Can there be urinary incontinence after childbirth? Urinary incontinence in women after childbirth: causes, how to treat

The birth of a child is the most wonderful and touching moment, causing enormous transformations in the female body. The changes occurring in the body have a significant impact on the well-being and health of the woman in labor. One of the most unpleasant symptoms that almost half of women have to treat is urinary incontinence - destabilization of the functions of the urinary system associated with loss of control over natural physiological processes.

The problem is accompanied by unpleasant sensations in the urethra and lower abdomen. Involuntary leakage occurs during physical activity, lifting heavy objects, while coughing or laughing. Urinary incontinence can be distressing because it is difficult to tolerate the urge to have a bowel movement, as well as the immediate aftermath. Sometimes women feel unable to urinate completely, even after visiting the bathroom. In the most difficult cases, urine may be released involuntarily during sexual intercourse.

Usually the problem makes itself felt in the last stages of pregnancy and worsens immediately after the birth itself. Often, urinary incontinence is not accompanied by pain, but if left untreated, this disorder provokes the appearance of edema and infectious inflammatory processes in the external genital organs, and in severe cases, the development of complexes, postpartum depression and complete isolation from society.

Why does urinary incontinence occur after childbirth?

No matter how natural, according to experts, the processes of pregnancy and childbirth are, they are always accompanied by global stress for the body. In the last trimester, a woman’s internal organs change their location, and the growing fetus puts considerable pressure on them.

During the process of contractions during childbirth, a whole group of deep muscle groups that are not used in everyday life are involved, which leads to their stretching and deformation. As the baby passes through the birth canal, these muscles are stretched, the blood flow in them changes, and nervous activity worsens. As a result of this, the woman in labor may subsequently experience pain throughout the entire abdominal cavity and lack of control over the process of emptying.

Urinary incontinence after childbirth can be caused by:

• increased load on the bladder and urethra;
• using obstetric forceps during delivery;
• deformation and rupture of the pelvic floor and perineal muscles;
• scarring of nearby tissues;
• injury and prolapse of the uterus;
• large fetal weight, polyhydramnios;
• multiple births with too short a break.

Often in the first days after a natural birth, which passed without any complications, women notice urine leakage. At the same time, the woman in labor can be absolutely healthy and active, the weight and height of the baby correspond to the norms.

This state of events only indicates that one of the indirect factors contributed to urinary incontinence after childbirth:

• excess body weight;
• acute lack of estrogen;
• previously untreated spinal injuries (pinched nerves, hernia, etc.);
• chronic pathologies of development of the pelvic organs;
• the presence of persistent infections of the genitourinary system.

In any case, urinary incontinence is a pathology that needs treatment. Don't expect it to go away on its own. To avoid further complications, it is important to pay attention to it in time and begin complex therapy.

What to do if you experience urinary incontinence after childbirth?

When a problem arises, it is important, first of all, to get rid of the underlying syndrome. To do this, you need to limit fluid intake, completely eliminating diuretic drinks and foods (alcohol, watermelon, coffee, rose hips, etc.). To avoid trouble, you should be especially careful about absorbing liquids immediately before going outside. You need to drink only when thirst occurs, in small sips, exactly the amount that the body requires at that very moment.

Experts say that breastfeeding helps remove excess fluid from the body and get rid of swelling after childbirth. They recommend putting the baby to the breast at the first request. As a rule, after childbirth this period is 1.5-2 hours.

To track the dynamics, you can keep a diary in which you need to regularly record the amount of absorbed and separated liquid, as well as record situations during which uncontrolled urination occurred. This will help track the dynamics and identify the causes of incontinence.

Treatment

If uncontrollable urination occurs, it is necessary to promptly begin to restore the physical form of the woman in labor. We should not forget about the psychological state of a woman. It is important to understand that only an integrated, comprehensive approach will help get rid of pathology without specialized help.

Treatment for urinary incontinence involves:

1. Restoring and strengthening the pelvic floor muscles, even if they are not the cause of the problem, because the speedy restoration of the functions of the reproductive system after childbirth, in any case, will only bring benefits. A woman in labor should master the technique of performing Kegel exercises. It consists of alternately squeezing and relaxing the muscles of the vagina and sphincter. When performing exercises, it is important to provide a quiet, calm environment that allows you to focus only on muscle tension. The lesson time should be 15-30 minutes daily. The first results will be noticeable within a couple of weeks.
2. After preparing the vaginal muscles, you can begin more serious loads: holding special balls or weights. To do this, you will need to purchase a special projectile, part of which is placed in the vagina, and the load is located outside. The challenge is to maintain weight using the vaginal muscles alone. At the same time, a woman can carry out everyday activities or even do light exercises at home. The degree of burden can be gradually increased.
3. Systematic training of the vaginal muscles will help to fully restore its functions, returning it to its prenatal state. But it is important not to forget about the bladder. To train it, you can create a special plan for urinating at regular intervals. In this case, time intervals should be gradually increased, allowing the body to adapt.
4. In the treatment of urinary incontinence, it would also be useful to take herbal medications. Patients suffering from this pathology after childbirth are recommended to take herbs that have a mild sedative effect (St. John's wort, lemon balm, valerian), as well as agents that activate blood circulation and strengthen blood vessels.

1. When treating incontinence, doctors advise doing more sports. In case of a difficult birth or a long and difficult recovery after it, you can attend water aerobics classes. This type of training will help to engage all the muscles of the abdominal cavity and pelvis, but will not lead to overstrain and exhaustion of the body.
2. If you feel well, you can go to the gym or go for a run in the fresh air. But it is important not to forget about the abdominal muscles. When running or exercising on exercise equipment, you need to ensure that your stomach is always retracted. This will increase the tone of the abdominal muscles and restore the normal arrangement of internal organs after childbirth.
3. When urinary incontinence occurs, experts recommend paying attention to the psycho-emotional state of the young mother. Since the psyche of women after childbirth becomes very vulnerable, the disorder can even be caused by being around the newborn around the clock. Therefore, women suffering from urinary incontinence need to establish the most comfortable sleep and wakefulness during the day. The woman in labor needs to be provided with at least minimal rest for 2-3 hours daily, transferring the responsibilities of caring for the baby to the father or another trusted person.

