Small urine leaks are common during pregnancy and after childbirth. If the disorders persist, re-education of the perineum is essential.

Urinary leakage is common during pregnancy. One study showed that symptoms of urinary incontinence were present in 30,7% of women at 20 weeks and 48% at 36 weeks. Anatomical factors as well as other risk factors facilitate urinary leakage.

To prevent them, it is recommended not to gain too much weight during pregnancy, as excessive weight gain is an added risk factor for urinary incontinence during pregnancy. It is also important to fight against constipation, this disturbance being at high risk of stress urinary incontinence during pregnancy.

Urinary leaks during pregnancy, what treatment?

Periodic rehabilitation prescribed during pregnancy improves urinary incontinence in pregnancy and decreases the frequency of urinary incontinence 3 months postpartum.

Urinary incontinence at 2 months postpartum is present in 15 to 40% of women.

Risk factors predispose to urinary incontinence after childbirth:

• Excessive weight gain during pregnancy is a risk factor for urine leakage after childbirth.
• Women who have a vaginal birth are more likely to experience urinary incontinence because their ligaments and pelvic floor were stretched during childbirth.
• Multiparous women (several pregnancies) have a higher risk than nulliparas (first pregnancy)
• Certain obstetric practices or trauma: expulsion efforts before complete dilation, tearing of the perineum or too late episiotomy.

If the leaks persist after the post-partum period (urinary incontinence resolves spontaneously in a third of women), rehabilitation of the perineum is imperative to fight against this perineal weakness. The re-education sessions make it possible to regain muscle tone allowing the perineum to be locked by contraction anticipated during efforts in order to avoid urinary leakage).

Three rehabilitation techniques are the most used:

• manual rehabilitation: it consists of a repeated voluntary contraction of the levator ani muscles with solicitation or resistance by the intravaginal fingers of the therapist.
• electrostimulation: this consists of the electrical stimulation of the muscles of the perineum via a vaginal probe, which results in their passive contraction.
• biofeedback: allows, by means of a vaginal probe associated with a sound or visual signal materializing the contraction and relaxation, to improve awareness of perineal functioning.

Most often, it is during the post-natal visit that the doctor or midwife judges the interest of perineal rehabilitation. If necessary, ten sessions can be paid for at 100% by the health insurance. The sessions are carried out by a midwife or a physiotherapist.

To resume a sport, you have to wait for the end of perineal rehabilitation. Likewise, abdominal rehabilitation should not be undertaken to regain a flat stomach!

Above all, do not do sit-ups before you have finished your perineum rehabilitation sessions. If you want to exercise after giving birth, take a walk! It is effective and safe.