Urinary incontinence after childbirth causes. An unpleasant, but avoidable problem is urinary incontinence after childbirth. Urinary incontinence after childbirth: what to do

Urinary incontinence is a delicate problem that women are embarrassed to discuss with loved ones. And not only with relatives - often patients play for time and avoid even going to the doctor, continuing to experience discomfort and false shame. However, it is not worth hoping that the situation will resolve itself - this condition belongs to the category of pathological and requires mandatory medical and psychological correction.

Why does urinary incontinence occur after childbirth?

Before talking about the specific causes that cause incontinence, let's talk about predisposing factors. They are formed at conception.

1. Overweight
2. Chronic constipation
3. Diseases of the urinary tract (chronic, frequent inflammation, etc.)
4. Spinal injury
5. Genetic predisposition to develop the disorder

There are several specific reasons. Childbirth acts as a kind of trigger for the development of a clinical disease.

REFERENCE! Even if a woman has had no problems with urination after her first birth, second and subsequent births increase the risk of incontinence.

• Pathology of the bladder(diseases, injuries, functional features).
• Disorders of the sphincter of the bladder and urethra. At the same time, they do not shrink to the required state, and urine begins to slowly leak.
• Excessive mobility of the urethra. The urethra can change its position due to illness or injury: the physiological curve straightens out and it becomes much more difficult to control urination than before. This condition can also be caused by the loss of muscle tone in the pelvic floor. In addition, in the case of complicated childbirth (often after the appearance of a second and subsequent child), when the muscles of the pelvic floor are stretched, weakened, and the woman does not do special strengthening exercises.
• Violation of the nervous regulation of the bladder and its structures. The passage of a child through the birth canal can cause dysregulation: at this time, the bladder, rectum, and nearby tissues are under special stress. If the process is delayed, the nerve plexuses of the bladder are compressed for too long, and their work is disrupted. The same picture develops after a caesarean section, when the intersection of the nerve endings occurs and it takes several weeks for their recovery.

What are the symptoms of this disease?

1. Leakage of urine when coughing, sneezing, sexual contact and even slight physical exertion. This happens both vertically and horizontally.
2. Abrupt urge to go to the toilet.
3. Feeling that the bladder has not emptied completely.
4. During the process, it is impossible to reduce (at the request of the patient) or interrupt the stream of urine with muscle strength.
5. Urine excretion can be reflexive: at the sound of water pouring from a tap, at a loud shout, etc.

REFERENCE! In adult patients, incontinence mainly occurs during the day. But it happens at night, though rarely.

Treatment for urinary incontinence:

To make a diagnosis, a woman should consult a urologist or urologist and necologist, and undergo an examination. First, the specialist will ask you to tell about the sensations and features that you are experiencing: verbally or describe in a special questionnaire. This is followed by an examination on a gynecological chair: the woman is asked to strain, and if at this moment urine is released from the urethra (even a few drops), we can talk about obvious problems in the body. The next stage is the delivery of tests. A urine test is required, which can show the presence of inflammatory processes and infections in the body.

Additionally, an examination of the bladder and urethra is prescribed using a special instrument (cystoscopy), ultrasound of the pelvic organs.

ATTENTION! In some cases, when the clinical picture is not so clear and understandable, the patient is asked to keep a diary of observations. It records the amount of fluid drunk and released from the body, and other nuances of well-being. Recordings are kept for at least a week. The PAD test is used - a method for measuring the amount of urine that is secreted involuntarily. To do this, the patient has to use special pads and weigh them at the end of the test.

Remember: the initial stage of the disease is cured quickly, easily and with a minimum of financial costs. But neglected cases can only be corrected surgically.

- medical treatment

There are no drugs for the treatment of incontinence, but the patient is allowed to take sedatives (sedatives), vitamin complexes, drugs to improve blood circulation and strengthen blood vessels.

- exercises that strengthen the vaginal muscles

Physical activity will be prescribed in the first place: they help to normalize the activity of the tone of the internal muscles, establish the activity of the bladder during its filling and emptying, and regulate urination.

• Kegel exercises involve squeezing and relaxing the perineal muscles that surround the urethra and vagina. Start with 30 reps and work your way up to 300 compressions in one session. Muscles need to be held in tension for 2-3 minutes. This complex is convenient because it can be done absolutely everywhere (both at home and in a public place), it does not require any preparation and there are no contraindications. Just remember that, firstly, the bladder must be empty during execution, and secondly, the number and duration of exercises must be adjusted if you had tears during childbirth and you had stitches. You need to clarify this point with your doctor: if the gaps were large, you will have to wait a couple of weeks with the exercises.
• The system of work with loaders helps to train the muscles of the vagina. You can work out both at home and in fitness centers according to special programs.
• Simple exercises: lifting the pelvis with an emphasis on the shoulders and feet (legs bent); breeding legs with effort; lifting the lower limbs to form an angle of 45 degrees; bicycle technique. It is useful to swim, engage in fitball and yoga.

