Incontinence during pregnancy… and what you can do to fix it

Incontinence during pregnancy. Ain’t nobody got time for that.

Do you hate that feeling…?

Fear… 
Your friend who you’d love to catch up with has called but you’ve said you’re too busy as you fear wetting yourself. 

Worry…
You’re at the shopping centre. And the first thing you do is worry and make sure you know where all the toilets are just in case.

Loneliness…
You feel trapped and isolated by your bladder which just doesn’t want to play nice.

Well you’re definitely not alone… and there is plenty you can do to help your incontinence.

Incontinence is ridiculously common given how effective treatment is.

In fact, incontinence affects 1 in 3 women across their lifespan. 

Think about that for a moment. 1 in 3!

But we can change this…

Wherever you are now… stop for a moment and look around at your fellow female work colleagues/train passengers/family/friends. Yep… someone has incontinence.

That is incredible….especially when often it is preventable.

So what do I mean by incontinence?

What is incontinence?

Incontinence is the involuntary loss of either urine or faeces.

Urinary incontinence is specifically the involuntary loss of urine.

Incontinence is not normal. Yep… even if you’ve had kids. Common but not normal. Incontinence is a sign of weakness or dysfunction. 

So please don’t accept it as just a normal part of life… at least not until you have tried the techniques outlined below. 

Types of urinary incontinence

There are two common types of urinary incontinence:

1. Stress incontinence
2. Urge incontinence

1. Stress incontinence

Stress incontinence is when you leak urine when there is pressure exerted on your bladder and pelvic floor.

What do I mean by pressure? Well anything that puts your bladder and pelvic floor under increased force. For example… coughing, sneezing, lifting or jumping. If you leak during any of these… you most likely have stress incontinence. 

Urine leaking during exercise due to stress incontinence Image credit: medfriendly.com

Pregnancy and child birth can increase your risk of developing stress incontinence because of the increased load on the pelvic floor.

However, in many cases you can avoid developing stress incontinence during pregnancy by following a structured pelvic floor exercise program supplemented with other techniques.

2. Urge incontinence

Urge incontinence is when you leak whilst experiencing an urge to empty your bladder.

It is commonly a symptom of an “overactive bladder” where the bladder gets grumpy and irritated and contracts when it shouldn’t.

Usually our brains can control the nerves to the bladder which tell it to “contract” or “relax”.

If we are out in public with no access to a toilet, our brain will tell our bladder to relax and our pelvic floor to contract… this will keep urine stored.

When we are ready to go to the toilet, our brain will tell our bladder to contract and our pelvic floors to relax… this allows urine to empty.

When you have an overactive bladder, your brain is no longer able to control this as well, and it may feel like your bladder has a mind of it’s own.

Can urinary incontinence be treated?

Luckily there are plenty of things we can do to fix your urinary incontinence. You are not a lost cause and you can improve your quality of life! 

Whilst I think it is great that incontinence is now spoken about much more openly and the stigma is reduced… let’s stop accepting it as a normal result of pregnancy and childbirth!

There are many treatment options that you can try to fix both stress incontinence and urge incontinence… and most treatments are largely successful.

How to know if you have stress incontinence

Do you leak when you…

Cough?

Sneeze?

Laugh?

Jump?

Run?

These are all signs of stress incontinence.

How you can fix your stress incontinence?

 1. Strengthen your pelvic floor muscles

There is fantastic evidence to show that pelvic floor muscle training is highly effective at reducing urine leakage. However, technique is super important when exercising your pelvic floor. In fact, up to 30% of women are doing their pelvic floor exercises incorrectly…and are actually making their incontinence worse.

2. Empty your bladder correctly

Make sure you don’t rush on the toilet or strain to void. Sit until you have completely emptied and then rock/tilt/circle or jiggle your pelvis around to make sure that there is no more pee left.

3. Improve your urethral support

Stress incontinence can occur if you have lost support in the ligaments that hold your urethra (urine passage) in place. Sometimes you can easily manage it by inserting a vaginal support device (there are plenty of different products on the market) which helps to support the urethra and bladder neck and therefore reduce stress incontinence. Speak to your women’s health physiotherapist about whether this may be useful for your condition.