The results of treating incontinence by strengthening the pelvic muscles should be noticeable within a couple of weeks. But it often takes months to fix the problem. If there is no slight improvement from therapy over a long period, the woman needs to consult a specialist for physical therapy or surgery.

Urinary incontinence after childbirth is a pathological condition that occurs as a result of weakening of the pelvic floor muscles and changes in the position of the pelvic organs. The problem requires medical supervision. In some cases, the pathology can only be eliminated through surgery.

Recovery after childbirth can take several months. During the rehabilitation stage, a woman may face many problems. For example, a patient is often concerned about urinary incontinence after childbirth. This is a phenomenon that causes a lot of inconvenience. Occurs in women during natural childbirth and after cesarean section. There are several types of postpartum incontinence:

Type of pathology	Description
Stressful	Involuntary loss of urine occurs when coughing, sneezing, or exercise. This form of pathology is typical for women who give birth naturally.
Imperative	Occurs with a sudden urge to urinate. In this case, the woman does not have time to react in time and finds herself in an awkward situation.
Involuntary	This urinary incontinence occurs throughout the day. In this case, urine can be released in both small drops and streams.
Enuresis	This form of pathology is extremely rare in adults. However, it can be observed in women who have just given birth. In this case, urination occurs during sleep.
When overflowing	In this case, urine is released in small portions and only when the bladder is full. This condition indicates pathology. For example, the phenomenon is often diagnosed with uterine fibroids or infections.
Reflex	Confusion can occur with a loud sound or unexpected action. Any external factor can cause urinary incontinence.

In addition to the above, women can also produce urine after emptying their bladder. Usually women observe small drops. This condition lasts about a couple of minutes, then goes away until the next urination.

Causes

Involuntary release of urine occurs as a result of dysfunction of the pelvic floor muscles. During childbirth, they stretch and become less elastic. Various factors can provoke urinary disorders:

• pregnancy with twins;
• the fruit is too large;
• mother's excess weight;
• perineal ruptures that occurred during childbirth;
• repeated births;
• mental disorders in women;
• infections;
• hormonal imbalances;
• the presence of a similar problem among close relatives.

To select an effective treatment, it is necessary to determine the exact cause of the development of the pathology. To do this, you need to visit a gynecologist. The doctor will perform the necessary examination and write a referral for tests.

Urinary incontinence after childbirth: what to do

Urinary incontinence after childbirth occurs in approximately 30-40% of women. Most often, pathology occurs during repeated births. The problem cannot be ignored. Also, you should not wait for the condition to normalize on its own. The sooner the problem is detected, the faster the woman will get rid of it.

If the problem does not disappear within a few weeks after childbirth, experts suggest several ways to solve it:

• conservative;
• surgical;
• physiotherapy.

Diagnosis of pathology

Before treatment, a woman must undergo a comprehensive examination. It includes a number of examinations and tests:

• taking an anamnesis - the gynecologist asks the woman questions about her current condition, finds out when the problem arose. The doctor must be informed about the presence of accompanying symptoms, such as pain when urinating, etc.;
• examination on a chair allows you to assess the condition of a woman’s birth canal, as well as identify pathologies that cause urinary incontinence;
• cystoscopy is a procedure that allows you to assess the condition of the walls of the bladder and identify foci of inflammation. In this case, effective treatment is selected. Sometimes a course of antibiotics is required;
• Ultrasound. The procedure is necessary to assess the general condition of the pelvic organs. Ultrasound also determines deviations in the location of organs relative to the norm;
• urodynamic study. Includes a wide range of procedures. These include profilometry and cystometry;
• Prescribing a general urine test is necessary to identify inflammatory processes in the urinary canal and bladder.

Treatment for incontinence is selected depending on the test results and the general condition of the woman.

Conservative therapy

In this case, you need to make sure that the problem was not caused by inflammatory processes. If tests confirm the presence of infection, the woman is prescribed appropriate medications. In all other cases, medication is not prescribed.

The main method of conservative therapy is special gymnastics. Kegel exercises help strengthen the muscles and normalize the condition of the perineal tissue. Exercises on a fitball are also recommended. Some exercises can only be done after the body has fully recovered. This is why you need to talk to a gynecologist before starting classes. Exercises can be done at home or enroll in special courses.

If conservative treatment of urinary incontinence is ineffective, the woman is prescribed surgery.

Surgery

There are several ways to eliminate involuntary urine leakage. Minimally invasive techniques help avoid injuries and significantly reduce the rehabilitation period:

• introduction of a special gel. In this case, a special composition is introduced into the paraurethral space. This method does not provide a 100% guarantee of urinary retention. After the procedure, relapses often occur that require repeated correction;
• use of synthetic loops. This loop is inserted under the middle part of the urethra. The design provides additional support and protects against unpleasant situations. This method is more effective.

Urethrocystocervicopexy is a full-fledged surgical procedure. Surgery is prescribed if minimally invasive methods do not give the desired result. The essence of the treatment is to fix the bladder, uterus and urinary canal. This method is used very rarely. After the procedure, the woman needs a long rehabilitation period. However, urinary incontinence goes away.

Physiotherapy

Physical therapy is optional. They are combined with the main therapy and allow you to achieve better results. There are several methods of physiotherapy:

• electrical stimulation;
• electromagnetic stimulation.

