Urinary incontinence is a loss of bladder control that results in unwanted leakage of urine. There are various types from stress incontinence to overactive bladder, which result in different amounts of leakage.
During pregnancy, women commonly develop transient stress incontinence. Due to an increase of fluid in the bladder combined with the weight of the baby on the abdomen, urine can accidentally spurt out when a woman coughs, laughs, or sneezes. And there are other risks that may predispose a woman to incontinence.
Fortunately, many instances of incontinence during pregnancy resolve within a month after childbirth, said Dr. David Shusterman, the managing urologist at Advanced New York Urology in Manhattan. But even if the leaking stops, a woman is likely to have the problem again later in life, he said.
However, she doesn’t have to keep it a secret or feel embarrassed, because there are treatment options that can resolve or significantly reduce leaking.
Risks
According to the Urology Care Foundation, pregnancy, delivery, and having more children increase the risk of incontinence in women.
And it doesn’t matter whether the woman has vaginal delivery or a C-section. Surgery doesn’t reduce the risk states the Urology Care Foundation website.
So it’s important to get a complete urological evaluation after childbirth.
Dr. Shusterman said he takes an accurate history and physical as well as a pelvic ultrasound because there are different variables that could be the cause of leakage.
“Not every leaking episode is the same and a lot of it all changes with the circumstances,” he said.
Older women are more likely to have incontinence than younger women during pregnancy. As a woman ages, the muscle tone of the pelvic floor, which supports the bladder, begins to weaken and limits her ability to sustain the extra pressure of pregnancy.
Also, underlying diseases such as kidney stones or Parkinson’s disease may trigger urine leakage.
Treatment Options
Dr. Shusterman recommends getting treatment early rather than waiting until the symptoms worsen.
“I try to have them proactive in improving their health,” he said. “By doing that they'll keep from surgery later on in life.”
He first advises patients to stop smoking and lose weight. Studies have shown that women who smoke are twice as likely to develop stress incontinence as women who don’t. And women who lose 8 percent of body fat can reduce episodes of stress incontinence by 47 percent, according to a New England Journal of Medicine study.
For the occasional leaker, Dr. Shusterman suggests wearing a pad or using InTone, a device women can use at home.
A probe inserted in the vagina stimulates and strengthens the pelvic muscles as a woman performs kegel exercises.
Since kegel exercises require contracting and holding pelvic floor muscles for 5- to 10-second intervals, women often don’t perform them properly without the device, so they aren’t effective. InTone provides biofeedback and recorded session data to let the patient know if she has completed the exercises most effectively.
Women who urinate more frequently or have an overactive bladder can also benefit from InTone or take medication to relax the bladder.
Another option Dr. Shusterman recommends for frequent urination is Urgent PC neuromodulation system, “a type of acupuncture for the bladder,” he said.
It’s a device that stimulates the nerves to the bladder. During this 30-minute, in-office treatment a small, slim needle electrode is inserted near the ankle. The electrode is then connected to a battery-powered stimulator. Mild impulses travel along your leg and into the pelvic nerves that control bladder function.
Although this treatment doesn’t require medication or have side effects, it may not be sufficient for more serious cases.
For persistent leaking, the patient can be fitted with a pessary, a small silicone ring inserted in the vagina to act as additional support for the bladder to limit leaking.
If the patient’s conditions worsens, surgery may be indicated. The most common surgery involves inserting a narrow ribbon-shaped mesh under the urethra—the tube that carries urine to the bladder—to help keep it closed if you cough or sneeze so urine won’t leak out.
In cases where the bladder has dropped, surgery can be performed to reposition and secure it with string attached to muscle, ligament, or bone.
According to Dr. Shusterman, the worse thing a woman can do is ignore the problem or self-treat by drinking less water.
“If it doesn’t get treated, you have a higher chance of getting bladder cancer, ... [or] having other things, like kidney [stones] because you’re not drinking enough water,” he said.
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