IMPORTANT! Conservative treatments are very effective, but don't expect quick results. Will have to work hard for a few months.

- physiotherapy for urinary incontinence

Together with Kegel exercises, electromagnetic therapy and electrical muscle stimulation are prescribed.

- surgical intervention

• Sling (loop) operation. A special loop is placed under the urethra, which covers it and prevents urine from leaking out. A synthetic thread is inserted under the canal for additional support or an alloprosthesis (supporting mesh). The operation is performed under general anesthesia, lasts 1-1.5 hours and is affordable (approximately 20,000 rubles). You can go home the same day. But there are risks: if the sciatic nerve is injured, the consequences will have to be dealt with for a very, very long time.
• Gel injection. An even more expensive procedure, which consists in introducing the gel into the urethra (in several places). The operation lasts 5-10 minutes, costs about 50,000 rubles, but this method has not yet been sufficiently studied and is rarely advised. In addition, relapses often occur.
• Urethrocystocervicopexy. It is carried out under general anesthesia in a hospital and requires a long rehabilitation. During the operation, the surgeon strengthens the pubic-vesical ligaments that hold the urethra and bladder. Types of procedure: Raza, Birch, Giggiz, etc.

Prevention of urinary problems before childbirth

First of all, this applies to those who already had cases of urinary incontinence in the family. But it will also be useful for the rest to remember a few simple rules.

1. Watch your weight. A taut, slender figure is not only beautiful, but also helps to maintain health, and for a pregnant woman, the last point is of particular importance.
2. Avoid constipation. We will not take isolated cases into account, but the tendency to form congestion in the intestines can cause a lot of trouble (stagnation of feces provokes not only incontinence, but also skin problems, digestion, etc.). So watch your diet.
3. Feeling that your bladder is full, hurry to go to the toilet. It is harmful to endure for a long time (it is fraught with weakening of the muscles).
4. Give up bad habits: alcohol, smoking, caffeine.
5. Listen to midwives and doctors during childbirth- this will help to avoid ruptures and complications.
6. Do exercises to keep your pelvic floor muscles toned. They will be useful not only as the prevention of incontinence, but also for the favorable course of the childbirth process.

Conclusion

Do not be shy about incontinence - this is not a vice, but a task that should be solved as soon as possible. And a lot depends on you: whether the treatment will take several days or you will have to deal with the problem for months. If you want to improve the quality of your life - take matters into your own hands, not avoiding trouble, but going towards it fully armed.

Specially for- Olga Pavlova

Approximately one third of all women experience urinary leakage after childbirth. For some, only a few drops are spontaneously excreted, for some, the volumes of urine are very significant. Most women consider urinary incontinence after childbirth to be a normal condition and do not go to their doctor about this. Some even consider the problem to be delicate and prefer to get rid of it in folk ways. It is important to understand that this postpartum condition is pathological and requires correction.

Urinary incontinence: concept

This disease is characterized by spontaneous excretion of urine. Currently, pathology is not uncommon, most often it is found in the postpartum period and in women who have reached the age of 40.

The disease does not pose a serious threat to health, but significantly reduces the degree of quality of life and negatively affects the psycho-emotional state. Many women believe that urinary incontinence after childbirth is a normal condition. Contrary to popular belief, it must be treated.

Symptoms

It is important to understand that isolated cases of urinary incontinence in women after childbirth do not always indicate a pathology. One-time episodes can occur in a completely healthy person.

The following symptoms serve as the basis for the diagnosis:

1. Involuntary excretion of urine occurs regularly, including at night. It is impossible to control it.
2. The amount of urine flowing out is usually significant.
3. Episodes of incontinence occur during sports, sexual intercourse, being under stress.
4. After emptying the bladder, residual discharge continues to flow.
5. Frequent and sudden urging.

However, even if the involuntary release of urine is not regular, it is necessary to consult a doctor in order to confirm or exclude the presence of an inflammatory process in the body.

Types of incontinence

There are several types of the disease, each of which has a characteristic symptomatology.

Urinary incontinence is of the following types:

• Urgent. It is impossible to control, the urge to urinate is very strong and appear suddenly.
• stressful. Urine leakage is observed even with a slight voltage. For example, urinary incontinence appears after childbirth when sneezing, laughing, coughing, during physical activity, both low and high intensity, etc.
• Paradoxical ischuria. Spontaneous excretion of urine occurs when the bladder is full. In this case, it is impossible to control the process.
• Reflex. The act of involuntary urination is a consequence of fright. It can also happen if a person hears the sound of running water.

As a rule, in women after childbirth, urinary incontinence is stressful.

The reasons

The occurrence of complications is associated with changes occurring in the body of a woman during pregnancy and its completion.