The procedures are aimed at strengthening the pelvic floor muscles in women. As a result, the process of urination is normalized. However, physiotherapy procedures for urine excretion have contraindications. Women who have the following problems will have to refuse additional assistance measures:

• the presence of malignant tumors;
• benign neoplasms with a high risk of degeneration into malignant ones;
• disorders and malfunctions of the cardiovascular system;
• liver and kidney diseases in the acute stage.

If there is at least one of the contraindications, the listed methods should be abandoned. Before starting the course, you must consult with a gynecologist and therapist.

When will it pass

If postpartum urinary incontinence was caused by natural causes, it will go away within a few weeks. As soon as the muscles acquire tone, the involuntary release of urine will stop. However, if the pathology does not go away within 2-3 weeks, you must urgently seek help. Perhaps this is exactly the case when surgical intervention is indispensable.

In the absence of timely assistance, complications may develop:

• prolapse of the pelvic organs - this involves displacement of part of the vagina, bladder and urethra. Organs take an unnatural position, which can cause more serious pathologies;
• development of skin infections - with constant leakage of urine, irritation of the skin occurs. If hygiene rules are violated, ulcers and rashes form in the perineal area. Such wounds take a long time to heal and have a high probability of infection.

If a woman resorts to conservative therapy methods and does regular exercises, then the final result from treatment can be expected in 6-12 months.

Urinary incontinence after caesarean section

Urinary incontinence can occur after both natural childbirth and cesarean section. The fact is that while carrying a child, the bladder and pelvic floor muscles experience increased stress. As a result, they stretch and lose their functionality. It takes some time for the urination process to normalize.

In addition, during a caesarean section, a woman's urethra is subjected to additional stress in the form of a catheter. Often the design injures the mucous membrane and disrupts the sensitivity of nerve endings. If the catheter is placed incorrectly, the risk of infection of the urinary organs increases.

Another factor causing incontinence is the location of the suture on the uterus.

For patients who have undergone a caesarean section, individual programs are selected to correct the problem. The fact is that after the operation, physical activity is prohibited for a long time. Thus, exercise balls or Kegel exercises are not suitable for such women. Incontinence is eliminated in other ways.

In addition, after cesarean it is important to assess the condition of the muscles, since there is a high probability that urinary incontinence after childbirth was caused by violations in the surgical intervention.

Prevention of pathology

Treatment of urinary incontinence is a long and complex process. In addition, the course of therapy takes away time that the woman could spend with the child. There are preventative methods to prevent the development of pathology:

• During pregnancy, it is necessary to follow a diet. Excess weight increases the load on the pelvic organs. As a result, the risks of developing postpartum urinary incontinence increase;
• Follow your doctor's recommendations. This will not only avoid problems with the perineal muscles, but also not harm the baby;
• use special designs. A postpartum bandage is a must-have device for pregnant women. The device reduces the load on the pelvic floor muscles;
• watch your food. Frequent constipation increases pressure on the urethra. This contributes to the risk of developing urinary incontinence;
• pay attention to hygiene. Urogenital infections can lead to postpartum urinary incontinence. The earlier the infection is detected, the lower the risks of developing pathologies;
• perform special gymnastics. Exercise strengthens the vaginal muscles and also reduces the risk of tearing during childbirth. Before starting a course of exercises, it is important to consult a gynecologist;
• do not tolerate the urge to urinate. This condition leads to stretching of the bladder muscles. As a result, incontinence develops.

Urinary incontinence after childbirth is common. Despite this, you should not wait for it to go away on its own. Sometimes, to eliminate the pathology, medical help or special exercises are required. If the condition worsens, you should contact a gynecologist. Sometimes a consultation with a urologist is required. The earlier the problem is detected, the fewer complications will arise in the future.

During pregnancy, the female body begins to undergo restructuring; almost all systems work more intensively, which is subsequently reflected in their functioning.

Very rarely, women in labor manage to recover from the first days without feeling any abnormalities.

Urinary incontinence after childbirth is a spontaneous action that cannot be controlled by volition.

This pathology occurs in many women, but not everyone knows what to do if they experience urinary incontinence after childbirth. Many mothers consider this phenomenon shameful and remain silent about the problem for a long time.

This position has a negative impact on health, leads to depressive disorders and a number of inconveniences, and disrupts normal life. This complication requires timely diagnosis and treatment; this is the only way to quickly resolve the problem.

According to statistics, this disorder appears in 10-15% of people after the first birth and 40% after the next.

What is urinary incontinence? This is the name given to a wide range of disorders:

• involuntary leakage of urine occurs under any type of load (even minor) - sudden movements, squatting, sneezing, etc.;
• there is a feeling of a foreign object in the pelvic area after childbirth;
• possible unregulated urination during sex;
• after bowel movement, the urge to go to the toilet remains;
• does not hold urine after childbirth, often when drinking alcohol;
• leakage occurs throughout the day, sometimes it hurts to urinate.

Main causes of urinary incontinence after childbirth

Pregnancy is a difficult period for the body, accompanied by significant stress on the pelvic floor muscles, which often leads to urinary incontinence. Every month the fetus grows, and the pressure increases simply in arithmetic progression.

Blood circulation and the functioning of internal systems change.

The muscles responsible for urination also change due to additional stress on the bladder. As a result, unpleasant phenomena that cause so much discomfort.

This dysfunction is most common in patients who have given birth without surgery, although this does not mean that patients who have had an incision during a cesarean section are immune from urinary incontinence.

