Ask An Expert: Incontinence After Giving Birth

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Ask An Expert: Incontinence After Giving Birth

Question:

I had a baby in 2003, and every since then it's been very hard to control my bladder. Can you give me any suggestions on what to do?

Answer:

Poor bladder control is called urinary incontinence. It is a common condition, affecting up to 25 percent of women. There are several different types of incontinence. Each type has its own set of risk factors, but there is a lot of overlap among them. Effective treatments are available for all types of incontinence, but treatment requires diagnosing the correct type affecting an individual patient.

Pregnancy is most commonly associated with stress incontinence. Stress incontinence is leakage of urine when physical pressure is applied to the bladder. For example, pressure may result from coughing, laughing, lifting and running. Pressure forces urine out of the bladder because the sphincter muscle responsible for keeping the bladder neck closed fails to do its job. Injury to the pelvic floor during childbirth can damage the bladder sphincter.

Another type of incontinence is called overactive bladder. Leakage occurs in this type because the bladder contracts when it shouldn't. Normally the bladder only contracts when we give it permission to empty. An overactive bladder tries to empty without permission, causing the woman to experience an uncontrolled urge. This type of incontinence is more common in older women, but can occur at any age.

Treatment of incontinence depends on the type. If a woman has stress incontinence, Kegel exercises can help restore strength in the sphincter muscle. If the exercises are not enough, the sphincter can be supported with a vaginal device called a pessary that acts as a brace. A supporting sling or hammock for the bladder neck can also be implanted surgically.

Treatment of the overactive bladder consists of retraining the bladder by scheduling frequent trips to the bathroom. The purpose is to teach the bladder to contract only when given permission. Medications can assist retraining by helping the bladder muscle relax between voids. Your doctor can help you choose the best therapy after diagnosing the type of incontinence present.

Joan Bengtson, M.D., is assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and a member of the Department of Obstetrics, Gynecology & Reproduction at Brigham and Women's Hospital.

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Last updated:	January 24, 2007