Contents
About one in three women experience urinary incontinence after childbirth. For most, symptoms are minimal (loss of a few drops of urine when coughing, sneezing, laughing, sudden changes in body position) and disappear within a few weeks, as tissues damaged during childbirth recover. FROM obstetrician-gynecologist Ekaterina Khivrich, we understand why incontinence occurs, how to deal with it and what to do to reduce the risk of this pathology.
Why does urinary incontinence occur after childbirth?
– During pregnancy, hormones are produced, under the influence of which the muscles and ligaments that support the uterus, bladder, stretch. When the baby passes through the birth canal, the muscles stretch even more. The head presses soft tissues against the pelvic bones. This makes it difficult for blood to flow to the tissues, causing ischemia (oxygen starvation of tissues). The result is damage to the nerve endings. As a result, the innervation of the muscles responsible for urinary retention, their damage and displacement is disrupted, says obstetrician-gynecologist Ekaterina Khivrich.- The severity depends on many factors: the weight of the baby, the size of the woman’s pelvis, the duration of labor, the use of forceps or vacuum. In most cases, the changes are reversible. But the speed of recovery is different for everyone (1).
At the first birth, a caesarean section reduces the risk of severe urinary incontinence from 10% to 5%. In the case of the third and subsequent births, this does not happen, since the change in hormonal levels during pregnancy is more affected.
Types of urinary incontinence after childbirth
| Type of incontinence | symptomatology |
| urgent | The urge to urinate is uncontrollable and sudden |
| stressful | Leakage during light exertion (laughing, sneezing, coughing, etc.) |
| Paradoxical ischuria | Spontaneous leakage when filling the bladder |
| reflex | Leakage occurs when frightened or at the sounds of murmuring water |
| Night | Involuntary leakage during sleep |
| involuntary | A small amount of urine leaks throughout the day |
| After emptying the bladder | Slight leakage after urination, lasting 1-2 minutes |
The main causes of urinary incontinence after childbirth include:
- loosening of ligaments during pregnancy,
- divergence of bones and weakening of the muscles of the pelvis. It is necessary in the process of labor, so that the child does not get injured during childbirth,
- breaks. A fairly common occurrence during childbirth, a natural consequence of which is urinary incontinence after childbirth when coughing, sneezing, playing sports, and so on.
Also, the increase in the likelihood of pathology is affected by:
- overweight,
- hereditary predisposition,
- pathology of the nervous system,
- psychoemotional disorders,
- anomalies in the development of the pelvic organs,
- surgical intervention on the pelvic organs in history.
Treatment of incontinence after childbirth: what to do at home
一 Two weeks after giving birth, you can begin to perform special exercises to restore the tone of the pelvic floor muscles, 一 says gynecologist Ekaterina Khivrich.一 They can be done at home, after consulting with a pelvic floor muscle rehabilitation specialist.
The effectiveness of exercise is assessed after 15-28 weeks. If there is no improvement, more radical treatments may be needed.
Diagnostics
Determining the cause of incontinence is easy. The doctor prescribes the following diagnostic measures (2):
- history collection,
- gynecological examination,
- endoscopic examination,
- laboratory tests,
- Ultrasound,
- cystometry,
- profilometry,
- urofluorometry,
- PAD-test.
Modern methods
一 Modern methods of therapy include BFB-therapy based on the biofeedback method, neurostimulation, various medications, 一 says obstetrician-gynecologist Ekaterina Khivrich.
There are other methods:
- laser therapy,
- colpovaginopexy,
- anterior colporrhaphy,
- loop operations,
- urethrocystocervicoscopy,
- operation with the introduction of the gel (3).
Prevention of urinary incontinence after childbirth
Obstetrician-gynecologist Ekaterina Khivrich says:
– Prevention of urinary incontinence after childbirth is the maintenance of normal body weight before pregnancy and normal weight gain during pregnancy, regulation of bowel function and prevention of constipation, smoking cessation, regular exercise to strengthen the muscles of the pelvic floor before pregnancy and during in the absence of contraindications.
Also recommended:
- daily walks of at least 30 minutes,
- timely treatment of diseases of the genitourinary tract,
- compliance with the drinking regime,
- proper nutrition.
Popular questions and answers
Any woman can experience urinary incontinence after childbirth. With obstetrician-gynecologist Ekaterina Khivrich, we will answer the most popular questions about this delicate problem.
When will urinary incontinence go away after childbirth?
If the loss of urine is pronounced – the leakage has the character of a “jet”, there is a need to wear urological pads, the quality of life decreases – or persists for more than 6 months, you should consult a doctor.
When is surgery required for urinary incontinence after childbirth?
Is it possible to play sports with urinary incontinence after childbirth?
Sources of
- Urination disorders after childbirth: methods of correction / Ilyina I.Yu., Dobrokhotova Yu.E., Chikisheva A.A., Malikova V.O., Goncharov I.Yu. // 2018
- Modern prehospital diagnosis of urinary incontinence in women of reproductive age / Yashchuk A.G., Kazikhinurov A.A., Musin I.I., Zainullina R.M., Naftulovich R.A., et al. // 2017
- Methods of surgical correction of stress urinary incontinence in women of reproductive age / Musin I. I., Yashchuk A. G., Dautova L. A., Matigullin R. M. // 2013