Continence Care for Women during Pregnancy
Treatment Options for Urinary Incontinence during Pregnancy
1. Healthy Bladder Habits
There are many things you can do on your own to improve your bladder health and decrease incontinence. Monitor your fluid intake, voiding frequency and volume with a diary. You may see trends that symptoms follow
- Keep yourself hydrated
Drink at least 4-6 cups (1000-1500ml) of fluid a day unless advised otherwise by your doctor. Don’t limit fluids in the hope of improving your incontinence. If you drink too little the urine becomes very concentrated. This will irritate your bladder and make it want to empty more often even if there is only a little in it. The best fluid to drink is plain water.
- Keep yourself hydrated
Don’t drink all of your fluids at once. Space your fluids out during the day. If you drink a lot at once, you can expect the need to go to the toilet urgently not too long afterward.
- Reduce intake of irritating fluids
Carbonated beverages may make your irritable bladder symptoms worse. Artificial sweeteners, citrus fruits and acidic foods, such as tomatoes may also cause trouble.
Try to reduce caffeinated drinks to 1 or 2 cups a day. Some people can be more sensitive to caffeine and it may be best to stop drinking all caffeinated beverages.
Be aware that decaffeinated beverages still contain some caffeine. It is best to stick to caffeine-free drinks.
- Void regularly throughout the day
Ignoring your body’s cues to void can lead to an overly full bladder, feelings of urgency, and leakage.
- Reduce your fluid intake in the evening and void well prior to bed
Drinking less in the evening reduces the need to get up at night to void.
- Empty your bladder completely with each void
You may need to shift positions, stand up and sit down again, lean forward or gently push on your lower abdomen.
- Stop smoking
Quitting smoking is vital to a healthy pregnancy and smoking also irritates the bladder causing feelings of urgency. It can also be the cause of a chronic cough that can put pressure on the pelvic floor muscles. Stop smoking
- Manage a chronic cough
If you are a smoker or have asthma, COPD or bronchitis, these conditions can cause you to cough more weakening the pelvic floor muscles. Talk to your family doctor about controlling your asthma, COPD or bronchitis.
- Keep your bowels regular
Straining during bowel movements weakens the muscles used to control urine leakage. Keep stools soft and avoid constipation. Try to increase your fiber or take gentle stimulants and stool bulking agents such as natural fiber, milk of magnesia, Metamucil or mineral oil are recommended.
- Seek treatment for urinary infections
Watch for symptoms of urinary tract infections such as urgency, frequency, blood in the urine, or burning with voiding. Report to your doctor if you have these symptoms.
2. Pelvic Floor Muscle Exercises (Kegels)
Like any muscle your pelvic floor muscles need to be exercised so they remain strong. These muscles can become weakened after childbirth, after menopause and as a result of chronic coughing or heavy lifting.
By doing pelvic floor muscle exercises you can build up and strengthen the muscles of your pelvic floor to help you hold your urine and improve your bladder and bowel control.
These exercises are also known as Kegel exercises. When done properly and regularly they can make a big difference to your bladder control.
Kegel exercises can be done standing, sitting or lying down
Step 1: Learning to Feel the Muscles
- To locate the muscles, it is best to sit down on a firm chair. Try to squeeze the muscles which prevent you from passing rectal gas.
- Try not to tighten your abdominal or buttock muscles.
- Do not hold your breath
- Inhale as you relax your muscles and exhale as you squeeze them.
- Lie down and place one or two clean fingers into your vagina and try to squeeze your muscles around it.
Step 2: Learning to Isolate the Muscles
- Be careful not to tighten your stomach, legs, or other muscles at the same time as you contract your pelvic floor muscles. In particular, try to relax your stomach while you squeeze the pelvic muscles. Do not hold your breath.
Step 3: Practicing Pelvic Exercises
- Slowly tighten your pelvic muscles over a count of 1-2-3.
- Slowly relax your pelvic muscles over a count of 1-2-3.
- It is easier to start doing these exercises while sitting in a firm chair so you can make sure that you are not tightening other muscles like your buttocks and abdominal muscles.
- Once comfortable with the pelvic muscle exercises while sitting you can try them lying and standing as well.
