Pregnancy Incontinence: Types, Causes, And Prevention Tips

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Pregnancy incontinence or urinary incontinence is the inability to control bowel or bladder function during pregnancy (1) (2). Sometimes women experience urine leakage in small amounts during childbirth (3). In a cross-sectional study conducted with 750 pregnant women, 300 experienced urinary incontinence (4).

Read more about the causes, diagnosis, treatment, and prevention of pregnancy incontinence.

Type Of Incontinence Experienced During And After Pregnancy

The most common urinary incontinence experienced during pregnancy and postpartum is stress urinary incontinence.

Women may leak urine while laughing, coughing, sneezing, or doing physical activity (2).

• During pregnancy, stress urinary incontinence occurs because the growing baby in the uterus compresses the bladder resting under it. This causes extra pressure in the bladder, causing urine leakage more often (2). A cross-sectional study on pregnant women demonstrated that more women experienced urinary incontinence in the third trimester than in the first trimester (5).

• After childbirth, stress urinary incontinence occurs because of stretching and weakening of the pelvic floor muscles (muscles that support the bladder, uterus, and bowels). When the body prepares for birth, and the baby moves down, progesteroneⁱA female reproductive hormone that plays an important role in menstruation, pregnancy, and breastfeeding levels change, causing the pelvic floor muscles to stretch (6). This means the muscles that control the bladder become weak, leading to incontinence (7).

Causes Of Pregnancy Incontinence

Apart from the growing uterus size during pregnancy and the hormonal effect during childbirth, pregnancy incontinence may also occur for the following reasons (2).

1. Pelvic organ prolapse: Childbirth, especially vaginal birth, may weaken the pelvic floor muscles, leading to pelvic organ prolapse, one of which is uterine prolapse during pregnancy. Besides the uterus, the bladder or the rectum can also slip down into the vaginal canal, leading to urinary incontinence (6).

Jennifer, a mother of five shares how she found out about her pelvic prolapse. She says, “This pregnancy was physically painful. I experienced frequent urinary incontinence in the form of constant leakage. I also suffered from constipation resulting in straining and hemorrhoids. But I thought it was normal. My friends were going through the same thing… After a very long pregnancy of over 42 weeks, our lives were blessed with a little baby girl. My urinary incontinence went away, so I thought I had nothing to worry about. But when I got constipated or had a large bowel movement something did not feel right! It was a weird feeling that I had a hard time describing, and it would go away on its own, so I pushed it to the back of my mind… One day, I attended a local woman’s health event that just happened to be about pelvic organ prolapse. It was not a topic that interested me because it did not seem to apply to me. I was young and healthy, after all. Boy oh boy, was I wrong… After I had time to process the information from the program, I realized that I was suffering some prolapse (i).”

2. Pelvic nerve damage: Long and difficult vaginal delivery may damage the pelvic nerves, thus affecting bladder function.

3. Injury during forceps delivery: In some cases, forceps delivery causes an injury to the pelvic floor and anal sphincter musclesⁱA group of voluntary muscles around the anal canal that control the release of stool .

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4. Prolonged pushing during vaginal delivery may injure the pelvic nerves, causing incontinence.

Quick fact

EpisiotomyⁱA cut made between the anus and vagina to make the opening bigger for the baby to be easily pushed out may increase the risk of pelvic prolapse and incontinence (9).

Risk Factors For Incontinence During Pregnancy

Some factors that increase the risk of incontinence during pregnancy are (1) (8):

• Previously weakened pelvic floor muscles
• Constipation because it puts pressure on the pelvic floor
• Urinary tract infection
• Neurological or musculoskeletal conditions, such as arthritis, dementiaⁱA syndrome characterized by the deterioration in cognitive functions, such as memory and thinking skills , and stroke
• Health conditions, such as diabetes, obesity, and heart disease
• Pregnancy with multiples
• Smoking

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• Sedentary lifestyle
• Having a large baby
• More than one pregnancy (9)

Diagnosis Of Pregnancy Incontinence

Your doctor will take you through a physical examination to check your bladder’s function and exclude other medical conditions. You will also be asked questions related to (10)

• Frequency of emptying your bladder
• Frequency of urine leakage
• Amount of urine leaked
• Other symptoms

The diagnostic tests include (2):

• Urinalysis, where the urine sample is examined for possible infections causing incontinence.
• Ultrasound imaging helps in examining whether the bladder is emptying completely or not.

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• A bladder stress test to check for signs of urine leakage while coughing.
• Cystoscopy involves the insertion of a thin endoscope with a miniature camera in the urethra. It helps examine the inside of the bladder.
• Urodynamics to measure the pressure inside the bladder. During this test, water is filled in the bladder through a thin tube inserted in it.