Urinary incontinence after childbirth can be caused by various reasons:

• Very large fruit.
• A significant number of perineal muscle ruptures during the birth process.
• Intensive weight gain, which increased the load on the pelvic floor muscles.
• Various complications after childbirth.
• Spinal cord injuries.
• Mental disorders (stress, neuroses, lack of sleep, multiple sclerosis).
• Dysfunction of the urinary system, urological pathologies.
• Chronic organ diseases (kidneys, gall bladder, liver).
• Spinal injuries.
• Narrow pelvis.
• Hormonal imbalances.
• Radiation damage.
• Surgical interventions and associated complications.
• Instability of intravesical pressure.
• Dysfunction of the pelvic floor muscles.

The development of urinary incontinence after childbirth can be caused by various reasons; there are also several types of disorders. For example, the stressful type manifests itself during physical activity, coughing, sneezing.

Reflex is based on the influence of external factors - the sound of pouring liquid, unexpected signals, etc. Involuntary urination occurs when muscles lose their strength.

Therefore, urine is excreted in small parts (drop by drop) throughout the day. Quite rarely, enuresis (discharge during sleep) can develop.

Of course, this condition significantly affects the life of a woman in labor. A constant feeling of discomfort, psychological disorders, and lack of self-confidence are far from the worst consequences.

If you do not consult a specialist in time and do not find out why urinary incontinence after childbirth and how to treat it correctly, you can develop a serious chronic disease.

Symptoms

In medical practice, there are several symptoms of this condition. In mild forms, there is a slight release of urine. The cause of this phenomenon can be strong tension in the abdominal wall, abs, or running.

With moderate severity of incontinence, more abundant urine flow appears after the birth process. Such symptoms can be caused by sneezing, coughing, light physical activity, or expression of emotions.

Symptoms in the severe form include involuntary urination throughout the day after childbirth. Unpleasant incidents during sleep become more frequent, most often when changing positions.

Such symptoms are often observed in advanced forms of the disease if timely treatment is not started immediately after childbirth. Manifestations of incontinence can be different, but even the most insignificant of them should be a signal for a visit to the doctor.

Diagnosis of urinary incontinence

Urinary incontinence after childbirth is a serious pathology that requires the attention of a doctor. A woman needs to see a specialist in urology.

It is very important to describe as accurately as possible all the symptoms and processes occurring. You should not hide some phenomena, as this may lead to an incorrect diagnosis.

The first visit is accompanied by a history taking, during which the doctor will ask about the course of pregnancy, childbirth, number of children, complications, and chronic diseases.

It is also important for the urologist to know about heredity; this often helps to find out the causes of urinary incontinence after childbirth.

After this, the patient must answer some questions in writing (sometimes orally): you need to describe the state of the genitourinary system on the day of the visit to the doctor, general symptoms and features of the course of the disease.

At the end, the woman is asked to keep a diary (over the next 2-3 days), in which she must indicate the exact time of each urination and the amount of liquid drunk.

It also needs to indicate sensations, involuntary discharge and the volume of fluid released, if this was observed. Based on the data obtained, the urologist can more accurately assess the patient’s condition.

After this, an examination is carried out on a gynecological chair. The doctor takes smears to analyze the state of the microflora and the presence of diseases (infectious, inflammatory). Also, examination of the vagina and cervical canal can identify neoplasms.

During this examination, a special test is performed. The patient in the treatment room is asked to cough, at which point the volume of urine produced is recorded. If there is no fluid, the test is considered negative.

• blood chemistry;
• Analysis of urine;
• ultrasound examination of the ovaries, uterus, kidneys, fallopian tubes and tissues in the pelvic organs;
• cystometry - a urodynamic examination that helps determine dysfunction of the urethra and bladder;
• cystoscopy - examination of the bladder and urethra using an endoscope;
• profilometry - measuring pressure inside the urethra;
• Uroflowmetry is a clinical method for determining urinary flow rate.

Treatment

Urinary incontinence in a woman after childbirth requires timely treatment. Today, both conservative methods and serious operations are used.

The simplest option is muscle training. You need to take special weights weighing 50 g and place them in the vagina. For 15 minutes, the young mother should do her usual activities, while holding the load.

Such procedures increase muscle tone. You need to repeat 3-4 times a day. The Kegel treatment method can also be called popular. It is based on squeezing and unclenching the vaginal muscles. You need to do this about a hundred times a day.

The essence of this technique is as follows: during urination, it is recommended to hold this process for 2-3 seconds, then continue. This restores the elasticity of the pelvic muscles. Results can be seen within a month.

Muscle exercises are based on going to the toilet at a certain time and at the same interval.

The essence of the idea is to develop the habit of urinating infrequently and to be more patient. These muscle exercises must be done for 2-3 months.

How to treat the problem of urinary incontinence after childbirth with medical means? There are no specific drugs that help with this pathology.

As a rule, treatment for urinary incontinence after childbirth includes taking vitamins and medications that improve blood circulation. Medicines prescribed for enuresis are drugs that affect the mental state and hormone levels.

Severe and advanced disease is treated with surgery. Most are performed under general anesthesia and involve securing the urinary tract and bladder.

To minimize urethral weakness, a gel mixture is injected into the paraurethral space. Today, the current method is to place a sling loop in the pelvic areas.

The operation is performed under anesthesia and is aimed at a quick recovery and improvement of the woman’s condition.

Prevention of urinary incontinence after childbirth

In order to avoid spontaneous urination after childbirth, it is very important to take care of yourself. Firstly, you don’t need to endure it, you should go to the toilet after the first urge.

Secondly, avoid constipation, as during attempts to empty the muscles become very tense and lose tone. Eat more fresh vegetables, herbs, grains, and dairy products. Maintain hygiene and health after childbirth.

Obesity also leads to incontinence problems. Every woman should know about the bandage and use it from the moment when the belly begins to increase significantly.

It redistributes all the heaviness and minimizes pressure on the pelvic floor. The best prevention is planned pregnancy, timely visits to the doctor and comprehensive treatment of inflammatory processes.