The main causes of urinary incontinence after childbirth are:

1. Weak links. During the bearing of a child, changes occur in the pubic and iliac-sacral joints. They are characterized by a gradual relaxation of the ligaments, which is the norm during pregnancy.
2. Weak pelvic muscles. The closer the process of childbirth, the higher the concentration of the hormone relaxin in the blood. This substance is necessary in order to weaken the muscles and ligaments of the pelvic floor. This is necessary to increase the degree of bone dynamics.
3. Expansion of the tissues of the pelvis. The divergence of bones during labor is necessary so that the child does not get injured.
4. Breaks. They are not uncommon during childbirth. In addition, doctors may resort to an episiotomy, a method of facilitating the passage of the child, which consists in dissecting the perineum. A natural consequence of ruptures and this surgical manipulation is urinary incontinence after childbirth when coughing, playing sports, sneezing, etc.

The following factors also increase the likelihood of complications:

• hereditary predisposition;
• excess body weight;
• anomalies in the development of the pelvic organs;
• psychoemotional disorders;
• hormonal disbalance;
• pathology of the nervous system;
• in the past, a person was exposed to radiation;
• previous surgery to the pelvic organs.

Thus, there are a lot of reasons for urinary incontinence in women after childbirth, and therefore a thorough examination is shown to each patient.

Which doctor should I contact?

When the first alarming symptoms appear, you need to make an appointment with a urologist. He will also find out the causes of urinary incontinence after childbirth, and the treatment will prescribe the most effective.

It is important to understand that the disease is dangerous because it develops gradually. The sooner an appeal to a specialist occurs, the less time the treatment period will take, and the likelihood that it will be possible to avoid surgical intervention will increase many times over.

Diagnostics

In the process of talking with the patient, the doctor needs to establish the type of pathology and determine the degree of its manifestation.

During the collection of an anamnesis, he should receive answers to the following questions:

• how many births the woman had, whether there were any complications;
• Does she have any chronic diseases?
• Have you ever had a hormonal imbalance?
• whether surgery was performed;
• whether the patient suffers from pathologies of the nervous system.

In addition, the doctor may ask other questions that a woman may not seem entirely appropriate, as they relate to her personal life. It must be understood that this information is required by a specialist in order to accurately diagnose, so it is important to provide it.

Diagnosis of urinary incontinence consists of several stages:

1. Examination on a gynecological chair. The doctor evaluates the location of the organs of the reproductive system, checks for the presence or absence of neoplasms, examines the mobility of the bladder neck, examines the mucous membrane and skin in the perineum. After that, he takes biomaterial for research from the urethra, cervix and vagina. These analyzes are necessary in order to confirm or exclude the presence of inflammatory processes. A general urinalysis and bakposev are also prescribed without fail.
2. Keeping an observation diary. In order to obtain the most complete information about the existing pathology, the doctor recommends that the patient record the following information within 2-3 days: how much fluid was drunk during the day, how much urine was excreted at a time, how many acts of urination and episodes of incontinence were in 24 hours ., how many pads were used, what load the patient was subjected to. An analysis of the observation diary will help the urologist not only in making a diagnosis, but also in drawing up an effective treatment regimen.
3. Instrumental research. As a rule, the patient is prescribed a transvaginal ultrasound, during which the condition of the urethra, the bladder itself is analyzed, and sphincter insufficiency is detected or excluded.

After completion of all diagnostic measures, the doctor makes a diagnosis and prescribes treatment. In cases where it is ineffective, the results obtained do not correspond to the symptoms, the woman suffers from psycho-emotional disorders, etc. A comprehensive urodynamic examination is indicated. It includes: uroflowmetry, cystometry, cystoscopy.

If during the diagnostic process a woman has disorders of the nervous system, she is referred for a consultation with a psychotherapist or neuropathologist. It is often necessary to consult an endocrinologist.

Conservative treatment

Urinary incontinence after childbirth in women is a pathology, for getting rid of which medications are prescribed extremely rarely. The exception is when the patient is diagnosed with enuresis. To reduce the severity of symptoms, the intake of vitamins and drugs that have a positive effect on the state of blood vessels, the circulatory process and the functioning of the nervous system is indicated.

The main conservative methods for the treatment of urinary incontinence after childbirth:

1. Strengthening the muscles of the organ itself and the pelvic floor. Your doctor may recommend exercises with weights and vaginal cones. Holding foreign objects helps to gradually strengthen the muscles of the vagina and those involved in the process of urination. A good effect is achieved with regular Kegel exercises. They are also based on muscle training. To understand which of them and how to strain, it is necessary to stop the stream during urination and remember these sensations. Thus, it is necessary to constantly strain the muscles of the rectum and vagina. For best results, do at least 200 repetitions a day.
2. Implementation of acts of urination according to the schedule. Its essence lies in the fact that the patient must empty the bladder at the time strictly set by the doctor. This method helps to improve the functioning of the bladder and the emergence of control over the situation. For each woman, the schedule is developed individually. It must be followed for at least 2 months.
3. Physiotherapy. As a rule, treatment with electromagnetic waves is prescribed. In combination with exercises, this method brings the best results.

