Pregnancy and Bladder Control

What are the signs of pregnancy incontinence?

Most of us have experienced an unintended dribble at some point. During pregnancy, these “accidents” can become more common. You may notice changes as early as your first trimester. The likelihood of losing bladder control increases as your pregnancy progresses.

Signs and symptoms include:

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• Dribbling when you cough, sneeze, laugh or exercise.
• Feeling a sudden urge to pee and being unable to “hold it.”
• Having to take more frequent trips to the toilet.
• Leaking or dribbling in between bathroom trips.

What causes bladder control loss in pregnancy and after childbirth?

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During pregnancy, your body goes through changes that are ideal for allowing a fetus to grow — but not so good for bladder control.

Your uterus is located behind your bladder. A growing fetus inside your uterus can pressure or squish your bladder so it holds less pee. Also, hormone changes during pregnancy cause the pelvic floor muscles that hold your bladder in place to loosen and weaken. An increase in progesterone causes these muscles to become more flexible. Flexibility allows your body to adapt to a developing fetus and (when the time comes) deliver a baby.

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But weak pelvic floor muscles also make it harder to “hold it” when the urge hits.

Childbirth (and vaginal deliveries in particular) can also lead to bladder control problems. Causes include:

• Pelvic nerve damage: The pelvic nerves that control your bladder function can get injured during a long or difficult vaginal delivery.
• Injury during delivery: Sometimes, delivery with forceps can injure your pelvic floor and anal sphincter muscles.
• Injury because of prolonged pushing: Pushing for a long time during a vaginal delivery can also increase the likelihood of injury to your pelvic nerves.
• Pelvic organ prolapse (POP): Your pelvic muscles can become so weak during pregnancy or vaginal delivery that they can no longer support your organs. For example, your bladder may sag or droop (cystocele). A sagging bladder can lead to incontinence issues.

Risk factors for incontinence during pregnancy

If you have bladder control problems before pregnancy, they’ll likely continue or worsen during pregnancy. Having conditions that affect your bladder, like repeat urinary tract infections (UTIs), can also lead to bladder control trouble. Other risk factors include:

• Obesity or overweight. Having overweight (BMI or body mass index > 25) or obesity (BMI > 30) increases your risk of UI. Some studies suggest that obesity can more than double your risk. Losing weight can sometimes reverse incontinence issues. Work with your provider to reach a weight that’s healthy for you.
• Age. Some studies suggest that people older than 30 during their first delivery have higher rates of SUI than people younger than 30.
• Vaginal deliveries. Delivering your baby vaginally (as opposed to a C-section) is more likely to cause incontinence issues after pregnancy. They’re also more likely to increase your risk of POP.
• Episiotomies. An episiotomy is a procedure where a provider makes a small incision (cut) in the tissue beneath your vaginal opening so it’s easier for a baby to exit. While medical professionals once thought that this procedure helped make for easier deliveries and reduced risks (like UI), it’s since been shown to weaken your pelvic floor muscles.
• Large babies. Babies who weigh more than 9 pounds at birth may increase the risk of nerve damage during delivery.
• Diet and lifestyle. Certain foods and drinks can irritate your bladder, increasing your risk of UUI. Drinking caffeinated beverages (especially coffee), alcohol and carbonated beverages can cause your bladder to contract, making you feel the sudden urge to pee. Spicy or acidic foods can also irritate your bladder. Although the evidence is mixed, some studies suggest that smoking increases your risk of urinary incontinence.

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