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| |    Pregnancy & Urinary Stress Incontinence by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Urinary stress incontinence (USI) occurs when a stress (like a cough, sneeze or sudden change in position) leads to loss of urine. Sometimes this is a mild and infrequent event, and sometimes it can be severe, interfering with normal activities. What causes urinary stress incontinence? A starting question really should be what prevents urine from leaking out of everyone's bladder? The continence mechanism consists of a muscular valve at the bottom of the bladder, and muscles of the pelvic floor that can contract and add to the obstruction of urine outflow. For most women, these muscles more than counter-balance the pressure of urine inside the bladder. They can be overwhelmed, however, if the pelvic floor muscles are weak or damaged, or when there is extra pressure or stress on the bladder. For example, someone may have no trouble with leaking until she gets a cough, which increases the pressure forcing the urine out of the bladder. In pregnancy, there is pressure on the bladder from the enlarging uterus. Trauma to the nerves and muscles of the pelvic floor during childbirth can worsen USI postpartum. Strengthening the pelvic floor muscles with Kegel exercises can usually improve or eliminate the leaking. Occasionally loss of urine is a sign of a bladder infection or other bladder problem. Discomfort with urination, frequent urination continuing after delivery, or loss of large amounts of urine, are all possible signs of problems that need medical attention. When in doubt, ask your doctor. What can be done? Often the symptoms will resolve within a few months after the baby is born, even without any treatment. Kegel exercises strengthen the pelvic floor muscles, improving the continence mechanism. You need to do about 100-200 Kegels a day to see a difference in USI! If loss of urine continues, consult your practitioner to discuss treatment options.
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