrying a heavy load, laughing, coughing, sneezing, etc.). It is therefore a very frequent situation and there is no reason to be unduly alarmed!

Despite its benign character, incontinence urinary can bother pregnant women and prevent them from living their pregnancy peacefully. This is why it is useful to understand its causes and to know some solutions to treat it or, even better, prevent it!

Urinary incontinence: some basic notions

First of all, it is important to remember some basic notions of human anatomy and physiology on the urinary system.

Urine is produced continuously by waist by filtering the blood. It then flows along the ureters to win the bladder where it is stored. When the latter is sufficiently filled (from 300 ml, much less during pregnancy), its walls stretch and a nerve signal is sent to the brain: “We have to go to the toilet! ".

The bladder has a continence system. Thanks to him, we have the ability to "hold back", to prevent urine from leaking, both involuntarily and voluntarily. This system is represented by two main anatomical structures:

  • The internal sphincter: it is formed of smooth muscle fibers surrounding the lower opening of the bladder (origin of the urethra). This sphincter works automatically, that is to say that we cannot control its contraction or relaxation.
  • The external sphincter: it is formed by muscles of the pelvic floor or "perineum". Being made up of skeletal muscle fibers, it is possible to control its contraction voluntarily.

During urination, several phenomena occur: the sphincter internal relaxes (involuntarily), the bladder contracts and releases the sphincter external voluntarily to let the urine escape via the urethra. If we want to hold back, we keep the muscles du perineum (forming the external sphincter) contracted to delay bladder emptying.

THEincontinence urinary, or "urinary leakage", is the loss of urine through the urethra accidentally or involuntarily.

There are two main forms:

  • Stress urinary incontinence: it is characterized by leakage of urine on the occasion of an effort increasing the intrapelvic pressure. This type of incontinence is not necessarily preceded by an urge to urinate. For example, the leak can occur after lifting a heavy load, coughing, sneezing, laughing…: “I peed on myself! ".
  • Urgent urinary incontinence ou urgency: here, the leakage of urine is accompanied, or immediately preceded, by an urgent urge to pee: “I couldn't hold myself back”.

In half of the cases, there is a association of the two types of urinary incontinence.

What are the causes of urinary leakage during pregnancy?

During the 9 months of pregnancy, the female body undergoes many physiological changes aimed at creating an optimal environment for the development of the fetus. Some of these changes affect the functioning of the urinary system and promote the appearance of leaks.

First, blood volume increases to provide for the needs of the fetus in addition to those of the woman. The kidneys therefore filter more blood and produce a larger volume of urine. This results in more frequent urges to urinate.

Then, as the pregnancy progresses, the uterus enlarges. It takes up more and more space in the pelvic region, then in the abdomen. It will then compress the various organs, including the bladder. The amount of urine that the latter can store will then gradually decrease. On the one hand, the woman will have more pressing desires. On the other hand it will present leaks urinary during efforts to increase intra-abdominal pressure (pressure from different organs, especially the uterus, on the bladder).

In addition, a few weeks before giving birth, the woman's body produces and releases a hormone called “relaxin”. This has the effect of relaxing the uterus and the muscles of the pelvic floor to facilitate the expulsion of the baby. Relaxation of the external sphincter of the bladder (which is part of the perineum) which results promotes incontinence urinary.

Other factors increase the risk of leaking urine during pregnancy:

  • Advanced age (over 35).
  • Initial overweight.
  • Excessive weight gain during pregnancy.
  • Multiparity (women having had several pregnancies).
  • Vaginal birth.
  • Progress of childbirth (long expulsion time, instrumental extraction of the baby, abdominal pressure or other brutal maneuvers during childbirth…).
  • Smoking.
  • Consumption of coffee or tea.
  • History of abdominal or pelvic surgeries.
  • Practice of intense physical activity.
  • Carrying heavy loads.
  • Existence of constipation (pushing efforts).

These risk factors are incriminated in the appearance of a incontinence urinary during pregnancy or its persistence after delivery. But their involvement has not been proven with certainty by the various scientific studies.

How to prevent incontinence during pregnancy?

The prevention of incontinence problems during pregnancy and after childbirth is essentially based on re-education perineal.

