Dear Doctor, I lost bladder control when I was pregnant with my first child, and even the slightest sneeze would make me leak. However, it’s been seven months since I had the baby and somehow, this hasn’t changed. I have to rush to the bathroom and sometimes I leak almost instantly. I didn’t have any complications when having the baby - was a natural birth. But I’m now worried. Will it eventually go back to normal? Nana ----- Dear Nana, Frequency of urination and incontinence are fairly common during pregnancy and after child birth, and it affects more than 50 per cent of women around the world. There are multiple reasons for it. As pregnancy grows, the bulky uterus presses on the bladder. This causes frequency of urination. The bladder sphincter (valve regulating the flow of urine) is also affected due to the pressure, thus causing some leaking of urine. Due to contraction of the bladder muscle, one suffers from urgency of urination as well as contributing to the incontinence. As such, women are vulnerable to infections of the bladder due to several reasons. Short length of the urethra (tube connecting the bladder to the exterior), dampness of private parts during menstruation, sexually acquired infections spreading to the bladder, are the factors that increase risks of acquiring cystitis (infection of the bladder). During pregnancy, the risk is enhanced further. The frequency and urgency of urination due to cystitis can cause incontinence as well. Some women develop diabetes during pregnancy. High blood glucose levels due to uncontrolled diabetes result in increased thirst and increased frequency of urination. Severe symptoms can lead to slight incontinence as well. During delivery, there is stress on the pelvic floor muscles, which can cause stretching of pelvic muscles and also affect the bladder. Supporting structures of the uterus may become weak after one or multiple pregnancies and deliveries. This causes prolapse of the uterus during exertion, which can press on the urinary bladder, resulting in incontinence. Prolonged labour can traumatise the pelvic muscles and also damage the bladder sphincter. This manifests as urinary incontinence after delivery. During the first delivery, often, the pelvic floor is cut (episiotomy) to facilitate the passage of the baby. Inadvertently, the cut can involve bladder fibres as well. This can cause leaking of urine even after delivery. Poor pelvic hygiene can lead to infection of the pelvic parts after delivery. Due to close proximity with the bladder, infection can easily spread to the bladder, resulting in some leakage of urine. Urinary infection can be easily detected by a urine analysis and is curable with antibiotics. Regular pelvic exercises can strengthen the pelvic muscles and any trauma incurred will gradually heal with time. Severe pelvic tear or damaged bladder sphincter can be repaired surgically. Incontinence can be controlled with bladder training. One should go to pass urine at fixed intervals of three to four hours, whether there is an urge to urinate or not. Thus, the bladder will be trained to empty at fixed intervals, consequently avoiding leaking. Dr. Rachna Pande is a specialist in internal medicine.