Urinary incontinence after childbirth is considered a dysfunction of the mother's body. Nocturnal enuresis, or the inability to control urine output during the day, is a problem experienced by 40% of women who have recently given birth to a child. Some young mothers consider it too delicate, and therefore do not inform the attending physician about the appearance of incontinence. This worsens the quality of life of women who give birth, who do not have the ability to control urine output. Difficulties associated with postpartum incontinence affect the physiological and psychological spheres of life. Young mothers feel inferior, and therefore wonder what to do and how to treat the pathology.

Urinary incontinence in women after childbirth is a pathology associated with the involuntary release of urinary fluid (and this process cannot be controlled). The volume of urine leaked can be scanty (just a few drops) or copious (when fluid flows constantly from the bladder). Incontinence of gases and urine after childbirth often manifests itself as a result of severe stress to which the woman’s body was exposed at the time of childbirth. Involuntary leakage of urine is provoked by severe overstrain of the abdominal muscles when the body experiences stress (during jumping, sneezing, coughing or sexual intercourse). If the pathology has become severe, urine leakage occurs even with a sudden change in body position or at night, during sleep.

In addition, women note the following symptoms:

• feeling of the presence of a foreign object in the vagina;
• incontinence that occurs while drinking alcoholic beverages;
• the patient feels that there is fluid in the bladder.

The problem of enuresis occurs in women who have given birth. The first birth increases the likelihood of incontinence to 10-15%, and with repeated labor, involuntary leakage of urine occurs in 40% of cases.

Doctors associate the occurrence of postpartum incontinence with the fact that functional disorders appear in the muscles that penetrate the pelvic floor. The appearance of such a pathology after childbirth as incontinence is also caused by an incorrect relationship between the organs located in the pelvis. The pelvic floor muscles form the support for the uterus, and therefore in late pregnancy, when the fetus is quite large, they are subject to enormous stress. It should also be noted that it is from them that, before the onset of labor, the birth canal is formed, through which the baby moves forward. When a child moves along the birth canal, the pelvic floor muscles are compressed, circulatory processes and the nervous connection with the central nervous system are disrupted.

Urinary incontinence sometimes occurs in response to traumatic situations that arise during childbirth (muscle tears, perineum, careless use of medical forceps). A large child, polyhydramnios or multiple pregnancies, having many children are risk factors that to some extent provoke urinary incontinence after childbirth.

Traumatic factors that occur during childbirth sometimes provoke the occurrence of the following pathological conditions:

• disruption of nerve muscle connections in areas where the bladder and urethra are located;
• the urethra and bladder become mobile;
• the obturator muscles in the urethra and bladder function poorly.

There are certain risk groups when the likelihood of developing postpartum enuresis increases.

The negative process is caused by the following factors:

1. Poor heredity, predisposition to the development of postpartum incontinence.
2. Pregnancy, birth of a child (especially if it is not the first).
3. Excess weight.
4. Abnormal development of organs in the pelvis, incorrect location of the pelvic floor muscles.
5. Surgical manipulations performed in the pelvic area, during which the nerve communication between the muscles is disrupted or damaged.
6. Hormonal imbalances when a young mother’s body lacks the female sex hormone estrogen.
7. Urinary tract infection.
8. Mental illnesses.
9. Radiation exposure.
10. Neurological pathologies, which include multiple sclerosis, Parkinson's disease, spinal injuries and diseases of the nervous system.

Excessive stretching and weakening of the pelvic muscles is the main factor causing the problem of incontinence. In an elastic state, they provide good support for the uterus throughout pregnancy.

But under the weight of the unborn child, such muscles lose their elasticity, weaken and become stretched. A fetus that is too large, complicated childbirth, or injuries that occur during labor also have a negative impact on their condition.

When a woman gives birth to a child, her body is rebuilt again, hormonal levels change, and the consequence of such changes is the appearance of additional problems. For example, urinary incontinence may develop after childbirth.

This pathology is divided into the following types:

1. Stressful. Urine is released involuntarily if a woman tenses her abdominal muscles, coughs, laughs hard, or cries loudly. Stress incontinence is the most common postpartum problem for many women.
2. Uncontrolled. Throughout the day, a woman who has given birth produces urine in small quantities.
3. Urgentnoe. Intense urge to urinate, unable to control the urge to urinate.
4. Enuresis. Involuntary leakage of urine at night.
5. Reflex. Urine separation is facilitated by external, irritating causes (for example, rain noise or splashing water).
6. Urine fluid begins to leak when the bladder is full, and these processes are influenced by internal factors (for example, benign neoplasms, infectious genitourinary diseases, uterine fibroids, tumors in the pelvis).

Regardless of the type of involuntary urination, the problem must be solved comprehensively. A woman should consult with her doctor about treatment for postpartum urinary incontinence. To achieve the best effect, it is necessary to combine drug therapy with exercises and traditional methods that will restore elasticity to the muscles.

Symptoms of postpartum incontinence

Urinary incontinence after childbirth is accompanied by the following symptoms:

• systematic flow of urine that occurs uncontrollably;
• urinary fluid is released in large quantities;
• urine leaks out when performing serious physical work during sex.

If a woman suffers from urinary incontinence after childbirth, she should definitely consult a doctor and get medical help. Only timely detection of the disease will allow the condition to be corrected and the development of undesirable consequences to be prevented.

Diagnosis of urinary incontinence after the birth of a child is performed by a urologist.

The attending physician carries out the following activities:

• examines the patient;
• asks her to tense her abdominal muscles or cough (testing to check spontaneous leakage of urine);
• if the test gives a positive result, the specialist asks the woman to continue to control her own urination, write down the cause and time of the problem;
• The doctor uses the resulting records to develop the correct treatment plan.

