Urine leakage during pregnancy

I am eight months pregnant. All of a sudden I find myself leaking urine every time I sneeze or cough. Is this normal? Will it go away after my baby is born?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

If loss of urine is first noted during pregnancy, and if it occurs only with increase in abdominal pressure as in coughing, running or sneezing, this is most likely a transient phenomenon. There is a low risk that it will persist after your baby is born, unless you sustain injury to the nerves during childbirth.

At eight months, there is significant pressure on the bladder, and the uterus impinges on the bladder, limiting its capacity. The hormones of pregnancy, especially progesterone, decrease sphincter tone as well. Although such symptoms do resolve in the postpartum period, you may notice some leakage for up to six months.

Initial treatment of urinary incontinence in pregnancy is always conservative. It consists of perineal (vaginal floor) exercises. These exercises would not be effective in the face of nerve damage or anatomical defect or injury but they are the mainstay of therapy during pregnancy. "Kegel" exercises should be taught by your care provider and instructions on frequency should be given. There are many different techniques and probably not one best regimen.

Kegel exercises consist of tightening the vaginal and rectal muscles, pulling them up as one would to stop the flow of urine. (I don't recommend that you actually practice this method during urination, but only use this as an example of how the exercise is done.) The woman would then hold these muscles contracted for about ten seconds and then slowly relax. I recommend a series of 10 to 15 of these several times during the day. Performing too many of these in one session just tires the muscle. It is best to do Kegels each time the phone rings or the baby cries and each time after urinating. Using a simple reminder will help a woman remember to do these exercises throughout the day.

Elizabeth Nobel in her book "Essential Exercises for the Childbearing Year," is an excellent text and discusses exercises for incontinence and postpartum recovery.

We used to think that relaxation of the pelvic floor is caused by lacerations of the birth canal. This is one reason that episiotomies became popular. Research, however, has demonstrated that aging, increasing parity, obesity and even episiotomies themselves may put women at increased risk for urinary incontinence.

There are two basic types of incontinence: meatal urinary leakage, that occurs with sneezing and coughing and another type, called urge urinary incontinence, which occurs involuntarily in association with a strong urge. Different therapies including medications, bio-feedback, electrical stimulation, voiding schedules, diaries and surgery may be beneficial for one and not the other. This is why proper diagnosis is so important.

For now, just concentrate on the Kegels. If this problem should persist past the first six months postpartum, it would be wise to visit a gynecologist or urologist.

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