Treatment And Prevention Of Pregnancy Incontinence

Pregnancy incontinence is usually not treated with medicines. However, some preferable treatment options include the following:

1. Include Kegel exercises: Also called pelvic floor exercises, you can perform them before, during, and after pregnancy to prevent and treat urinary incontinence (2) (7).

Kegel exercises

• Heal the perinealⁱThe area between the genitals and anus tissue
• Strengthen pelvic floor muscles
• Ensure better urinary control

To perform Kegel exercises (7)

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• Breathe in and out
• Contract the pelvic floor muscles and pull them up and in as if to control the urine flow
• Breathe normally and squeeze and hold for ten seconds
• Then, relax and repeat the process
• Do three sets of ten exercises each, every day

Quick tip

Aim for three to six exercise sessions daily. You can perform exercises while lying down (up to week 16 of gestation) or sitting or standing (1).

3. Avoid carbonated or caffeinated drinks because they increase the urge to urinate. Instead, drink water and decaffeinated beverages to enhance your bladder capacity (11).

4. Avoid drinking large amounts of fluid after dinner to reduce urination at night (2).

5. Eat a high-fiber diet to avoid constipation because the additional pressure created by this condition may increase the risk of urinary incontinence (2).

6. Being overweight can increase the pressure on the bladder and worsen incontinence. Therefore, maintaining a healthy weight after delivery may improve bladder control (2).

7. Quit smoking: Smoking increases the risk of chronic cough and irritates the bladder, so quit smoking to improve your urinary incontinence (6).

8. Include regular exercise for at least 30 minutes a day.

9. Avoid exercises involving lifting heavy weights, contact sports, excessive twisting, bouncing, holding breath, curving the back, and standing on one leg for a long time.

10. Do not delay going to the toilet when you are urged to do so.

11. Get treated for UTI during pregnancy if you have the condition.

Medications and surgery to treat urinary incontinence are required only in some cases. However, it is good to consult a healthcare provider about it (7).

A study was conducted to determine the clinical impact of urinary incontinence (UI) in pregnancy and delivery. UI was most prevalent in the third trimester when compared to the first. Only 13% of women sought medical help to treat UI, as the majority weren’t bothered by UI and believed that the condition would resolve on its own. The below graph depicts the beliefs and help-seeking behavior exhibited by pregnant women. 56% of women who did not seek help believed that the condition would completely resolve or improve in the future.

Beliefs about prognosis of urinary incontinence if help is not sought among non-help-seekers and help-seekers

Point to consider

Severe cases may require treatment measures such as electrical stimulation (to help rehabilitate weak pelvic floor muscles), medications, pessary (a removable plastic insert that supports the vaginal walls), and surgery (6).

Signs To See A Doctor

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You should consult your doctor if you experience (12)

• Pain or burning sensation during urination
• Fever
• Lower backache that does not get better with rest
• Any fluid leakage from the vagina
• Unusual or smelly vaginal discharge

Infographic: Severe Symptoms Of Urinary Incontinence

The growing belly and fetal size often increase the risk of developing frequent urination and incontinence in pregnancy. Simple exercises and changes in lifestyle and eating habits can help manage this condition. But there could be some scenarios when medical treatment may be necessary. The infographic below lists some signs of urinary incontinence that warrant a doctor’s visit.

Illustration: Momjunction Design Team

Illustration: Pregnancy Incontinence: Types Causes And Prevention Tips

Image: Stable Diffusion/MomJunction Design Team

Urinary incontinence during pregnancy may be addressed with the help of kegel exercises. Learn how to perform these exercises correctly while expecting with the help of this video.

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Reviewer Author Editor Fact Checker

Dr. Shashwat JaniMS

Dr. Shashwat Jani is a consultant obstetrician & gynecologist in Smt. N.H.L. Municipal Medical College, Ahmedabad. He has 14 years of experience with a special interest in high-risk pregnancy, infertility, and endoscopy.

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Pragya BhargaviMSc, BEd

Pragya Bhargavi has been in the field of content research, writing and editing for over six years. Her passion for academics and science has enabled her to write creative as well as research-based articles. She has completed her Masters in Microbiology from Bangalore University and obtained a Bachelor’s degree in Education (BEd) from Acharya Nagarjuna University, Guntur.

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Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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Reshmi DasMSc

Reshmi Das has over four years of experience as a clinical coordinator, medical content writer and medical conference coordinator. Her continuous interest in medical journals and writing makes her write well-researched articles for MomJunction.

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