To speed up diagnosis, make it effective and accurate, a woman giving birth is prescribed the following procedures:

• laboratory tests of urine and blood;
• ultrasound examination of the pelvic organs and kidneys;
• cystometry (research work that helps detect pathological bladder function);
• uroflowmetry (testing the urodynamic characteristics of the female body);
• urethral profilometry (urodynamic tests to check the condition of the urethra).

After childbirth, a woman should promptly examine her genitourinary system. Based on the diagnostic results, the doctor will develop effective treatment tactics that will help quickly get rid of postpartum urinary incontinence.

Many women, faced with postpartum urinary incontinence, do not know that such a pathology can be successfully treated. True, success depends on timely diagnosis. In this case, the functioning mechanism of the bladder is disrupted to a small extent, which means that there are all possibilities for treating the pathology without surgical intervention. But if the case is severe, the patient is offered the help of a surgeon.

Conservative treatment of female urinary incontinence involves the use of exercises to help train the muscles of the urinary system.

Below is a list of procedures recommended for women with postpartum urinary incontinence:

1. Kegel exercises. Throughout the day, a woman should tense the muscles surrounding the bladder and rectum. You need to do this exercise 100-200 times, keeping the muscles tense for several seconds.
2. Retention of conical weights in the vagina. The weights have different weights, and the woman’s task is to hold these elements. Doctors recommend starting classes with the use of small weights, gradually increasing the weight. It is recommended to perform this procedure at least 3-4 times a day, and spend 15-20 minutes on each approach.
3. Physiotherapeutic treatment. To strengthen the pelvic muscles, the specialist recommends that the woman undergo physiotherapy, which includes electromagnetic stimulation. A good effect is achieved by combining physiological procedures with exercises to improve muscle tone.
4. Bladder training sessions. The urologist develops a special plan, recommending that the patient go to the toilet “little by little” at a certain time, which is indicated in the plan. Gradually, the time interval between visits to the toilet increases. A prerequisite for a woman is to urinate strictly following the scheme proposed by the doctor. This treatment helps a woman learn to control her own urination. The duration of the therapeutic course reaches 2 months.
5. Drug treatment. If a woman is diagnosed with incontinence, she is prescribed special sedative medications. They improve blood supply, help strengthen vascular walls, and saturate the body weakened by childbirth with vitamin complexes. But it should be noted that in pharmacology there are no drugs that would help cope with the problem of urinary incontinence. The medications offered by urologists act only indirectly, strengthening the immune system and muscles.

Conservative therapy does not always help eliminate the problem of incontinence in a woman who has recently given birth to a child. What to do if the developed drug treatment regimen does not produce results? In this case, the patient is offered surgical intervention.

Surgical therapy for postpartum urinary incontinence is represented by various operations:

1. Surgical intervention using gel. A medical composition in the form of a gel is used to create a support surrounding the urethra. In duration, such an operation takes no more than 30 minutes and is performed in a hospital or on an outpatient basis. Local anesthesia is used for pain relief.
2. Urethrocystocervicopexy. Surgical intervention is aimed at strengthening the ligaments located in the pubic area. When in normal condition, these ligaments support the urethra and the neck of the bladder. Technically, such surgical work is very complex, so general anesthesia is used to perform it. The rehabilitation period after surgery is quite long, so doctors rarely perform the procedure of urethrocystocervicopexy.
3. Loop operations. For therapeutic purposes, doctors place a support loop under the urethra. It is made from biomaterial (skin of the upper thigh). Sometimes the support is made from synthetics, which is not rejected by the body. To perform the surgical procedure, the doctor makes a small incision in the patient's skin. This technique is low-traumatic and this is its main advantage. The woman recovers quickly after such surgery.

The correct tactics for treating urinary incontinence in a woman who has given birth will help eliminate the problem painlessly and quickly. The patient must understand that only if she consults a urologist in a timely manner will she be able to avoid surgical intervention. In the early stages of development, urinary incontinence can be successfully treated with conservative methods.

Urinary incontinence can be cured, but it is better to prevent this problem from occurring.

A woman carrying a baby must adhere to the following recommendations:

• control your body weight (excess weight creates additional stress on the bladder, increasing the symptoms of urinary incontinence);
• treat infectious diseases occurring in the genitourinary system in a timely manner and do not neglect them;
• in late pregnancy, support the abdomen with a bandage;
• When carrying a child, adhere to the advice given by the doctor, undergo regular examinations and tests (this way it will be possible to identify bladder incontinence at an early stage of its development and begin therapeutic measures in a timely manner).

The problem of urinary incontinence cannot be called an incurable pathology. A wide arsenal of modern treatment methods makes it possible to easily and quickly correct the situation, saving a woman from such a delicate disease.

Postpartum urinary incontinence is an important and often overlooked form of maternal morbidity. This pathology can occur both in pregnant women and after the birth of a child, but in the second case, treatment may be more difficult. It is important that every woman knows the main causes and risk factors of this pathology.

ICD-10 code

N39.4 Other specified types of urinary incontinence

Epidemiology

Statistics show that the problem of urinary incontinence is widespread. Almost half of all women have this problem after childbirth. Unfortunately, despite the fact that incontinence is something that many new mothers suffer from, it remains an issue that is not discussed or prevented. The research found that a third (33%) of women who had urinary incontinence after childbirth were embarrassed to discuss it with their partner, and almost half (46%) felt uncomfortable talking about it with their doctor.

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Causes of urinary incontinence after childbirth

There are various reasons why a woman may suffer from urinary incontinence after childbirth. The bladder muscles may weaken after constant stretching of the pelvis during pregnancy. This causes the urethra to lose control of holding urine.

Urinary incontinence is often associated with vaginal birth, especially in first-time vaginal births. Many clinical studies have attempted to discover the specific obstetric event that causes urinary incontinence. An obvious reason may be large children and “difficult births”, which are complicated by surgical interventions. Pelvic organ prolapse (cystocele, rectocele and uterine prolapse) and anal urinary incontinence are also complications of physiological childbirth.

