Dear Doctor,

I am entering my third trimester and this is my first child. I am having serious issues with bladder control and even sneezing makes me leak even if I just used the bathroom. I am now not eager to go anywhere because of this problem. What can I do to avoid this?

Kate

Dear Kate,

Problems with bladder control and "leaking” is fairly common during pregnancy. About 40 per cent of women, world over, experience this. It may start at the beginning of pregnancy or in the middle as well. But in the majority of cases it is fairly common during the last trimester. About four per cent of women also have associated anal incontinence. Urine involuntarily leaks out during coughing, sneezing or even laughing.

There are multiple reasons for the urinary incontinence during pregnancy. One is the fluctuating hormone levels. Changing levels of progesterone and relaxin (that controls the bladder), leads to incontinence.

The bulk of the growing gravid uterus puts pressure on the pelvis, including the urinary bladder. This irritation of the bladder muscle leads to frequency of urination and difficulty to hold a full bladder. The sphincter of the bladder (valve that regulates passing of urine), may also become slack due to pressure of the gravid uterus, thus unable to hold back urine when bladder is full.

As such, women are more vulnerable to urinary tract infections, due to several causes. Any pre-existing infection can be aggravated during pregnancy. This manifests as frequency and urgency of urination and some incontinence can invariably occur. Sexually acquired pelvic infections can infect the bladder as well, leading to incontinence.

The risk of incontinence increases with obesity and advancing age as well.  Women with previous vaginal delivery or previous complicated labour are more susceptible to develop urinary incontinence.

Some women reduce drinking fluids to avoid this embarrassing "wetting” during pregnancy. But this leads to dehydration and increased risk of urinary tract infection, which in turn leads to more incontinence.

Exercises of the pelvic muscles can strengthen the bladder muscles, thus reducing the risk of incontinence. But this would be useful if done from the beginning of pregnancy. One should avoid constipation, cough, and lifting heavy weights, and etcetera, factors that can induce and aggravate incontinence. Drinking one to two litres of water helps to prevent urinary tract infection and also helps in cleansing of bowels.

Irrespective of the urge to urinate, one should visit the toilet at fixed hourly or two hourly intervals and try to pass urine. This would train the bladder to empty at fixed intervals, thus avoiding incontinence.

If in spite of these precautions, some incontinence does occur, there is nothing to worry about. Just carry a pair of extra underwear while going to a party or outdoors for a long time. The problem will resolve after child birth.

However, if incontinence occurs more than just a, "leak” and there is associated abdominal pain, fever, or other out-of-the-ordinary symptoms, seek medical consultation.

 Dr. Rachna   Pande is a specialist in internal medicine.