It is recommended that pregnant women consult regularly a kinesitherapy (physiotherapy) professional specializing in the rehabilitation of the perineum.

Here are the main elements on which the latter will be based to prevent a problem of urinary incontinence:

  • Recommend exercises to strengthen the muscles of the perineum: Contrary to what one might think, strengthening your pelvic floor during pregnancy will not make childbirth more difficult by "fighting against the baby coming out", quite the contrary! A healthy perineum will not only contract effectively, but also relax more easily.
  • Accompany and supervise the woman to ensure that she performs the various rehabilitation exercises correctly, correct her if not. Written or verbal instructions are generally not sufficient for the correct execution of the exercises. The supervision of a professional is therefore highly desirable.
  • Giving advice and biomechanical tips during and after pregnancy (how to lift loads safely, correct your posture, correct method for picking up the baby, etc.).
  • Preparing the woman for childbirth giving her advice on how to breathe, how to relax her perineum properly, how to push well during contractions, etc. Good preparation before childbirth significantly reduces complications, both maternal (vaginal tear, hemorrhage, etc.) and fetal (asphyxiation or fetal distress).
  • Raising women's awareness on the need to continue perineal rehabilitation exercises after childbirth, without wanting to go too fast by forcing your body. The latter needs to recover serenely during a pregnancy.

Other general measures may reduce the risk of urinary incontinence during pregnancy:

  • Avoid gaining too much weight during pregnancy (balanced diet and regular moderate physical activity).
  • Avoid carrying heavy loads.
  • Avoid the consumption of tea and coffee.
  • Treat possible constipation.

How to treat urinary incontinence after pregnancy?

In more than 30% of cases, urinary incontinence regresses spontaneously during pregnancy. If it persists postpartum, perineal rehabilitation remains the first-line treatment.

A dozen rehabilitation sessions of the perineum in a physiotherapy professional (physiotherapy) are necessary to restore their tone to the muscles of the pelvic floor, and thus regain normal continence function. This kind of session is 100% covered by social security in the postpartum.

Several methods of rehabilitation of the perineum exist:

  • The manual method: the exercises consist of voluntarily contracting the perineum with stimulation or against resistance from the physiotherapist's intravaginal fingers. These exercises can then be repeated at home by the woman.
  • Biofeedback: a probe is introduced into the vagina, it emits sound or visual signals to indicate the contraction or relaxation of the muscles of the perineum, their duration. The objective for the woman will then be to become aware of the use of her perineum by learning to voluntarily control the duration and intensity of her contraction.
  • Electrostimulation: here too, a probe is introduced into the vagina. But the principle is different. The muscles of the perineum are stimulated with small electric waves. This allows them to be contracted passively or involuntarily.

References

[1] X. Deffieux, “Urinary incontinence and pregnancy”, J. Gynecology Obstetrics Biol. Repr., flight. 38, no 8, p. S212-S231, 2009.

[2] E. Masson, “Urinary incontinence and pregnancy”, EM-Consult. https://www.em-consulte.com/article/238765/incontinence-urinaire-et-grossesse (accessed April 12, 2022).

[3] I. Aubin, “Postpartum urinary incontinence: mention it in the consultation following childbirth”, Rev Exercise, flight. 77, p. 40‑4, 2006.

[4] V. Letouzey, R. De Tayrac, N. Paradis, and P. Mares, "Interest of prenatal perineal rehabilitation in patients with stress urinary incontinence during pregnancy: Preliminary study", J. Gynecology Obstetrics Biol. Repr., flight. 35, no 8, p. 773-777, 2006.

[5] V. Battu, "Urinary incontinence: perineal rehabilitation", Current. Pharma., flight. 54, no 544, p. 53-57, 2015.

[6] SA Baydock et al., “Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery”, J. Obstet. Gynecol. Can., flight. 31, no 1, p. 36-41, 2009.

[7] "Problems of incontinence, pregnancy, childbirth: solutions & rehabilitation of the perineum", Let's talk about incontinence, March 2, 2016. https://www.parlons-incontinence.fr/l-incontinence-chez-la-femme/incontinence-et-grossesse-les-solutions/ (accessed April 12, 2022).

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