Women contemplating pregnancy are rarely warned by their OB-GYNs that having a baby can wreak havoc “down there,” but it does.
Incontinence can have a negative effect on a woman's physical, psychological and social well-being, but patients can see improvement without taking drugs, researchers reported Monday in the Annals of Internal Medicine.
After analyzing 84 studies that looked at various treatments, they found behavioral therapy — on its own or combined with other approaches — was more effective than medicine alone in treating urinary incontinence. That applied to both stress and urge incontinence (more on that later).
Behavioral therapy focuses on bladder training techniques, such as learning to gradually hold urine for longer periods, and muscle strengthening, the paper noted.
Drugs can address bladder and urethral sphincter function, but besides being less effective than behavioral therapy, they can have side effects such as dry mouth, nausea and fatigue.
No matter which option they choose, women definitely should always seek help: Most any intervention is more likely than no treatment at all to improve the condition, the researchers concluded.
Being aware of what to expect, and knowing what steps you can take to improve incontinence can help women deal with the issue.
What is incontinence?
It can come as quite a shock to learn that pregnancy and vaginal delivery can increase the risk of urinary incontinence. Rarely, women can also experience the even worse outcome of uterine prolapse, where the uterus gets out of place and droops into the vagina — sometimes so far that it can come out of the vaginal opening.
A recent survey of middle-aged women found that 43 percent between the ages of 50 and 64 suffered from urinary incontinence, and the numbers increased with age, with 51 percent of those 65 and older reporting a leaky bladder.
Most women, the survey found, suffer in silence, with just one third even bringing the subject up with their doctors, even though 41 percent of the women said that incontinence was a major problem or somewhat of a problem. One third said that they experienced leakage nearly every day.
While pregnancy and delivery aren’t the only risk factors — the biggest one is simply older age — they certainly play a prominent role for some women.
What causes incontinence in women?
It helps to understand the anatomy down there. All our pelvic organs, including the bladder and the uterus, rest on a hammock-like structure called the pelvic floor. Smallish openings in the pelvic floor allow for the urethra, the vagina and the anus to pass through, explained Dr. Carolyn Swenson, an assistant professor of obstetrics and gynecology at the University of Michigan in Ann Arbor and a sub-specialist in female pelvic medicine and reconstructive surgery.
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“The changes to the pelvic floor start during pregnancy,” Swenson explained. “That’s because a lot of things have to happen to those tissues to allow passage of the fetus through the pelvic floor.”
During delivery, “to allow the head to pass through, the muscles sometimes get stretched beyond their capacity,” Swenson said. “Some 80 percent of women will have a tear during their first vaginal delivery. That tear can be minor, not needing stitching, or it can go through all the muscles to the bowel.”
While vaginal delivery can be a big contributor to incontinence, “even if there was a 100 percent C-section rate we would still have these problems,” Swenson said. “Around 50 percent of women have some sort of leakage during pregnancy. A lot have some resolution after they have delivered, but some don’t and that are at increased risk for long-term urinary incontinence.”
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What is stress incontinence?
Stress incontinence comes on when you laugh, sneeze or jump, Swenson explained. That’s compared to urge incontinence — the kind of leakage that occurs when you can’t quite make it to the bathroom on time. Urge incontinence, which is also typified by frequent urination, is not related to pregnancy.
What is pelvic floor therapy?
The best way to deal with stress incontinence is through “pelvic floor therapy,” said Dr. Tanaka Dune, a urogynecologist and an assistant professor at NewYork-Presbyterian/Weill Cornell Medicine. “This is where a trained therapist goes in and works with the pelvic floor muscles,” Dune said. “It’s different from doing exercises on your own. Pelvic floor therapy has a high cure rate for most women.”
If pelvic floor therapy isn’t for you or you can’t work it into your schedule right away, another choice is a pessary, Dune said. “It’s inserted into the vagina and has a little nob that fits under the urethra. The nob exerts enough pressure under the urinary tract that it blocks the [accidental] flow of urine when you laugh or jump or run.”
Bottom line, if you're experiencing incontinence, there are things you can do to improve it. Talk to your OB/GYN about options and explore what feels right for you.