- Start by doing this at least 3 to 4 times a week. As you get better at it, try to increase your exercises to one set (10 times) 5 times a day.
When Will I Notice Improvement?
Many women notice an improvement after 3-6 weeks of doing the exercises daily. It may even take up to 6 months, especially if you have gone through menopause.
After you train yourself to tighten the pelvic muscles, you will have fewer accidents.
These exercises need to be continued in order to have lasting effect, just like any other form of exercise.
What if I can’t contract my pelvic floor muscles?
If you are having a hard time doing these exercises or find you are not making progress, ask your health care provider whether a pelvic floor physiotherapist or biofeedback might be helpful for you.
3. Timed Toileting and Double Voiding
What is timed voiding?
Timed voiding refers to going to the bathroom to void based upon the clock, not how you feel. Often, by the time a woman feels the need to void, it’s too late. The purpose of timed toileting is to prevent the bladder from overfilling so that you don’t need to rush to get to the toilet in time and you have less leakage.
- When you wake up in the morning, the first thing you should do is empty your bladder.
- Watch the clock. You should try to void every 2 hours. If you drink a lot of fluids or have caffeinated drinks you may need to void every 1-2 hours.
- Try to not go more than 3 hours without visiting the toilet. If you wait too long you will be more prone to accidents.
- You should go to the washroom just before you go to sleep.
What is double voiding?
Double voiding refers to spending extra time on the toilet to try to empty your bladder completely. Many women rush to get off the toilet and leave urine inside the bladder. Over months and years of doing this, it may become harder for the bladder to fully empty. When urine is left inside the bladder it increases your risk of bladder infections, increases how often you need to void and you can have more leakage.
- When you go to the washroom, don’t rush!
- Relax when you void. Do not try to stop the stream of urine. This will help the bladder empty fully.
- When you think you’re done, use the following methods to try and void a second time.
- Sit for another 15-45 seconds
- Lean forward and sit up straight again
- Move side to side
- Stand up, move around and sit down again
- Some women have a prolapse of their bladder. If you feel a bulge in the vagina, you can use your fingers to push the bulge back up in to the vagina. Urine stuck in that pocket can then empty. You cannot hurt yourself doing this.
- At the end you should give a little push to make sure the last drops of urine get out. Do this by pushing your belly out and holding for a few seconds.
4. Bladder Training and Urge Control
Bladder training helps you increase the amount of time between visits to the toilet, increase the amount your bladder can hold, and control the feelings of urgency when the bladder contracts unnecessarily.
The best place to start is to limit substances that can irritate the bladder as outlined in the Healthy Bladder Habits section.
Part of this training is learning to understand the messages your bladder is sending you. You need to learn which messages to listen to and which ones to ignore. A bladder training program should help you recognize when your bladder is full and when it is not.
It may have taken weeks, months or even years to establish these bad habits so it will take time to fix the problem. Be encouraged, most people notice some improvement within 2 weeks although it may take 3 months or more to regain bladder control.
You should go to the bathroom every 2-3 hours during the day. If you are going more frequently, you need to try and increase the time between visits to the toilet. For example if you are going every hour set your target at an hour and 15 minutes. If you get the feeling of urgency before that time is up try techniques from the section below to control this feeling and make your bladder wait.
Urge control techniques
Tighten your pelvic floor muscles as hard as you can and hold on for as long as you can. Keep doing this until the feeling of urgency goes away or is under control. Contracting the pelvic floor muscles helps to squeeze the urethra (the tube from the bladder) shut and prevent leakage.
Tighten your pelvic floor muscles quickly and as hard as you can, then let go. Repeat this several times in a row. Some women find that several contractions in a row work better than trying to hold onto one contraction for a long time.
Put firm pressure on the pelvic floor. You can do this by crossing your legs or sitting down on a firm surface. This also sends a message to the bladder via the nerves that the outlet from the bladder is closed so it should wait before it tries to empty.
Place a rolled up towel between your legs to support the pelvic floor before standing to help with urine loss.
Change your position if this decreases the feeling of urgency. Some people find that leaning forward a little helps.
Stay still when you get an urgent bladder contraction and control the urge.
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