At the end of the course of treatment, the doctor evaluates the changes. If they are insignificant or absent at all, surgical intervention is prescribed.

Duration of treatment

Urinary incontinence after childbirth is a complication that requires an individual approach. As a rule, the process of getting rid of pathology is quite long. The patient should exercise regularly throughout the year. During this time, she needs to undergo 4 courses of physiotherapy. After 1 year, the doctor assesses the patient's condition. If the disease has not receded, the woman is sent to the hospital with a referral for surgery.

Surgery

In practice, several methods of getting rid of pathology are used. The operation usually takes 30 to 45 minutes. It is performed under local anesthesia. On the second day, the woman is discharged from the hospital, but if her daily activities are associated with intense physical activity, the patient can start it no earlier than 2 weeks after the operation.

Possible complications include: damage to the walls of the bladder, blood vessels, intestines. Turning to a highly qualified doctor reduces the likelihood of these risks to a minimum.

If not treated?

Urinary incontinence after labor is a complication that is not dangerous at the initial stage. But it significantly worsens the quality of life and the emotional state of every woman. Ignoring this problem leads not only to its progression, but also to the occurrence of inflammatory processes in the organs of the genitourinary system.

Forecast

In most cases, it is favorable. The vast majority of women forget about the problem of urinary incontinence after childbirth. Very rarely, conservative methods of treatment do not bring the desired result, surgery is prescribed only in isolated cases. But even after it, the likelihood of relapse is minimal.

Preventive measures

In order to prevent the occurrence of complications, it is necessary to follow simple recommendations throughout life:

• regularly train the muscles of the pelvic floor and vagina;
• do not tolerate if the bladder is full;
• eat a balanced diet, do not abuse alcohol-containing drinks, do not smoke;
• keep body weight under control;
• empty your bowels regularly;
• observe the drinking regime.

Attentive attitude to your health significantly reduces the risk of pathology.

Finally

A third of women experience urinary incontinence after childbirth. What to do? First of all - make an appointment with a urologist. Ignoring the problem can lead to serious illness. Based on the results of the diagnosis, an individual treatment plan will be drawn up. In most cases, it is enough to perform special exercises and go to physiotherapy. With the ineffectiveness of these methods, surgical intervention is indicated.

The appearance of a child is the most wonderful and touching moment, which is the cause of the colossal transformations of the female body. The changes that occur in the body have a significant impact on the well-being and health of the woman in labor. One of the most unpleasant symptoms that almost half of women have to treat is urinary incontinence - destabilization of the functions of the urinary system associated with a loss of control over natural physiological processes.

The problem is accompanied by discomfort in the urethra and lower abdomen. Involuntary leakage occurs during physical activity, lifting weights, while coughing or laughing. Urinary incontinence can be disturbing because of the difficulty to endure the urge to void, as well as immediately after it. Sometimes women feel the impossibility of complete urination, even after visiting the bathroom. In the most difficult cases, urine can be involuntarily excreted during sexual contact.

Usually the problem makes itself felt in the last stages of pregnancy and is aggravated immediately after the birth itself. Urinary incontinence is often not accompanied by pain, however, if left untreated, this disorder provokes the appearance of edema and infectious inflammatory processes in the external genital organs, and in severe cases of the disease, the development of complexes, postpartum depression and complete isolation from society.

Why does urinary incontinence appear after childbirth?

No matter how natural, according to experts, the processes of pregnancy and childbirth are, they are always accompanied by global stress for the body. In the last trimester, the internal organs of a woman change their location, and the growing fetus puts considerable pressure on them.

In the process of contractions during childbirth, a whole group of deep muscle groups that are not used in everyday life are involved, which leads to their stretching and deformation. During the passage of the child through the birth canal, these muscles are stretched, the blood flow in them changes, and nervous activity worsens. As a result of this, the woman in labor may subsequently experience pain in the entire abdominal cavity and lack of control over the emptying process.

Urinary incontinence after childbirth can be triggered by:

• increased load on the bladder and urethra;
• the use of obstetric forceps during delivery;
• deformation and rupture of the muscles of the pelvic floor and perineum;
• scarring of nearby tissues;
• injury and prolapse of the uterus;
• large fetal weight, polyhydramnios;
• multiple births with too little break.

Often in the first days after natural childbirth, which took place without any complications, women notice urine leakage. At the same time, the woman in labor can be absolutely healthy and active, the weight and height of the baby can comply with the norms.

This state of events only indicates that one of the indirect factors contributed to urinary incontinence after childbirth:

• excess body weight;
• acute lack of estrogen;
• previously untreated spinal injuries (pinched nerves, hernia, etc.);
• chronic pathologies of the development of the pelvic organs;
• the presence of persistent infections of the genitourinary system.

In any case, urinary incontinence is a pathology that needs treatment. Don't expect it to go away on its own. To avoid further complications, it is important to pay attention to it in time and start complex therapy.

What to do with urinary incontinence after childbirth?

