I’ve had a baby, why am I leaking?

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Written by Ellen Barnett 

  • Wesnes et al (2009) found that 14% of women after their first baby had stress urinary incontinence 6 months after delivery
  • Thomasen et al (2007) found that less than half of women with urinary incontinence during pregnancy had resolved 6 months after delivery

Stress urinary incontinence is the involuntary loss of urine with activities that increase the pressure inside the abdomen. It is commonly seen with activities such as coughing, sneezing, lifting, running or sport. Leakage of urine after having a baby is common, however not something you have to just put up with! To understand why we need to step back first and look at the continence mechanism.

The mechanism of urinary continence is reliant on several factors. The first key factor is the ring of muscles around the urethra called the urethral sphincter. This needs to maintain a higher resting pressure than the pressure inside the bladder. The second factor is the pelvic floor muscles. The pelvic floor muscles should automatically activate prior to the increases in abdominal pressure (e.g. cough) to help with the closure of the urethra. The third factor is the connective tissue. The ligaments around the urethra, bladder, and pelvic floor need to have enough resistance and strength to support the continence mechanism. 

 

Hose

Picture this: the urethra is like a hose. Someone’s foot stamping on the hose is like the urethral sphincter and the pelvic floor. Provided these muscles have good strength, then no water should leak out of the hose. 

Let’s take it one step further and imagine now the hose is resting on a trampoline. The trampoline is like the connective tissue supporting your muscles and organs. A firm trampoline will allow a small amount of stretch or bounce but you will be able to still stamp down to close the hose with your foot. A soft and stretchy trampoline will make it much harder to stop the hose leaking completely.

 

So, what are the risk factors for developing incontinence post birth?

  • You are more likely to experience urinary incontinence after birth if you had some leakage of urine prior or during your first pregnancy.
  • Increased maternal weight at the end of pregnancy increases the risk of stress urinary incontinence post-natally. Deitz-Itza et al (2009) found the pregnant term body weight of >75kg more than doubled the risk of stress urinary incontinence.
  • Family history of urinary incontinence. The connective tissue which supports the urethra is a factor related to the development of stress urinary incontinence. It is suggested that the genetic component is a factor related to the development of stress urinary incontinence (Deitz et al 2005).
  • Gestational diabetes increases the risk of post-natal incontinence

What should I do if I have urinary incontinence?

Get properly assessed by a trained health professional. A women’s health physiotherapist will be able to determine the strength of your pelvic floor muscles and assess the stretch in your connective tissue. Specific exercises will be given to you to build up the closure mechanism around the urethra, and in some cases fitting a pessary can help the continence mechanism. You should receive advice on what type of exercises are right for you and guidance on progressing back into exercise or sport safely. 

 

Deitz et al 2005, BJOG, Blacker neck mobility is a heritable trait?, vol 112 (3) pp 334 339

Deitz – Itza et al 2009, Influence on maternal weight on the new onset of stress urinary incontinence in pregnancy women, IUJ, vol 20: 1259- 1263

Thomasen et al 2007, Urinary incontiencne symptoms during and after pregnancy in continence and incontinent primiparas, Int Urogynaecol J Pelvic Floor Dysfunction, vol 18 (2) pp 147- 151

Wesnes et al 2009, The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum, a cohort study, Br J Obstet Gynecol 116 (5) pp 700 – 707

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