Each woman should have sufficient information to determine which set of risks she prefers for herself and her baby. In the general situation, when there is no additional risk to the baby, obstetric management should focus on reducing maternal morbidity, including postpartum urinary incontinence. New mothers are likely to benefit from routine symptom screening and early discussion of healthy bladder habits and proper muscle techniques as part of their postpartum care. Obstetric care should include an assessment of the maternal outcome of this birth, including the full range of pelvic floor injuries known to be associated with childbirth.

Therefore, the causes of this pathology are most often limited to pathology during childbirth. If a woman has had an epidural or spinal anesthesia, it may cause a numb sensation in the bladder. This may last several hours after anesthesia or several days. In the first few hours after birth, a woman will not be able to accurately feel all the organs, both due to anesthesia and the birth process itself. The presence of a catheter during a cesarean section can make bladder control difficult and may cause further complications.

The main causes of urinary incontinence after childbirth can be identified as follows:

1. The pelvic nerves, which control bladder function, can be injured during prolonged or heavy vaginal delivery.
2. Forceps birth can cause injury to the pelvic floor and anal sphincter muscles.
3. Pressing for long periods of time during vaginal birth also increases the likelihood of pelvic nerve damage and bladder control problems that may follow.
4. vaginal physiological birth (although even women who choose cesarean section may be prone to incontinence);
5. invasive use of instruments during childbirth.

Pathogenesis

The pathogenesis of the development of urinary incontinence after childbirth, as a common problem, lies in the structural features and innervation of urine.

The bladder sphincter is a muscular valve located at the bottom of the bladder. It works to control the flow of urine. A healthy bladder empties 5 to 9 times a day and no more than once at night. Usually every 2-4 hours – the woman should urinate. Caffeinated drinks, foods with artificial sweeteners, acidic foods and alcohol can irritate the bladder and cause you to go more often, so avoidance can help control urgency and reduce frequency. The bladder sphincter relaxes when the bladder fills with urine, and the sphincter muscles help keep the bladder closed until you are ready to urinate. Other body systems also help control the bladder. Nerves from the bladder send signals to the brain when the bladder is full; nerves from the brain signal the bladder when it needs to be emptied. All of these nerves and muscles must work together for the bladder to function properly.

During pregnancy, the expanding uterus puts pressure on the bladder. The muscles in the bladder sphincter and pelvic area may become overloaded with additional stress or pressure on the bladder. Urine may leak from the bladder when there is extra pressure, such as when playing sports or during any movement.

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Symptoms of urinary incontinence after childbirth

Pregnancy comes with its share of joys and discomforts. One such common problem is that most women have stress urinary incontinence.

There are different types of urinary incontinence after birth. Stress urinary incontinence is classified as the involuntary loss of urine during exertion. Urinary incontinence when coughing or sneezing after childbirth is a stress factor that can provoke sphincter relaxation. Such stress factors primarily affect the innervation of the bladder, and then involuntary release of urine occurs. A healthy, functional pelvic floor has a balance between the ability to contract and the ability to relax. A pelvic floor that is too relaxed or too compressed is dysfunctional and can cause these symptoms.

Another type of incontinence is under the influence of physical activity. Urinary incontinence during jumping or during physical activity after childbirth develops against the background of muscle weakness and sphincter relaxation, and disruption of innervation is of secondary importance here.

Symptoms of this pathology are the appearance of a small amount of urine or complete urination against the background of an irritant. A woman may leak urine when she coughs, sneezes, laughs, or moves quickly. The amount of urine can vary from a few drops to a sufficient amount. The first signs often appear immediately after childbirth. If you pass a small amount of urine in the first few days after giving birth, don't worry as it may normalize in the first few days. If this is observed for several weeks, then this is already a serious pathology.

Complications and consequences

The consequences and complications of not seeking help in a timely manner can be serious. This can make women feel lonely and isolated, impact relationships and careers, and can be a barrier to having sex.

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Diagnosis of urinary incontinence after childbirth

A gynecological or proctological examination can diagnose the causes and type of incontinence to provide targeted treatment and prevention of urinary incontinence.

Diagnosis should begin with a history taking. And every doctor must remember that not every woman can complain of urinary incontinence. Some patients may simply not mention these symptoms, considering them normal, or may simply be embarrassed. Therefore, during the examination, the doctor should ask the woman about possible symptoms. If a woman talks about having symptoms of incontinence, then you need to find out under what conditions this occurs and how long it lasts.

Tests must be carried out to rule out urinary tract infection. A woman must undergo a general urine test, which allows to exclude infection and localize the pathological process, for example, to clarify whether the process is in the bladder or kidneys. Laboratory tests should also include serum creatinine, which may be elevated if there is urinary retention (overflow bladder) caused by bladder outlet obstruction or detrusor denervation.

Instrumental diagnostics are also carried out to exclude concomitant conditions. For this purpose, most often they start with ultrasound diagnostics. This method allows you to determine whether there are changes in the bladder and kidneys, as well as whether there are any problems with the uterus.

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Differential diagnosis

Differential diagnoses for urinary incontinence are varied. Sometimes there is more than one factor contributing to further complications in diagnosis and therapy. Distinguishing between these different etiologies is necessary because each condition requires a different, but often overlapping, therapeutic approach. Urinary incontinence after childbirth must be differentiated from urinary tract infection and cystitis in women. It is also necessary to exclude multiple sclerosis, spinal cord neoplasms, birth injuries of the spinal cord and concomitant diseases, spinal epidural abscess, and vaginitis.