When a problem appears, it is important, first of all, to get rid of the underlying syndrome. To do this, you need to limit fluid intake, completely eliminating diuretic drinks and foods (alcohol, watermelons, coffee, rose hips, etc.). To avoid trouble, you should be especially careful with the absorption of liquid just before going outside. You need to drink only when thirst arises, in small sips, exactly the amount that the body requires at that very moment.

Experts say that breastfeeding helps to remove excess fluid from the body and get rid of swelling after childbirth. They recommend putting the baby to the breast at the first request. As a rule, after childbirth, this period is 1.5-2 hours.

To track the dynamics, you can start a diary in which you need to regularly record the amount of absorbed and separated fluid, as well as fix situations during which uncontrolled urination occurred. This will help track the dynamics and identify the causes of incontinence.

Treatment

With the appearance of uncontrolled urination, it is necessary to take time to restore the physical form of the woman in labor. Do not forget about the psychological state of the woman. It is important to understand that only an integrated, comprehensive approach will help get rid of the pathology without specialized help.

Treatment for urinary incontinence is:

1. Restoring and strengthening the muscles of the pelvic floor, even if they are not the cause of the problem, because the speedy restoration of the functions of the reproductive system after childbirth, in any case, will only bring benefits. A woman in labor should master the technique of performing Kegel exercises. It consists in alternately squeezing and relaxing the muscles of the vagina and sphincter. When exercising, it is important to provide a quiet, calm environment that allows you to focus only on muscle tension. Class time should be 15-30 minutes daily. The first results will be noticeable in a couple of weeks.
2. After preparing the muscles of the vagina, you can proceed to more serious loads: holding special balls or weights. To do this, you will need to purchase a special projectile, part of which is placed in the vagina, and the load is outside. The task is to hold the weight with the help of the vaginal muscles alone. At the same time, a woman can perform daily activities or even do light exercises at home. The degree of weighting can be gradually increased.
3. Systematic training of the muscles of the vagina will help to fully restore its functions, returning it to the prenatal state. But it is important not to forget about the bladder. For his training, you can draw up a special plan for urinating at regular intervals. At the same time, time intervals should be gradually increased, allowing the body to adapt.
4. Not superfluous in the treatment of urinary incontinence will be the use of herbal medicines. Patients suffering from this pathology after childbirth are recommended to take herbs with a slight sedative effect (St. John's wort, lemon balm, valerian), as well as agents that activate blood circulation and strengthen blood vessels.

1. In the treatment of incontinence, doctors advise more exercise. In case of difficult childbirth, long and difficult recovery after them, you can attend water aerobics classes. This type of training will help to include in the work all the muscles of the abdominal cavity and pelvis, but it will not lead to overstrain and exhaustion of the body.
2. In case of good health, you can visit the gym or go for a run in the fresh air. But it is important not to forget about the abdominal muscles. When running or exercising on simulators, you need to ensure that the stomach is always drawn in. This will increase the tone of the abdominal muscles and restore the normal arrangement of internal organs after childbirth.
3. With the appearance of urinary incontinence, experts recommend paying attention to the psycho-emotional state of the young mother. Since the psyche of women after childbirth becomes very vulnerable, even being around the newborn around the clock can be the cause of the violation. Therefore, women suffering from urinary incontinence, it is necessary to establish the most comfortable regime of the day of sleep and wakefulness. A woman in labor needs to provide at least a minimum rest for 2-3 hours daily, shifting the responsibility for caring for the baby to dad or another trusted person.

The results of treating incontinence by strengthening the pelvic muscles should be noticeable in a couple of weeks. But it often takes months to fix the problem. In the absence of the slightest improvement from therapy for a long period, a woman should consult a specialist for physical therapy or surgery.

Carrying a child is a difficult life stage, during which a woman's body experiences heavy loads. As a result, some disturbances may appear in the work of the body. Urinary incontinence that occurs after childbirth is one of such failures. This problem is a very delicate issue for most mothers. It interferes with maintaining a normal lifestyle and, in some cases, negatively affects a woman’s health.

Many women who gave life to a new man are embarrassed by this problem and hide it. Because of this, their self-esteem drops, a feeling of inferiority appears, which causes a depressed state and mood. However, urinary incontinence after childbirth is quite common. In the case of the first birth, this problem occurs in 15% of women, and after the second birth it reaches as much as 40%. Therefore, it is important to understand what causes urinary incontinence. It may appear in the following situations:

• Leakage of urine during light physical exertion (for example, when jumping or while doing squats);
• Uncontrolled urination that occurs when coughing or sneezing;
• Urinary incontinence can also occur during intercourse.

The reasons for this problem are very different. This condition is usually caused by pelvic floor dysfunction during childbearing. Even if the pregnancy proceeds normally and without problems, the pelvic organs are still constantly under load. And also urinary incontinence after childbirth sometimes occurs after a caesarean section. Or if the birth was difficult, then due to the compression of the pelvic muscles, a violation of blood circulation occurs in them. There are a number of factors that can cause this ailment:

• repeated childbirth;
• Narrow pelvis of a pregnant woman;
• Multiple pregnancy;
• Diseases of the genitourinary system;
• overweight;
• Existing hormonal disorders in the body;
• Heredity;
• Large fruit or its incorrect location.

