Incontinence

At times during pregnancy, many women find that they wet themselves slightly when they cough, laugh, exercise, bend over, or lift something. This condition is known as stress incontinence – very embarrassing, but extremely common.

Your pelvic floor muscles are under considerate strain during pregnancy. They have to support the weight of your growing uterus, and cope with the changes caused by pregnancy hormones. A sharp increase in abdominal pressure – as happens when you cough or jump – may be momentarily too much for the muscles to hold back the flow of urine, with the result that a few drops may escape.

Stress incontinence may happen at anytime in pregnancy, but is more common towards the end. It is often worse for a few days following the birth, when the muscles of the pelvic floor and other structures are recovering. That said, women who give birth by caesarean section may also suffer from stress incontinence. Things should start to improve within 7-10 days.

What can I do about it?

• The best remedy is regular and effective pelvic floor exercises, to keep the muscles toned. Although you may not make a full recovery during pregnancy, regular exercises now will minimise the problem and help you towards a full recovery after your baby is born.
• Don’t let your bladder get overfull. If you need to go – go! At the same time, don't restrict your fluid intake. This may be harmful in other ways.
• If stress incontinence does not get better after your baby's birth – in spite of six weeks of rigorous pelvic floor exercises, talk to your health visitor, practice nurse or doctor. They may be able to refer you to a specialist physiotherapist. You should not have to suffer long-term without help.
• Stress incontinence may be an early sign of urine infection. If it suddenly happens to you for no obvious reason, have a word with your doctor or midwife – especially if you feel unwell or have other symptoms.

Is it urine or amniotic fluid?

In the last few weeks of pregnancy it can be hard telling the difference between stress incontinence and leakage of amniotic fluid (your ‘waters’).

If your waters break, amniotic fluid will leak from your vagina. There may be a gush – or just a trickle. Amniotic fluid is more likely to leak out when you stand up after sitting or lying for a while – even if you move slowly and carefully. Amniotic fluid is usually clear, although it may contain specks of mucus or blood. It does not usually smell.

Urine, on the other hand, tends to escape when you cough, laugh or move suddenly, even when lying down. It is clear or straw coloured, generally with a distinctive smell.

If you think you are leaking amniotic fluid, put a sanitary towel inside your pants. (Do NOT use tampons – doing so may introduce infection). Contact your midwife, doctor or labour ward. A gentle internal examination will help decide what is happening.

Revised by babyworld midwife, Hannah Hulme Hunter November 2000.