Urinary tract infections are common, especially during the postpartum period. Cystitis (inflammation of the bladder) represents the majority of these infections. Related terms include pyelonephritis, which refers to an upper urinary tract infection; bacteriuria, which describes bacteria in the urine; and candiduria, which describes yeast in the urine.

Symptoms and signs of a urinary tract infection include: urinary disturbance, urinary frequency, bladder discomfort, flank pain and musculoskeletal tenderness (may be present with cystitis), fever, chills and malaise. The main differential sign of a urinary tract infection is the detection of pyuria or changes in urinalysis. Therefore, in case of incontinence, a urine test is always performed, and if there are changes, this indicates an infection.

Urinary incontinence in the postpartum period can occur due to various pathological processes of the spinal cord, including trauma. Regardless of pathogenesis, it can result in significant impairment of motor, sensory, or autonomic function. Therefore, if any such symptoms are present, spinal cord injury must be ruled out.

Treatment of urinary incontinence after childbirth

What to do about urinary incontinence after childbirth? Urinary incontinence after childbirth is not something you should simply accept as a normal function. It can affect your mental health if symptoms continue, so don't wait too long to seek help and start treatment.

Since this problem does not involve any disturbances at the biochemical level in its development, medications are not used.

The first thing to consider with this problem is dietary changes.

Certain foods and drinks are believed to contribute to bladder incontinence. These products include: alcoholic beverages, carbonated drinks (caffeinated or decaffeinated), coffee or tea (caffeinated or decaffeinated). Other changes include drinking less fluid after lunch and getting enough fiber to avoid constipation. Also, avoid drinking too much.

While some mothers still smoke after birth, researchers are still showing a link between incontinence and cigarette smoking. Therefore, this factor must be excluded.

A pessary is the most common device used to treat urinary incontinence. This is a rigid ring that a doctor or nurse inserts into your vagina. The device is pressed against the wall of the vagina and urethra. This helps reposition the urethra to reduce leakage of urine during straining.

Some people with urinary incontinence may not respond to behavioral treatments or medicine. In this case, electrical stimulation of the nerves that control the bladder may help. This treatment, called neuromodulation, may be effective in some cases. The doctor will first place the device outside your body to deliver the pulse. If it works well, the surgeon implants the device.

Vitamins can only be used as prescribed by a doctor, taking into account that the woman is breastfeeding.

Physiotherapy treatment can also be widely used. Biofeedback can lead to conscious control of the pelvic floor muscles and support voluntary contraction of the bladder muscles. A small electrode is inserted into the vagina to measure muscle activity. Acoustic and visual feedback indicates whether the correct muscles are being controlled and the intensity of their contraction (can also be combined with electrotherapy). Some electrotherapy devices, such as the STIWELL med4, have a biofeedback function that displays contractility via electromyography. Even minute progress in therapy has been shown to motivate the patient.

In gynecological applications, electrotherapy can ideally complement traditional physical therapy. It should be used exclusively after childbirth. This therapy maintains pelvic floor stability and controlled coordination of the urethral sphincters and pelvic floor muscles. An electrotherapy device sends electrical impulses to stimulate nerve cells and strengthen the pelvic floor and bladder muscles that were tense during labor. A small electrode is inserted into the vagina to send electrical impulses to the pelvic floor muscles. An electrode may also be attached to the skin to stimulate the pelvic floor.

The electrotherapy device also allows the combination of biofeedback and electrical stimulation. This is called EMG-induced electrical stimulation. The patient must actively contract the pelvic floor muscles, and electrical stimulation provides an additional electrical impulse when a predetermined threshold is reached. The goal is to continually increase this threshold until the patient is able to fully contract the muscles without support.

Traditional methods of treatment and homeopathy have little evidence of effectiveness and are therefore used very rarely.

Surgery– most effective for people with stress urinary incontinence who have not responded to other treatments.

The most effective and initial stage of treatment may be physical exercise. Exercises for urinary incontinence after childbirth that have proven effectiveness are Kegel exercises. The main principle of such exercises is to train muscle control by performing the exercises every day. They have been proven to treat and prevent incontinence.

You can start exercising soon after your baby is born. Kegel exercises also help blood circulate around the vaginal (perineal) area and this will help any swelling or bruising to heal. If you stop exercising, your muscles may weaken over time and symptoms may recur.

How to do Kegel exercises to strengthen your pelvic floor?

Make sure you are relaxed and breathing freely, with your belly up as you inhale and your belly in as you exhale. Along with your inhalation, you should squeeze your abdominal and pelvic floor muscles. You should feel a tightening around your vagina and anus. Try not to tighten your buttocks or upper abdominal muscles, and make sure you don't hold your breath, but breathe evenly. Don't worry if you can't hold the squeeze for long. Gradually increase the time you squeeze your pelvic floor muscles. Try to hold the squeeze for four or five seconds.

When practicing the exercises regularly, you should hold the contraction for 10 seconds while breathing normally. Rest and wait at least 10 seconds before squeezing again. Women who do Kegel exercises regularly can see results in four to six weeks.

Prevention

There is still a way to prevent this problem. While there is nothing you can do to solve the problem itself, there are simple measures you can take when trying to avoid incontinence. Here are a few measures that can be taken to prevent stress incontinence after childbirth:

1. Doctor's assessment:

Let your doctor examine you closely after delivery and examine your condition to manage any chances of a urinary tract infection.

1. Kegel exercises are not only beneficial during pregnancy, but also help strengthen your pelvic muscles after childbirth and can prevent incontinence in each subsequent pregnancy.

Women should try to stay in shape and do Kegel exercises before giving birth to help prevent urinary incontinence. Kegel exercise is a basic exercise that can be done anytime, anywhere. What you are trying to do is isolate your pubococcygeus muscles and hold them in a squeezing position, count for 3-5 seconds, release and relax for 5 seconds. You should do this for 5 repetitions per day.

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