Post-partum urinary incontinence is less common in women who have a caesarean delivery but it is still a persistent problem for one in seven women a recent study has shown.
A prospective study of more than 1500 nulliparous women found that persistent urinary incontinence was experienced by 25% of all women up to 18 months after giving birth.
Rates of urinary incontinence among women who had a caesarean were about 40% those of women who had a spontaneous vaginal birth, but persistent incontinence was still seen in 16% of women after a caesarean, according to the findings published in the British Journal of Obstetrics and Gynaecology this month.
Women who have given birth should not view urinary incontinence as an avoidable part of motherhood, it has been claimed.
Noreen Dockery, a chartered physiotherapist who specialises in rehabilitating the pelvic floor, told the Irish Independent that female incontinence is a “very common” problem.
She revealed that a greater number of women are choosing to seek help for incontinence nowadays, but that she still sees patients who wait until their children are teenagers before getting advice.
According to Ms Dockery, it is “far preferential” to deal with post-pregnancy incontinence a few months after a woman has given birth.
“It is hard for women, though, especially with a new baby; but, if it’s left too late, symptoms can deteriorate, especially in menopause when the muscle tone gets more relaxed and hormones are involved,” she explained.
Ms Dockery revealed that one of the goals of physiotherapy for this condition is to lengthen or relax the woman’s pelvic floor muscles so that they are no longer in spasm.
“The pelvic floor muscles are very much connected to the abdominal muscles, and releasing tension here can have a major effect on the tension found in the pelvic floor,” she told the news provider.
“Most patients feel their pelvic floor is weak but in actual fact the resting tension or already elevated tone prevents the muscle from lifting any higher.”
The physiotherapist also emphasised the fact that women with female incontinence should not feel isolated, as many other women suffer from the same issues after having children.
Studies suggest that about 13 per cent of women in the UK are affected by urinary incontinence to some extent, along with five per cent of men.
There are a number of other risk factors for incontinence alongside childbirth, including age, depression and a high intake of caffeine.
Urinary incontinence is a common condition, with research suggesting that around 13 per cent of UK women are affected to some extent. One of the most important known risk factors for female incontinence is childbirth, with a significant proportion of women relying on incontinence supplies during pregnancy, immediately after giving birth and, in some cases, for months or even years to come. Here, we take a closer look at the problem, possible reasons for the links between pregnancy, childbirth and incontinence, and ways in which women can manage their condition. 90
Incontinence during pregnancy
The extra weight that is placed on the bladder during pregnancy typically causes women to urinate more often than usual. However, some also experience urinary incontinence and depend on products such as Tena Pants Super. The reasons for this are not yet fully understood; it may be that the weight of pregnancy causes incontinence, or that hormonal fluctuations contribute to the problem. In most cases, the incontinence resolves itself soon after giving birth, although some women continue to experience problems.
Risk factors for persistent incontinence
A number of factors relating to pregnancy and childbirth can increase the risk of ongoing female incontinence. Pregnancy itself is a known risk factor for urinary incontinence, with research indicating that women who develop stress incontinence during pregnancy or in the first six weeks after their baby’s birth are more likely to still be experiencing problems five years later.
There is evidence to suggest that a vaginal birth – as opposed to having a caesarean section – may be associated with an increased risk of stress incontinence, although studies have produced conflicting results. For instance, a recent investigation published in the obstetrics journal BJOG by British scientists found that women who delivered exclusively by caesarean section were only slightly less likely to have urinary incontinence than those who only had vaginal births. In fact, 40 per cent of caesarean-only patients who took part in the ProLong Study still reported urinary incontinence.
Other pregnancy-related factors that may increase the risk of incontinence include giving birth to a high number of children and having babies with a higher-than-average birth weight.
Treatment and management
Women are usually advised to do pelvic floor exercises to strengthen the muscles that control urination and reduce the risk of stress incontinence. In order to exercise the muscles, women should pretend they are trying to stop the flow of urine, holding this squeeze for about ten seconds. This should be repeated for three or four sets of ten contractions each day in order to strengthen the pelvic floor musculature. Results will not be seen immediately, but women should start to notice the benefits within a few weeks.
Women who are still experiencing bladder problems several weeks after giving birth should speak to their doctor, as they may require treatment. This may include medication, such as the anti-depressant duloxetine, which is thought to interfere with chemicals involved in the transmission of nerve impulses to the muscles around the urethra so that they contract more strongly.
In certain cases, doctors may recommend surgery to tighten or support the muscles around the urethra. Surgery usually has a high rate of success, but it usually not considered until other treatment options, including pelvic floor exercises, lifestyle changes and medication, have failed to provide relief.
Women with pregnancy-related incontinence have a range of products to choose from to help manage their condition on a day-to-day basis. Products include disposable incontinence pads, such as Cottons Comforts Pantyliners and Cottons Comforts Light, and washable products such as Ladies Cotton Briefs with extra absorbent built-in pads. Selecting the right incontinence supplies can greatly improve women’s quality of life and enable them to get out and about without fear of embarrassment.