Complete Overview of Urine Leakage During Pregnancy

The embarrassing problem of urine leakage during pregnancy is common. However, for most women the problem usually goes away as the body recovers after giving birth.

Pregnancy Causes Incontinence

Even if you have never had problems with urinary leakage (incontinence) prior to getting pregnant, you might find yourself leaking urine. This is more likely as you progress to the third trimester of pregnancy. All the types of urinary incontinence can occur in pregnancy.

Stress Urinary Incontinence

A 2013 review in the International Urogynecology Journal (IUJ) states stress urinary incontinence (SUI) is the most common type of urine leakage in pregnant women. The problem occurs more often from the late second trimester on. In the third trimester, you are more likely to have SUI than other types of urinary incontinence.

Pregnancy, labor, and delivery are the main causes of stress urinary incontinence in women. Important things to understand about how pregnancy might cause SUI include the following:

• One of the mechanisms that keeps urine from leaking is the normal position of the bladder and the sphincter at the bladder neck junction between the bladder and the urethra.
• SUI occurs when the muscles at the bottom of the pelvis that support the bladder, urethra, and bladder neck stretch, weaken, and relax towards gravity, or the sphincter is damaged in some way.
• The changes in pregnancy that affect the pelvic floor muscles and the position of the bladder and sphincter include:
  • Growth of the fetus and uterus: As your baby and uterus grow, this puts increasing pressure on your bladder and the pelvic floor muscles and lowers the position of your bladder and sphincter.
  • Hormone effects: Your high progesterone level in pregnancy softens the type of muscle that is in the bladder. This might make it easier for the bladder neck to sag and the bladder sphincter to open easily. In addition, a lower relaxin hormone level in the second trimester interferes with its normal support of the function of the sphincter.
• Urine leaks when your urethral sphincter opens easily with the stress of laughing, coughing, sneezing, heavy lifting, exercising, or other movements.

Older and obese women are more at risk for SUI during pregnancy due to the effect of these factors on weakening the pelvic floor muscles.

Urge Incontinence

According to the IUJ reference cited above, the weight of the growing uterus puts pressure on and reduces its capacity as well as irritates the bladder. This increases the urge to urinate and can lead to urge urinary incontinence.

The problem also occurs if your bladder muscle wall is overactive and constantly triggers the urge to void (overactive or irritable bladder). Urge incontinence can also happen in the following situations:

• Fetal movement, such as strong kicks, might also cause an involuntary bladder contraction and urine leakage.
• Sex during pregnancy might also increase the urge to urinate and cause urine to leak.
• Additional pressure on the bladder after the baby's head engages in the pelvis during the third trimester can also cause overactivity of the bladder. This can lead to a more frequent urge to urinate after this point and trigger urge incontinence.

Overflow Incontinence

According to American Family Physician, overflow incontinence occurs when the bladder is over distended. Before you sense your bladder is full, you might start to leak urine. During pregnancy, a potential cause is softening of the bladder muscle by the higher level of the hormone progesterone in pregnancy.

Relaxation of the muscle might allow your the bladder wall to stretch and fill more before triggering the urge to urinate (atonic bladder). Overflow incontinence can start as early as the first trimester and might also occur during pregnancy because of the following:

• When your bladder doesn't empty each time you urinate, persistent or intermittent dribbling of urine can occur. Medications, nerve injuries, and diseases such as multiple sclerosis can cause this problem,
• Gestational diabetes can also contribute to the problem of an atonic bladder. Symptoms of diabetes include thirst and frequent urination.
• The increase in urine output because of the normal changes in blood volume and fluid shifts from the first trimester can also be a factor in bladder overflow.

Mixed Urinary Incontinence

Some women can have mixed urinary incontinence - a mixture of all the factors that cause each type of urine leakage during pregnancy. Symptoms or activities that tend to trigger each type might help to identify which one predominates.

Incontinence Due to Urinary Tract Infection

Sometimes urine leaks because of a urinary tract infection (UTI), which is more common in pregnancy. A UTI can irritate the bladder and urethra and cause the bladder muscle to contract or the sphincter to relax and open without warning.