4. Avoid placing unnecessary pressure on your pelvic floor

Straining to open your bladder or bowels, doing star jumps or moving furniture (that’s what husbands and friends are for!) places pressure on your pelvic floor, which is exactly what we want to avoid. Yep exercise is vital to stay healthy during pregnancy… but remember that there is lots going on inside of you whilst pregnant… so it is important that you are following a safe and structured exercise program designed by a pelvic floor specialist.

How to know if you have urge incontinence

Do you leak when you…

Are rushing to the toilet?

Open the front door?

Hear a running tap?

Pull your pants down to go to the toilet?

These are all signs of urge incontinence.

How you can fix your urge incontinence?

1. Monitor your bladder habits

It is normal to empty your bladder 6-9 times/day. Try to keep a track of how many times you are visiting the toilet to empty your bladder. It is also normal to empty 250-400mls from your bladder each time. Try measuring your urine output with a cheap disposable measuring jug to track your output. If your bladder habits seem abnormal, start to question…Do you really need to pee? Or do you empty your bladder out of fear or habit? Do you do a lot of “just in case” toilet visits? If so try to defer the urge to go so that your bladder doesn’t become too familiar with only holding small volumes. Mindfulness techniques can be very beneficial to help overcome your fear and reduce your urge to pee.

2. Suppress unnecessary urges

Did you only pee 30 minutes ago? Have you had any fluid to drink since then? If not, your bladder doesn’t need to empty right now. It is capable of holding a much larger volume. Remind yourself that your brain is in charge, not your bladder. Distract yourself and wait… chances are that urge will go away. Try counting backwards from 100 by 7’s, making a shopping list or calling a friend to keep your brain busy on other things.

3. Try sitting on a rolled up towel

Sitting on a rolled up towel will compress the perineum (the area between your front and back passages) and provide mild urge suppression. Wait to see if the urge to pee goes away after a few minutes. Remember when you were a young girl and how you would press your hands into your perineum to stop yourself needing to pee?! Well that’s what we’re aiming for here.

4. Remind yourself that a normal bladder should be able to hold 300-400mls during the day

If you are going to the toilet for anything less than this… it’s not worth your time! Positive affirmations and mindfulness can be very helpful. Talk to your bladder like you might talk to a naughty pet “No, no, you don’t need to go now… I’m busy.. you can wait your turn!”

5. Reduce your caffeine intake

Caffeine is a known irritant for the bladder.. and if your bladder is already a little grumpy and irritated then caffeine can set it right off the edge. It is recommended that healthy adults consume no more than 300-400mg caffeine per day. This equates to approximately 3-4 espressos. However, this recommendation is for a healthy adult with presumably a healthy and normal bladder. I advise most of my clients to aim for less than 2 coffees per day (approximately 200mg caffeine). As with any change in diet or lifestyle.. don’t be drastic. Start small by replacing one caffeinated drink per day with a decaffeinated replacement (decaf coffee ain’t all that bad!) and see what effect it has on your bladder control.

6. Don’t restrict your fluid intake

Lots of women stop drinking water because they think it will mean they’ll go to the toilet less. This isn’t always the case. The more dehydrated you are… the more concentrated your urine… And the more irritated and grumpy your bladder might be!

7. RELAX

I know, I know. How can you relax when you constantly feel like you’re about to pee yourself?! But the more you tense your abdominals and inner thighs, the more pressure you can put on your bladder which can actually make you more likely to pee yourself. Keep your pelvic floor gently lifted, but relax everything else.

8. Pelvic floor activation

Do some gentle squeezes of your pelvic floor when you feel the urge to go. Remind yourself that those muscles can hold on and that you are in control. Technique is paramount when activating your pelvic floor and doing your exercises incorrectly can actually make things worse. Be sure to follow a safe and structured pelvic floor program designed by pelvic floor specialist.

What if this doesn’t help?!

Everyday I am lucky enough to treat women who implement these techniques with amazing results. I can tell you… this stuff works. So have faith!

However, if you’ve trialled the above techniques and you are still finding it difficult to suppress the constant need to go to the toilet, make sure you book an appointment with your local women’s health physiotherapist for a thorough assessment and bladder training. 

Remember that 1 in 3 stat! Together, we can change that!

You can absolutely get help. Your pelvic health is important. Your general well-being is important. YOU are important.

xo Physio Laura