Urinary incontinence is caused by weakness of the pelvic floor muscles

Types of Urinary Incontinence

The following types of illness are characteristic of the postpartum period:

• Urinary incontinence caused by stress. It can cause loud laughter, crying. It appears even when coughing or sneezing.
• Reflex factor - causes incontinence with reminiscent associations (for example, the sound of pouring water).
• Urgent leak. With too frequent urge to urinate, it becomes impossible to control it.
• Uncontrolled incontinence. A small amount of urine can be excreted little by little throughout the day.
• Intrinsic factor - when an overfilled bladder is unable to hold back urine. This is usually due to some kind of infection or tumor.
• Bedwetting is a fairly rare incontinence during sleep (enuresis).

According to the degree of the disease, the disease can be divided into 3 categories: mild, moderate and severe. A mild degree is incontinence that appears only during heavy exertion. The average degree causes urination when coughing, while laughing or with light exertion. During a severe degree of the disease, urine output can occur for no apparent reason and even from a simple change in body position.

Urine leakage when coughing or sneezing

Diagnosis of the disease

As with any other disease, in case of urinary incontinence after childbirth, you should seek medical advice from a urologist and gynecologist. Despite the delicacy of this problem, a woman who has given birth must come to the consultation of doctors and openly talk about the illness that has arisen. A professional examination will allow you to examine the woman's body for the presence of postpartum tears. And the tests carried out will reveal the presence of infections, if any, in the female body. And also for a more accurate diagnosis, doctors will ask the woman to notice situations in which incontinence occurs and note the smell of urine.

Rapid diagnosis, allowing for accurate analysis, includes the following procedures:

• Delivery of a general blood and urine test. The smell of urine and its content will show if there are deviations from the norm.
• Cystoscopy. During this study, a cystoscope is used. With its help, the bladder is examined from the inside along with its mucous membrane. This will determine the changes that cause urinary incontinence.
• Ultrasound of the bladder and kidneys.
• Profilometry is a procedure that allows, by measuring pressure, to assess the general condition of the urethra.
• Uroflowmetry. This test is prescribed when it is necessary to determine how much urine is excreted for a set period of time, the duration of emptying and the total volume of discharge. The study will help to identify possible damage in the dynamics of the lower urinary tract.
• Cystometry - measurement of the total volume of the bladder and comparison with normal pressure.

The degree of incontinence depends on the method of treatment of the disease.

Possible treatment options for urinary incontinence

The optimal treatment of urinary incontinence after childbirth is prescribed after a thorough study of the results of the examination. There are two options for getting rid of the disease - conservative and radical treatment. It is not worth treating this ailment on your own, because a thorough examination by a doctor will help identify and exclude options for infectious diseases and inflammations. Moreover, most cases of involuntary urination are successfully treated without surgical intervention.

Conservative treatments

They are acceptable for mild to moderate disease. Usually the essence of the disease lies precisely in the weak muscles of the pelvic floor, which cause urine to be released only during exertion, coughing or sneezing.

It is necessary to ensure that the following actions are carried out:

• Kegel exercises. The essence of this exercise is to strengthen the vaginal muscles. To understand the correct technique, when natural urination occurs, you need to stop it for a couple of seconds with muscle strength. Feeling the work of the muscles, it is necessary to do up to 200 squeezing and unclenching per day. Exercise strengthens and maintains the tone of the muscles of the urinary canal. It is very easy and can be done at any time.
• Training of the vaginal muscles with the help of special weights. This exercise consists in the fact that special small weights are placed in the vagina, which are held. For 15 minutes, you need to go about your usual business and hold the weights. Of course, during the exercise it is better not to sit on the couch, but to walk around the house. It is recommended to do this exercise 3-4 times a day for 15 minutes. Such therapy begins with the retention of smaller weights, the weight of which is deliberately increased every day. The maximum weight allowed is 50 grams. In general, the exercise is aimed at strengthening the muscles of the pelvic floor.
• Bladder training. This behavioral therapy is aimed at the time agreed with the doctor to urinate. That is, you need, for example, every 2 hours to go to the toilet without waiting for the urge. Gradually increase the time between trips to the toilet. Treatment with this method takes up to two months. This workout aims to develop the habit of keeping time between trips to the toilet.
• Physiotherapy. During therapy, mommy is stimulated with a magnetic field or electrical stimulation of the pelvic floor muscles. After its passage, the excessive activity of the muscles responsible for the emission of urine decreases. Almost always, this therapy is used in conjunction with the above training. And after completing such a course, there is no need to treat urinary incontinence in women after childbirth.
• Medical treatment. Scientists have not yet come up with such drugs that could eliminate the problem of involuntary urination. However, the doctor may prescribe drugs that improve blood circulation in the body, sedative pills or vitamins. They are taken as an adjunct to physiotherapy and muscle training.

