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  4. Incontinence - the silent condition

There are some physical aspects of pregnancy and post birth which many women find hard to discuss. Generally, this comes down to two reasons - embarrassment and fear. And wetting, formally known as incontinence, is one of those topics which is often kept silent.

Wetting is a common condition for women both during pregnancy and in the first few months after birth. In fact, although 30-50% of women experience some degree of wetting, many choose to keep this a secret, even from their partners.

If you are wetting yourself, there is no need to feel embarrassed – help is available from many sources, you just need to ask.

What is urinary incontinence?

Urinary incontinence is when wee leaks from the bladder involuntarily. It can happen to women and men, though is more common in women, especially those who’ve had children or have been through menopause.

Incontinence can be ‘light bladder leakage’ with only small amounts escaping from the bladder, or larger amounts to the point of completely wetting underpants and clothing. What’s important to know about incontinence is that it’s not under the person’s control.

How would I know if I have incontinence?

You are likely to have incontinence if your underpants are wet with wee and you frequently feel damp. If you need to buy incontinence pads and wear them ‘just in case’ you also fit the definition of being incontinent.

You may find you’re more likely to wee involuntarily when you’re laughing, sneezing, coughing, exercising and standing upright from a sitting position - these are all more common times to experience ‘stress’ incontinence. Involuntary wetting is also more common when there’s increased pressure on the bladder and surrounding pelvic organs. Though sometimes wetting can also happen without any triggers.

Some women with mild incontinence are able to ‘hold onto’ their wee by sitting down or crossing their legs. Others have a sudden ‘urge’ to go to the toilet and almost empty their bladder before they get there.

Another type of incontinence is when the bladder doesn’t fully empty, so wee trickles out when there is pressure put on the bladder. Wetting at any or all of these times are reason to suspect you have incontinence.

What causes urinary incontinence?

We don’t always know what causes incontinence, but the most common reason is weakening of the pelvic floor muscles. These work like a ‘hammock’ of muscles, ligaments and tissues which support the organs in the pelvis, including the bladder.

During pregnancy, the muscles in and around the bladder become stretched and weakened. Pregnancy hormones also have a softening effect and during labour and childbirth, the pelvic floor muscles become further weakened and may be damaged.

Having a forceps delivery, a large baby e.g., >4 kgs, a long second (pushing) stage of labour can all add to the risk of pelvic floor damage. Heavy lifting, being overweight and having a long-term cough can also increase the risk of incontinence.

I think I may have incontinence – what can I do?

  • Go to your GP or maternity care provider and talk with them about your symptoms. Avoid feeling embarrassed, they’ll have supported many women who’ve had the same experiences.
  • Speak with your GP about being examined for a prolapse. This is where the uterus drops down towards the vaginal opening. You may suspect you have a prolapse if you feel a dragging sensation or a bulge in your vagina.
  • Keep a bladder diary for a few days before your appointment. Make a note of how much fluid you drink, how many times you go to the toilet and the times you leak wee. It may also help to measure your wee each time you go to the toilet.
  • Avoid constipation by eating a high fibre, nutritious diet.
  • Watch your weight, being overweight or obese adds to the risks of incontinence. It could help to see a dietician for expert guidance.
  • Wear good quality, absorbent incontinence pads until you regain bladder control. Experiment with different sizes so you feel comfortable.
  • Drink more, not less water. Around eight glasses each day will help to maintain your healthy kidney function and avoid urinary tract infections. It will also help your kidneys to produce normal volumes of wee which will flow into your bladder and expand it to a normal capacity. A healthy bladder can hold 300-400 mls of wee during the day and around 800 mls at night.
  • Ask for referral to a physiotherapist who specialises in pelvic floor function. The stronger your pelvic floor, the sooner you’ll regain bladder control.
  • Ask for referral to a Clinical Nurse Consultant in Continence who can help diagnose Incontinence and assist in Bladder Retraining Programs.
  • Also ask about getting a referral for a bladder retraining program. These can be run by physiotherapists or occupational therapists.
  • Ask about the benefits of having a urodynamics bladder test. This is a type of test which helps to identify the cause for incontinence.

Managing incontinence

Pelvic floor exercises (Kegels)

Squeezing and drawing in the muscles around your bottom (anus) and vagina at the same time will help your pelvic floor muscles to become stronger. Don’t worry if, at first, you struggle to hold tight for only a short time. With practice and repetition, you’ll get to the stage of completing increasing sets of timed exercises.

Bladder training

This helps to ‘retrain’ the bladder to fill with normal amounts of wee. Many of us go to the toilet ‘just in case’ which does not help to support healthy bladder function. Over time, this can create extra sensitivity to even small amounts of wee in the bladder, triggering the need to go even when it’s not really necessary.

Bladder retraining also focuses on behavioural change in putting off going to the toilet for increasing lengths of time until the bladder is full.

For more information check:

https://www.continence.org.au/who-it-affects/women/pregnancy-and-childbirth

Written for Poise by Jane Barry, midwife and child health nurse, 03/06/2021

Whilst you are training your pelvic floor POISE can help keep you comfortable and dry and protected from leaks.

Get a free sample here.