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Pregnancy-Related Urinary Incontinence
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Diane K Newman, RN-C, MSN, ANP posted:
How many of you who are pregnant have experienced urine leakage? How about you women who have given birth in the last six months?

A woman who has had one vaginal birth is more than two and a half times as likely to report stress urinary incontinence. Even during a first pregnancy, 50 percent of women experience problems with bladder control, especially during the third trimester. These problems often become more pronounced with each successive pregnancy.

The urinary system may change during pregnancy in ways that affect urinary control in some women. Trauma (injury) during and after delivery from stretching or compression of the pelvic floor muscles can cause damage to the pudendal and pelvic nerves that serve the pelvis, uterus and bladder. Depending on the size and weight of the baby and length of labor, damage occurs to the soft tissue of the muscle and nerves and may cause tears in ligaments that support the urethra and bladder muscles. In addition, episiotomies, anesthesia and the use of forceps all may cause urinary incontinence.

Urinary incontinence that begins after delivery usually stops in the next 3-6 months, but it may persist and return after additional pregnancies. Women often report difficulty with contracting their pelvic floor muscles after childbirth which is exactly why a program of pelvic floor muscle exercises (Kegels) should begin early in pregnancy and continue after delivery until any incontinence issues improve.

Unlike health care services in countries such as Great Britain and France, the U.S. health care system does not promote pelvic floor muscle rehabilitation during pregnancy or immediately after childbirth, although the data strongly suggests that this is a crucial time when pelvic floor muscle and nerve damage occur.

If you aren't doing Kegels during pregnancy or after delivery, discuss them with your health care provider. Our Kegel Quick Start Tip Sheet and our Printable Kegel Exercise Log may help you get started on a pelvic floor muscle exercise program to help you prevent or improve pregnancy-related urinary incontinence.
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Louise_WebMD_Staff responded:
How does Great Britain and France promote pelvic floor muscle rehab? I remember going for my 6 week checkup after my third child and complaining about incontinence but my doctor just said "well, I could refer you for biofeedback"-and then described it in such distasteful terms that I said no, thank you.
 
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Diane K Newman, RN-C, MSN, ANP replied to Louise_WebMD_Staff's response:
They have national health insurance with an emphasis on prevention so women, post childbirth, are instructed to see a specialist (nurse like myself or a physical therapist) who teaches pelvic floor muscle rehabilitation. This is needed in the US but I am sad to say, we may never see it as our focus is on disease not health promotion or prevention.


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