Radical Methods

• It is used in severe degrees of the disease or when the above methods do not help. In modern medicine, 3 possible operations are performed:
• Operation with a gel injected into the urination canal. This is the simplest type of surgery. The gel, injected into the area near the channel, creates an additional support that ensures the fixation of the channel.
• loop operation. The most common and effective type of intervention. With the help of a special loop made of surgical materials, the urethra is wrapped. This creates additional fixation of the urethra.
• Urethrocystocervicopexy. It consists in strengthening the pubic-vesical ties. However, due to the complexity of the operation and the rather long and difficult period of rehabilitation, it is performed extremely rarely.

We offer you to watch a useful video that details the structure of the pelvic floor muscles and why it is important to train them.

Prevention

Urinary incontinence after childbirth is a common problem in women who have given birth. Do not be ashamed of this or try to treat it yourself. As a preventive measure. For prevention, all types of physical training described in this article are suitable. They can be practiced both before pregnancy and during it. These exercises increase muscle tone and improve blood circulation in the pelvic organs. Therefore, even if the mother who gave birth is faced with such an ailment, then it is necessary to go to the doctor without hesitation. The most important role in the fight against this unpleasant disease is played by timely diagnosis and the right treatment.

Urinary incontinence is one of the most unpleasant consequences of childbirth, which they prefer to remain silent about. According to official statistics, pathology occurs in 15% of women who have given birth for the first time, and more than 40% in mothers with two and three children. Many patients are embarrassed to address this problem to the doctor, which makes it difficult to access information about the pathology and methods of treatment.

A delicate problem: why does urinary incontinence occur after childbirth?

The main cause of urinary incontinence, as well as frequent urge to empty the bladder, is a decrease in the elasticity of the pelvic muscles after childbirth. During gestation, the excretory system experiences pressure that increases as the fetus develops. When the child passes through the birth canal, the muscles are compressed, as the tone of the uterus decreases and the tension that has been familiar for many months disappears.

During the birth of the baby, the muscles of the small pelvis experience the greatest load for the entire period of gestation. Supporting the fetus and forming a “corridor” for the child to leave the womb, the muscles overstrain and suffer from impaired blood circulation and innervation - connections with the central nervous system, due to which the brain does not receive a signal in time to empty the bladder.

The risk of urinary incontinence increases after a complicated delivery with perineal ruptures, the birth of a large fetus, and second births. Despite the successful course of pregnancy, the pelvic muscles still experience tremendous stress, which often leads to problems with urination.

Why is urine not holding after a caesarean section? It is erroneously believed that urinary incontinence occurs only after natural childbirth. A woman who underwent a caesarean section also carries a fetus for 9 months that presses on the pelvic organs. Of course, the degree of bladder atony in this case is less, but it requires similar treatment.

The risk of a decrease in bladder tone after childbirth increases if a woman has the following factors in her anamnesis:

• anatomical anomalies in the development of the pelvic organs;
• overweight;
• lack of estrogen;
• frequent infectious diseases of the excretory system;
• injuries of the spine and pelvic organs and surgical interventions.

Types of urinary incontinence after childbirth

Depending on the etiology of involuntary urination, the following types of pathology are distinguished:

• incontinence that occurs at the slightest impact on the muscles of the pelvic floor - when sneezing, coughing and blowing your nose, not to mention sports;
• urge incontinence, when the sudden urge to urinate cannot be tolerated;
• urinary incontinence associated with the action of psychological factors - the sound of a babbling stream, laughter or fear;
• residual urination, when urine leaks after emptying the bladder;
• enuresis - involuntary urination during sleep.

Depending on the amount of urine excreted during the day, the following degrees of severity of the pathology are distinguished:

• light - up to 100 ml, flowing out during sports, carrying heavy objects and other significant physical exertion;
• medium - up to 200 ml, in which leakage is associated with laughter or sneezing;
• heavy - more than 200 ml, when urine leaks even at rest.

Ways to deal with urinary problems

The main problem in the treatment of urinary incontinence after the birth of a baby is the lack of awareness among women about how to prevent and eliminate this problem. It is erroneously considered that violation is a price for the opportunity to give birth to a child, and this must be accepted. In practice, pathologies of mild and moderate severity are easily treated conservatively.

Drug therapy

There are no drugs that directly eliminate the causes of urinary incontinence. There are medications that work on parts of the brain that don't respond to signals from the bladder to urinate.

Such medicines are used to treat enuresis. As a rule, the therapy of this pathology also includes taking anticholinergic drugs - Oxybutynin, Tolterodine, Atropine.

In the treatment of urinary incontinence, sedatives are prescribed. Diazepam, Valium, infusions of chamomile, mint and lemon balm help the patient cope with the disease faster. Antidepressants such as Duloxetine and Imirappine are used for bedwetting. Preparations of this group eliminate tension in the muscles of the small pelvis, but can be addictive, and therefore are prescribed exclusively by a doctor.

