Introduction:
Reduced bladder control can cause urinary incontinence, which can be distressing physically and mentally. It can be burdensome to the individual and society. Many women may first experience this issue during pregnancy. Physiological changes during pregnancy may make women more prone to urinary incontinence. As a result, more than 50 percent of women suffer from urinary incontinence during pregnancy which peaks in the last few months. Urinary incontinence during pregnancy is a strong predictor of urinary incontinence postpartum and later in life, even for those women who recovered immediately after birth.
Why Is Bladder Control Affected During Pregnancy?
Many women experience changes during pregnancy regarding bladder function. The problems with bladder control can range from urination to leakage. Bladder control during pregnancy can be impacted by several factors, such as hormonal changes, increased pressure on the bladder, and changes in the nerves that control urinary function.
1. Effect of Hormonal Changes During Pregnancy on Bladder Control
Hormones play an essential role in regulating the physiological processes in the body, including bladder function during pregnancy. Significant changes in the hormone level can affect the muscles and nerves controlling the bladder, resulting in changes in urinary functions. One of the most significant hormonal changes during pregnancy is the level of progesterone hormone. Progesterone is responsible for the relaxation of all body muscles, including bladder and urinary tract muscles. During pregnancy, increased progesterone levels facilitate the relaxation of the bladder to accommodate the growing fetus. However, it can also lead to an increased frequency of urination because the bladder may not be able to hold as much urine as the pre-pregnancy level. In addition, hormonal changes during pregnancy may also affect the pelvic floor's strength and tone of muscles. These pelvic floor muscles support the bladder, uterus, and other pelvic organs. They also help in controlling urinary functions. The hormonal level fluctuation during pregnancy can weaken the pelvic floor muscles, contributing to urine incontinence.
2. Increase Pressure on the Bladder During Pregnancy - As the pregnancy advances, the uterus also expands to accommodate the growing fetus, increasing pressure on the bladder. This pressure is especially significant during the latter stages of pregnancy when the uterus is at its largest size. This pressure can compress the bladder and reduce its capacity to hold urine resulting in the need for frequent urination and sometimes may cause urinary leakage.
3. Changes in the Nerves Controlling the Bladder During Pregnancy - The nerves of the bladder muscle may get compressed due to the weight of the growing uterus, which may also contribute to reduced bladder control during pregnancy.
What Issues Can Pregnant Women Face Due to Reduced Bladder Control?
Reduced bladder control is not a life-threatening condition. However, it can have many more detrimental effects on health-related quality of life, such as physical, psychological, and social well-being, than other diseases. These include:
-
Pregnant women with urinary incontinence may hurry to the bathroom, increasing the risk of falls and fractures.
-
Many women may face issues during mobility (the ability to exercise, travel, or move) due to urinary incontinence. Because of this, many women tend not to go out due to fear of urinary leakage.
-
Besides, urinary incontinence is also associated with sleep disturbances and urinary tract infections.
-
In addition, urine incontinence also hampers psychological and social functions as distress, including shame and embarrassment due to urinary incontinence, may force women to choose a solitary life. In rare cases, it can, in turn, cause even depression.
What Are the Risk Factors for Developing Urinary Incontinence During Pregnancy?
-
Urinary incontinence before pregnancy is the strongest predictor for reduced bladder control during pregnancy.
-
Women with a history of vaginal delivery are more likely to suffer from urinary incontinence during pregnancy, whereas a history of cesarean section exhibits neither protective nor aggravating effects.
-
Coffee consumption is also associated with an increased risk for urinary incontinence.
-
Childhood enuresis (loss of bladder control) is also associated with urinary incontinence during pregnancy. It may be attributed to the incapacity to achieve proper urination control during toilet training.
-
Pregnant women with a prior urinary tract infection are more likely to report urinary leakage.
What Is the Treatment for Urinary Incontinence During Pregnancy?
During pregnancy, conservative therapy or perineal rehabilitation by pelvic floor muscle exercise (PFME) is the first-line intervention to manage urinary incontinence.
The doctor often advises pregnant women to perform PFME to prevent the development and manage symptoms of urinary incontinence during pregnancy. Other medical or surgical treatments are not advisable during pregnancy or the immediate postpartum period.
Pelvic Floor Muscle Exercise - It is the repetitive, selective contraction and relaxation of specific pelvic floor muscles. This exercise is also known as the Kegel exercise. It is the most popular method for treating urinary incontinence. PFME strengthens the pelvic floor and periurethral muscles, which improves bladder control. As a result, this method can cure or relieve urinary incontinence by decreasing incontinence severity, frequency, and volume of urinary leakage. In addition, PFME practiced during pregnancy improves bladder control and reduces the prevalence of urinary incontinence in late pregnancy and early postpartum. PFME is the most effective treatment for urinary incontinence during pregnancy, as it is a safe treatment with no complications. It is inexpensive, easy to perform, does not mandate instruments, and pregnant women can do it anywhere and anytime.
Conclusion:
Reduced bladder control during pregnancy is a highly prevalent problem. Although urinary leakage during pregnancy tends to be mild to moderate, it can have a wide range of detrimental influences on health-related quality of life. Reduced bladder control during pregnancy is due to the increasing force of the growing uterus and weight of the fetus on pelvic floor muscles throughout pregnancy, concurrently with pregnancy-related hormonal changes, which may cause reduced strength of the pelvic floor muscle and urethral sphincter incompetence. Some women are more prone to have bladder control issues than others. PFME is an effective treatment for urinary incontinence during pregnancy with no significant adverse effects.