A UTI increases the risk of miscarriages or preterm labor. Call your doctor immediately if you are leaking urine and have symptoms of a UTI including:

• 
  Burning or tingling on urination (dysuria)
• Constant urge to urinate (urinary urgency)
• Frequent urination of small amounts of urine (urinary frequency)
• Leaking immediately after you thought you emptied your bladder
• Strong smelling urine
• Dark colored urine or blood in the urine

Effect of Multiple Pregnancies

Women who have had multiple pregnancies and delivery might find they begin leaking urine sooner in the next pregnancy:

• Each pregnancy relaxes and weakens the pelvic floor muscles, which might also be damaged during labor and delivery.
• Some of the changes in the muscles might not return to normal between pregnancies. Difficult vaginal births, large babies, or forceps delivery can contribute to this problem and cause urinary incontinence even while not pregnant.
• The chance of urinary incontinence in pregnancy increases after the first pregnancy. In a large Norwegian study of women pregnant up to 30 weeks, 46 percent of women in their first pregnancy complained of leaking urine compared to 67 percent of women who had other children.

Urine Versus Water Leaking

In the second and third trimesters you might wonder if the fluid you are leaking is urine or if it means your water is breaking. If the pattern of your leaking or amount of fluid is different from what you previously had with your urinary incontinence, the fluid could be your waters (amniotic fluid).

You might also be able to tell the difference between urine and amniotic fluid from the odor or the color:

• Odor: Does the fluid smell like your usual urine or have the smell of ammonia? If it has no odor or a sweetish smell, it is more likely to be your waters.
• Color: Urine is yellowish while amniotic fluid is usually colorless or very pale.

If you are not certain, consult with your doctor, especially if you have abdominal or back pain that feels like contractions.

Coping With Urine Leakage During Pregnancy

Although you may not get relief from urinary incontinence until after the baby is born, there are a few things you can do to help the problem during pregnancy.

Kegel Exercises

Kegel exercises help strengthen the pelvic floor muscles. Do at least three sets of ten repetitions throughout the day. Kegel exercises are safe to do during pregnancy according to a 2010 review in Maturitas and are especially helpful with SUI. However, ask your doctor if the exercises are safe for your pregnancy and for his/her instructions.

Scheduled Bathroom Visits

Schedule regular bathroom visits to decrease your chance of overflow incontinence. In addition:

• Empty your bladder before exercising or any prolonged activity.
• Don't wait until your bladder feels like it's overfull before heading to the bathroom to avoid leaking before you get there.
• Make sure you are emptying your bladder completely each time you go to the bathroom. If you have difficulty doing so, try gentle pressure on your bladder with your hand.

Absorbent Pads

Wear a panty liner or incontinence pad such as Depend to protect your underwear and clothes. This will avoid embarrassing moments in case of an accidental leak while you are in public.

Stay Hydrated

Don't cut back on fluids to try to avoid urinary incontinence. Remember it is important to stay hydrated throughout your pregnancy. Drink at least six to eight glasses of water a day to avoid dehydration, pregnancy headaches, preterm labor and other problems. Cut down on caffeine as it can cause you to have to urinate more often.

Post-Partum Incontinence

Most women will get relief from pregnancy-induced urine leakage within six weeks to three months after giving birth. However, some women will continue to have urinary incontinence a year or more after delivery. Often this is due to traumatic injuries to the pelvic floor muscles, bladder, urethra, vagina, or nerve fibers during childbirth.

A study reported in 2006 in BJU International found 10.5 percent of women had problems with urine leakage a year after giving birth. In some women urinary incontinence can persist many years after delivery.

Doctor's Evaluation and Management

After childbirth, continuing regular Kegel exercises to strengthen the pelvic floor and urethral muscles might be helpful for some women. However, if the urinary leakage persists, see your doctor for further evaluation and management.

Depending on the cause of the urinary incontinence, according to the National Kidney Foundation, options for post-partum treatment include:

• Medications including vaginal estrogen
• Therapy for pelvic floor muscles and bladder training, including:
  • Electrical stimulation helps strengthen the muscles
  • Biofeedback helps women to be aware of and control the activity of their bladder and urethra
  • Timed voiding also helps women gain control and empty their bladders before they leak
• Behavioral therapy combined with biofeedback
• A pessary to support the bladder and urethra in a more normal position
• Surgery to repair any damage to tissues or restore the bladder and urethra to their normal position

A doctor will help you decide which treatment is right for you.

Your Well-Being in Pregnancy

Urine leakage and other urinary problems are common complaints during pregnancy and can disturb your lifestyle and your well-being but you dont have to suffer. Follow the coping advice above and talk with your doctor or midwife so you can manage your incontinence as best as possible.