Women must be prescribed drugs that increase blood flow in the pelvic area and increase vascular tone (Aescusan, Askorutin). With a lack of estrogen, which provokes a loss of tissue elasticity, hormone replacement therapy is performed. Be sure to prescribe the intake of B vitamins, folic acid.

Physiotherapy procedures

Physiotherapy is indicated for incontinence after a difficult birth, with too relaxed muscles. To strengthen the muscles of the pelvic floor, they resort to electromagnetic stimulation and electrical stimulation. The task of physiotherapy procedures is to restore the process of transmission of impulses signaling the need to empty the bladder from the excretory system to the brain.

Pelvic floor exercises and urinary regimen

Kegel exercises are the easiest way to strengthen your pelvic muscles. It is necessary to quickly compress and decompress the vaginal muscles at least 100 times. The easier the exercises are, the more repetitions should be. In case of violation, it is necessary during urination to delay the flow of urine for a few seconds and continue the process.

Exercises with weights help to improve control of the pelvic muscles. At the initial stage, bars weighing no more than 50 g are used. The weight is placed in the vagina, then you need to walk around the room for 1520 minutes, trying to keep it inside. The exercise is repeated 4 times a day. As the therapeutic effect is achieved, the weight of the weight is increased.

Urinary incontinence will pass faster if you do daily morning exercises. Performing exercises takes no more than 20 minutes a day and allows the patient to feel increased blood flow in the pelvic area.

Muscle training includes:

• Squats. Having straightened your back and put your feet shoulder-width apart, you need to do slow squats (not to the floor), strongly squeezing the vaginal muscles. Having reached the bottom point, they linger for 15 seconds and return to their original position. Repeat 15 times.
• Separation of the buttocks from the floor. You need to lie on your back, pressing your lower back and buttocks to the surface, fix your heels on the floor, put your hands along the body. Then slowly raise the pelvis, trying to strain the vaginal muscles as much as possible. Repeat 20 times.
• Description of circles. Having taken a similar position, but straightening the legs, you need to raise the limbs up and rotate them clockwise and counterclockwise for several minutes, describing an imaginary figure. Repeat 3 times.
• Stretching your legs against the wall. Having taken the same position, but at a distance of 0.5 m from the wall (head to it), you need to carefully, not abruptly, throw your limbs behind your head, trying to touch the support. Repeat 10 times.

Surgery is a last resort

If conservative treatment fails, a woman is diagnosed with a severe form of pathology or the disease progresses rapidly, surgery is necessary. To eliminate urinary incontinence, the following operations are performed:

1. The introduction of the shaping gel. An effective and least painful way to treat pathology. It is characterized by the introduction of the drug into the urethra, due to which a synthetic sphincter is formed that keeps the urinary canal from leaking. Surgery is performed under local anesthesia. The therapeutic effect will last up to 2 years.
2. Sling (loop) operation. The most effective and safest option for surgical treatment. It is characterized by the introduction into the urethra, between the urethra and the vaginal wall, supporting the loops. Within 2 days the patient is under the supervision of a doctor, after which she can return to normal life.
3. Implantation of an artificial sphincter. The installation of a prosthesis instead of a natural valve is carried out mainly with stress urinary incontinence. The device is installed through the labia majora and activated 1.5 months after the operation. During this time, the artificial sphincter must take root in the tissues, and the patient must adapt to the presence of a foreign body in the pelvis.
4. Urethrocystocervicopexy. The most complex type of surgery, associated with the risk of complications and requiring a long recovery. It involves "pulling up" the ligaments that hold the bladder, urethra and uterus. It is performed by open or laparoscopic method through the abdomen under general anesthesia.

Prevention of urinary problems before childbirth

At the stage of pregnancy planning, one of the most important activities, along with laboratory diagnostics and specialist examinations, is the preparation of the pelvic muscles for childbearing and childbirth. Kegel exercises increase muscle elasticity, which will not only facilitate delivery, but also reduce the likelihood of urinary incontinence after childbirth, speed up the recovery process (we recommend reading: Kegel exercises for women after childbirth: rules for doing gymnastics at home).

To prevent the development of atony of the bladder, you need:

• do not tolerate the urge to urinate;
• give up the habit of crossing your legs while sitting;
• do not wear tight clothes;
• do not lift weights weighing more than 5 kg;
• control body weight, especially for women with a hereditary predisposition to atony of the bladder;
• adhere to an active lifestyle, including daily walks, sports, or at least morning exercises;
• wear a bandage after the fourth month of pregnancy.

If you delay the treatment of urinary incontinence after childbirth, surgery will be required. A progressive inflammatory disease of the excretory system reduces the tone of the bladder walls. To prevent urinary incontinence after childbirth, you should strictly go through all the examinations prescribed by your doctor that allow you to diagnose inflammation at the initial stage.