Ask an Expert: Pregnancy and Incontinence

Answer from Nancy H. Sullivan, CNM, MS: 

Congratulations on your pregnancy. You are dealing with stress incontinence, a condition many pregnant moms experience. It affects an estimated two to nearly seven women out of 10 during pregnancy, according to The American College of Obstetricians and Gynecologists.

Urinary incontinence, as you may know, is the medical term for leaking urine. It may be common, but no one has to suffer through it. You can definitely take steps now to minimize the problem: exercises to strengthen the pelvic floor muscles.

Understanding the pelvic floor
The pelvic floor muscles support the organs of the pelvis – including the bladder and the uterus. These muscles also surround the openings of the vagina, anus and urethra. (The urethra is the pipe that carries urine from your bladder out of your body.) Pregnancy, weight gain and a vaginal delivery are a triple whammy on over-stretching and weakening the pelvic floor muscles.

In stress incontinence, you may notice a small leak when you laugh, cough, sneeze, exercise, get up from a low chair or awkwardly lift a heavy object (which you should avoid when you're pregnant, anyway). These actions suddenly increase abdominal pressure or stress on the bladder. When the muscles that control the junction of the bladder and urethra do not work properly, urine can suddenly leak out.

The good news: If you are conscientious with pelvic floor exercises now, and continuing after your baby is born you likely will minimize or completely avoid the problem.

One, two, three, squeeze!
Pelvic floor exercises are also called Kegels. To do Kegels correctly, you must figure out the proper set of muscles to tighten. The pelvic floor muscles are the ones that allow you to "hold it" when you have the urge to pass gas or urinate at an inappropriate time. They include the vaginal muscles that respond during orgasm.

To begin, lie on the floor and squeeze or pull in the pelvic muscles. Keep them tight for a count of three. Release; rest for a few seconds. Repeat. (Remember to keep breathing!)

The goal, over time, is to work your way to 10-15 repetitions per set. Vary the routine a bit. Do Kegels while sitting down or standing, not just lying down. I like the APTA recommendations to sometimes tighten the muscles for five to 10 seconds, and other times to quickly contract and release. This makes the exercise much more effective. Challenge yourself by coughing or clearing your throat while performing Kegels.

Some Kegels here, some Kegels there
As you master Kegels, you can practice them any time: in line at the store, waiting for an appointment, riding the bus, on-hold on the phone. No one will be the wiser.

We advise doing a set of 10-15 Kegels at least three times a day. As the muscles build strength, your bladder control will improve. The length of time depends on the woman; it can be anywhere from three weeks to 12 weeks.

Studies show that about one of every three women has a hard time isolating the pelvic floor muscles on her own. If that's the case for you, please ask for a referral to a physical therapist specializing in women's issues. Physical therapists use a biofeedback device or electrical stimulation to help patients isolate and work the right muscles. They are very experienced in this matter. Once you succeed, don't slack off. Continue a daily set or two of Kegels throughout adulthood or whatever it takes to keep the problem under control.

Not better?
If Kegels don't solve the episodes of leaking, absolutely let your health care provider know so you can explore other causes and solutions. Also, be aware that your childbirth experience can affect your risks of incontinence after delivery or in later life. Vaginal delivery; a large baby; a long, difficult labor; a surgical episiotomy (a cut in the muscle to aid delivery); or a birth that involves a torn rectum or forceps may put women at higher risk for stress incontinence. Discuss this with your obstetrician or midwife.

And keep exercising!