Stress Urinary Incontinence in Women of Childbearing Age

What Is Urinary Incontinence?

Urinary incontinence is the inability to control the passage of urine. During urinary incontinence, there will be an urgent feeling to urinate or urine leak between trips to the bathroom. This can occur due to many reasons, including childbirth, pregnancy, menopause, and old age. There are different types of urinary incontinence, of which stress urinary incontinence (SUI) is very common in pregnant women.

What Are the Types of Urinary Incontinence?

There are four different types of urinary incontinence:

• Stress Incontinence - This is the most common type of urinary incontinence, and it is seen to affect the younger women more. Stress incontinence usually occurs when there is pressure or stress on the bladder. It usually occurs when the weak pelvic floor muscles compress on the urethra and the bladder. In people with stress incontinence, coughing, sneezing, or laughing, which requires the use of the pelvic floor muscles can cause a leak of urine. Physical activity and sudden movements can also cause urine leakage.

• Urgency Incontinence - This type is also called an overactive bladder, the urine leakage usually occurs after a sudden, strong urge to urinate and before reaching the bathroom. Some women will be able to get to the bathroom in time but the urgent urge to urinate is more frequent than normal people. And they cannot empty the bladder. Urge incontinence is most commonly seen in older women. It can occur unexpectedly during sleep, touching running water, or after drinking water.

• Functional Incontinence - This type of urine leakage can occur due to difficulty reaching a restroom on time because of mental or physical conditions, such as injury, arthritis, or other disabilities.

• Overflow Incontinence - In this type of urinary incontinence, the leakage happens when the bladder’s capacity is full to hold the quantity of the urine.

What Are the Symptoms of Urinary Incontinence?

Urinary incontinence is not a disease but it can be a symptom of another health issue, usually due to weakness of pelvic floor muscles.

The common symptoms of urinary incontinence are as follows:

• Leakage of urine during coughing, sneezing, bending over, laughing, exercising, during sex, and while lifting heavy objects.

• Feeling of spasms or pressure in the pelvic area causing a strong urge to urinate.

• Frequent urination than usual.

• Urinating while sleeping.

Why Does Stress Urine Incontinence Occur During Pregnancy?

• Increased Weight - Weight gain during pregnancy can cause increased pressure on the bladder and the pelvic floor muscles, which may lead to greater urethral mobility. Additionally, excess weight gain during pregnancy may obstruct the blood flow and nerve supply to the bladder and urethra. Many studies have reported that stress urinary incontinence increases with increasing prenatal BMI. It is also noted that increased BMI not only causes urinary incontinence but also pelvic organ prolapse. Weakening of pelvic floor muscle is found more often in women with pelvic organ prolapse. Weight reduction will be an effective treatment option.

• Growing Fetus - The growing fetus weighs solely on pelvic floor muscles. This contributes to major stress on pelvic floor muscles throughout pregnancy, leading to its weakness.

• Nerve Damage - Childbirth and prenatal issues can cause pudendal nerve, levator ani muscle, and external and internal anal sphincter damage. This can reduce the strength of pelvic floor muscles and lead to stress urinary incontinence.

• Changes in Hormones During Pregnancy - The level of relaxing and progesterone changes during pregnancy have a significant role in stress urinary incontinence. Relaxin increases urethral pressure and stimulates the growth of tissue in the lower urinary tract. Progesterone increases during pregnancy from 24 ng/ml to 150 ng/ml during pregnancy. When the progesterone is increased, it may cause smooth muscle relaxation in the urinary system leading to urinary incontinence.

• Collagen Changes During Pregnancy - Collagen changes can cause reduced functional support of pelvic floor muscles, and total collagen content reduction can result in stretching of pelvic ligaments and joint laxity.

How to Diagnose Urinary Incontinence?

All the problems related to urinary incontinence during or after pregnancy will disappear over time. If the problem continues for more than six weeks after birth it is advised to consult a doctor. During the consultation, the doctor will perform a physical examination to check the functioning of the bladder. The following tests will help to diagnose urinary incontinence:

• Ultrasound - Ultrasound images will be helpful to check the emptying of the bladder completely.

• Bladder Stress Test - This test checks for the signs of urine leakage while coughing forcefully or leaning down.

• Urodynamics - During this test, a thin tube is inserted into the bladder during this test. Water is passed through the tube to fill the bladder which helps to check the pressure inside the bladder.

What Is the Treatment for Stress Urinary Incontinence?

The first-line treatment for stress urinary incontinence during pregnancy and after pregnancy is pelvic floor muscle exercises. Pregnant people are often instructed to perform these exercises to prevent the onset and treat the symptoms of urinary incontinence during pregnancy. Medications and surgery are other treatment options during pregnancy or postpartum period.

• Pelvic Floor Muscle Exercise - Pelvic floor muscle exercise also known as Kegel exercises is the most popular treatment for stress urinary incontinence. During this exercise, the specific pelvic floor muscles contract and relax. This exercise is useful for treating postpartum urinary incontinence and improving the tone and functioning of pelvic floor muscles after childbirth. Kegel exercise is very successful and women who have done these exercises have reported a high rate of success and improvement rates. Pelvic floor exercise should be performed under the direction of a therapist and it helps to reduce the severity of incontinence, including the volume of urine leakage and frequency of urination. Pelvic muscle exercise is a more effective treatment during pregnancy because it is a safe treatment simple to perform, without complications, inexpensive, can be done anywhere and anytime, and does not require instruments.

• Medical Treatment -Applying a low dose of topical estrogen in the form of a vaginal cream, patch, or ring may help in rejuvenating and toning tissues in the vaginal and urethral areas.

• Surgical Treatment - Sling procedures use strips of the body's tissue or mesh to create a pelvic sling underneath the area where the bladder connects to the urethra and the urethra. This sling keeps the urethra closed, mainly during cough or sneezing.

• Interventional Therapies - Bulking material injections are a procedure in which a synthetic material is injected around the tissue surrounding the urethra. This material helps in keeping the urethra closed and reduces urine leakage. This method is generally less effective than more invasive treatments.

Conclusion:

Stress urinary incontinence is common in pregnant women and increases with gestational age. The main reason is the fetal weight and increasing pressure of the uterus on the pelvic floor muscles. Changes in pregnancy-related hormones also play a role in reducing the strength of pelvic floor muscles. So, an effective treatment for stress urinary incontinence during pregnancy is pelvic floor muscle exercise. Consult a doctor before performing any pelvic floor muscle exercise during pregnancy.