Incontinence after childbirth and pregnancy
Women may suffer from urinary and fecal incontinence after pregnancy and childbirth. Incontinence has many different causes. A doctor or therapist may identify weak pelvic floor muscles as the cause of incontinence.
Incontinence is a common and often embarrassing problem but patients should not hesitate to talk about their incontinence with a gynecologist or proctologist to find suitable therapy methods.
How does pregnancy affect the pelvic floor?
The pelvic floor supports the pelvic organs and the sphincters. It consists of ligaments, muscles and connective tissue. A weak and/or overstrained pelvic floor can cause urinary or fecal incontinence.
Pressure – Incontinence during pregnancy:
During pregnancy hormones are released which increase the elasticity of the pelvic floor and relaxation of the pelvic ligaments. Decreased tone of the pelvic floor facilitates childbirth. At the same time, the pressure on the pelvic floor increases significantly by the weight of the uterus and the child thus seriously straining the soft pelvic floor. Bladder pressure also increases and urinary incontinence may occur already during pregnancy.
Overextension – Incontinence after childbirth:
During childbirth the pelvic floor may be overextended or injured. As a consequence, the loose pelvic floor cannot completely control the bladder sphincter causing involuntary loss of urine. Prophylactic prenatal exercises train extensibility and voluntary relaxation of the pelvic floor. Regular pelvic floor training after childbirth (e.g. postnatal exercises) strengthens the strained and overextended muscles.
The uterus dilates during pregnancy. A mild uterine prolapse is to be expected after childbirth. Excessive pressure on the pelvic floor, injury during childbirth or an existing connective tissue weakness can lead to a serious uterine prolapse towards the pelvis. This can cause urinary incontinence.
How is urinary incontinence after childbirth treated?
Urinary incontinence after pregnancy and childbirth is often stress incontinence. Stress incontinence is usually caused by weak pelvic floor muscles and urethral sphincters. The pressure in the abdomen increases with physical, mechanical stress or exertion (e.g. laughing, sneezing, coughing, jumping or heavy lifting). This pressure overstrains the closure of the urethra causing involuntary urine leakage. The severity ranges from a few drops to complete enuresis. Depending on the underlying cause and symptoms, stress incontinence is treated conservatively or surgically.
Conservative treatment / therapy of stress incontinence:
The muscles of the pelvic floor can be strengthened by exercising before and during pregnancy. Postnatal exercises are important to strengthen the pelvic floor muscles. In addition, everyday movements should be executed without straining the pelvic floor.
Physiotherapy for stress incontinence after childbirth includes the following options either individually or in combination:
Pelvic floor training
Therapeutically guided exercises are intended to strengthen the tissue and the supportive function of the pelvic floor. In addition, they increase blood flow in the flaccid muscles. Home therapy may commence as soon as patients learn to be consciously aware of their pelvic floor and are able to perform the exercises correctly.
Vaginal cones can also be used when exercising at home. Vaginal cones are weights inserted like tampons. They should be retained by contracting the vagina.
Electrotherapy in combination with biofeedback supports the control of these muscles and helps strengthen them.
Biofeedback can lead to conscious awareness of the pelvic floor 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 if the correct muscles are controlled and/or the intensity of their contraction (can also be combined with electrotherapy).
Some electrotherapy devices like the STIWELL med4 have a biofeedback function which displays the contractibility via electromyography. Even minute therapy progress is shown to motivate the patient.
Electrotherapy (incontinence after childbirth)
In gynecological applications, electrotherapy can ideally supplement conventional physiotherapy. It shall be used exclusively after childbirth. It supports stability of the pelvic floor and a controlled coordination of the urethral sphincters and pelvic floor muscles.
The electrotherapy device sends electrical pulses to stimulate the nerve cells and strengthen the muscles of pelvic floor and bladder which have been strained during childbirth. A small electrode is inserted into the vagina to send the electrical pulses to the pelvic floor muscles. The electrode may also be attached to the skin to stimulate the pelvic floor.
Electrotherapy in combination with biofeedback (EMG-triggered electrostimulation)
The electrotherapy device also allows combining biofeedback and electrostimulation. This is called EMG-triggered electrostimulation. The patient shall actively contract the pelvic floor muscles and electrostimulation provides another electrical pulse when a preset threshold has been reached. The goal is to continually increase this threshold until the patient can completely contract the muscles without supportive stimulation.
Application of electrotherapy is very easy and ideal for home use. Patients can use some electrotherapy devices at home according to the expert’s instructions (STIWELL med4).
In severe cases medication may be administered to stimulate closure of the bladder sphincter. This may have undesired side-effects and requires consultation with a doctor.
A doctor may prescribe surgery when conservative procedures failed to improve the patient’s condition.
If incontinence after childbirth and pregnancy persists over a longer period of time, it is recommended to seek medical advice. A gynecologic or proctologic examination can diagnose the causes and type of incontinence to enable targeted treatment and therapy of urinary or fecal incontinence.
This article contains only general information and must not be used for self-diagnosis or self-treatment. This information does not replace medical advice.