Pregnancy & Continence: How Pregnancy Can Cause and Impact Incontinence and Management

Overview

According to the Continence Foundation of Australia, 1 in 3 women who have had a baby wet themselves¹, so should incontinence be expected during and following pregnancy? While incontinence is common, it is not necessarily ‘normal’, at least in the sense that it should be ignored. Certainly, incontinence has been shown to have a profound impact on a woman’s psychological well-being and quality of life².

The following types of incontinence may occur due to hormonal and physical changes in pregnancy:

• Stress urinary incontinence is the loss of small volumes of urine during activities that place pressure, or ‘stress’, down on the bladder such as coughing, sneezing, or laughing. This is the most common type of incontinence experienced during pregnancy and occurs because of the increasing pressure being placed on the bladder by the growing uterus. Hormonal changes will also cause the pelvic floor muscles to soften, contributing to the incidence of stress urinary incontinence.
• Urge urinary incontinence, as the name suggests, involves the sudden urgent need to urinate, resulting in the loss of small or large amounts of urine before reaching the toilet. In pregnancy this may occur more often due to the increasing pressure from the growing uterus on the bladder, and changes in bladder sensitivity.
• Faecal incontinence, the involuntary loss of bowel movements in solid or liquid form, is less common but can occur during pregnancy. More likely to occur in the later stages of pregnancy, faecal incontinence can happen as the growing uterus places pressure on the lower gastrointestinal tract. A weaker pelvic floor from hormonal changes can also affect bowel control, while constipation, a common complaint during pregnancy, may contribute to issues with bowel control.

In some cases, incontinence can persist postpartum, most commonly stress urinary incontinence. Reported rates of postpartum urinary incontinence vary from 10% to 63% worldwide², possibly due to diverse medical standards used in different regions. According to Dai, Chen and Luo² risk factors for postpartum incontinence include vaginal delivery, advanced maternal age (over 35yrs), neonatal weight of greater than 4kg, prolonged second stage of labour, instrumentation during delivery, perineal laceration, multiparity (more than 2 deliveries), high pre-pregnancy BMI, and previous history of urinary incontinence.

Management

Pelvic floor muscle exercises – most bladder issues can be managed conservatively during and after pregnancy. Pelvic floor muscle exercises are important to minimise urinary and faecal incontinence during pregnancy and following delivery³. These exercises help to strengthen the muscles that control bladder, bowel, and sexual function. If you have not performed pelvic floor muscle exercises before, or have trouble locating and contracting your pelvic floor, speak with an experienced healthcare provider such as a physio, midwife, obstetrician, or continence nurse.

Fluid management – maintain hydration with small frequent sips throughout the day. Avoid consuming large volumes all at once, as subsequent urine volumes could exceed your bladder capacity and cause accidents. Don’t be tempted to minimise fluid intake to reduce leakage, as hydration during and following pregnancy is very important. Lastly, be aware that certain types of drinks can irritate the bladder and make incontinence worse, including drinks containing caffeine and alcohol. Water is always best.

Toileting habits – having a toileting schedule can help reduce accidents. Try scheduling in bathroom breaks about every two hours and adjust this time limit as required. Don’t leave using the toilet until you are busting! Lean forward and sit comfortably on the toilet with feet apart and knees bent. Relax and ensure you completely empty your bladder or bowel, trying not to rush.

Diet and exercise – maintain a balanced diet consisting of fruit, vegetables and whole grains, coupled with adequate hydration, as this will reduce your risk of constipation. Gentle, consistent exercise will also promote bowel motility and support a healthy digestive system.

Continence aids – if you do experience light bladder leakage, consider using maternity pads or liners. These can help you feel more confident and manage the risk of embarrassing leaks when out and about. Remember to change pads as soon as they are wet and practice good intimate hygiene to prevent urinary infections and skin irritation.

Seeking help – in most cases, incontinence improves over time following delivery. However, if you find your incontinence is persisting, getting worse, or having a significant impact on your quality of life and sense of well-being, it is important that you seek help. For any further questions or concerns, speak with your healthcare provider or call the Continence Foundation of Australia helpline on 1800 33 00 66.