Pregnant sneeze and pee

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Here’s What Happens to Your Body When You Hold in Your Pee

It might not feel like it, but the adult bladder can hold as much as half a litre (2 cups) of pee before you’ll feel the need to ‘go’.

Your body knows how much is in there because your bladder wall is filled with tiny receptors that send a message to your brain when the bladder reaches capacity.

Fortunately, most of us have full control over our bladder function, so when we receive this message, we can choose to either relieve ourselves right away, or hold it because it’s a really long way to the bathroom from the couch.

But what exactly are we doing to our body when we hold all that pee in?

In an episode of SciShow, Michael explains that once you’ve made the decision that you’re too busy to pee right now, the cylindrical sphincters in your bladder close up tightly to keep all of the urine from leaking through your urethra.

These little muscles are great at what they do, until you make them do it consistently for a really long time, say if you’re a trucker and you’re holding in your pee on long trips several times a week.

If you make a habit of holding in your pee for ages, you’re subjecting yourself to pretty serious long-term effects, including a higher risk of infection.

And as the video below explains, constantly holding in your pee can weaken your bladder muscles, which could lead to urinary retention – the dreaded condition that prevents you from being able to fully empty your bladder when you pee, which means you feel like peeing a lot.

Holding in large amounts of urine for an extended period of time also exposes your body to potentially harmful bacteria, which can increase your chances of getting a urinary tract infection (UTI) or bladder infection.

All of which sounds pretty bad, but not exactly life-threatening, right? Well, you’re just not trying hard enough.

Enter Tycho Brahe: a Danish astronomer and alchemist back in the 16th century.

Brahe was a fantastic scientist, contributing to the scientific literature on everything from supernovae, comets, and planetary orbits. He also ended up in a duel with a fellow nobleman over the legitimacy of a mathematical formula, and because they chose to duel in the dark, he ended up losing the entire bridge of his nose.

For the rest of his life, Brahe glued a silver or gold nose replacement onto his face.

As colourful as all that is, Brahe’s cause of death is perhaps even more ridiculous.

He reportedly refused to leave a banquet to relieve himself because he believed it to be a breach of etiquette, but then once he got home, he found he was unable to pee at all. He descended into delirium and died soon after when his entire bladder burst.

The good news is that Brahe’s bladder wasn’t like most – in the vast majority of cases like this, a person will just wet themself before any bursting occurs. If bursting happens, it’s almost always because the bladder was already damaged for some reason.

But not always. As Michael explains for SciShow, there have been cases where people’s bladders burst because they were too drunk to notice the signal from their brain telling them to pee.

Watch the episode of SciShow below to find out more:

A version of this story was first published in January 2016.

Controlling Your Bladder During Pregnancy (Urinary Incontinence)

Your frequent need to pee may have turned into urinary incontinence, or leaking of urine, especially when you sneeze, cough, laugh or strain. Don’t worry; it’s very common and likely won’t last. Here’s what you can do to minimize the possible embarrassment factor.

When does urinary incontinence start during pregnancy?

You may have noticed soon after you learned that you were pregnant that you suddenly needed to run to the ladies room more often than usual. Gradually, a frequent need to pee during pregnancy may have become even more frequent, especially during the last trimester, when your growing baby puts extra pressure on your bladder. It may even turn into difficulty with bladder control.

Don’t worry or be embarrassed! Involuntary peeing during pregnancy can be annoying, messy and occasionally mortifying. But it’s normal, very common and (mostly) temporary.

What causes urinary incontinence during pregnancy?

Hormonal changes, especially fluctuating levels of relaxin and progesterone (which help control your bladder), are mainly to blame. Risks for incontinence during pregnancy increase if you’ve have a history of urinary tract infections, you previously delivered vaginally, you’re older or you weigh more (excess weight puts more pressure on the bladder).

If you were bothered by leaks before getting pregnant, you’ll probably experience even more now. Unintended leakage can happen anytime but especially when you laugh, sneeze or cough. (If you’re going to a funny friend’s house for lunch, pack an extra pair of undies!)

What can I do about urinary incontinence when I’m pregnant?

  • Do your Kegels! Try to work up to three sets of 30 Kegel exercises a day.
  • Try doing a Kegel exercise when you feel the need to cough or sneeze, or when you’re about to laugh or lift something heavy.
  • Keep your pregnancy weight gain moderate, since extra pounds put extra pressure on your bladder during pregnancy.
  • Train your bladder to behave. Urinate every 30 minutes — before you have the urge, in other words — and then try to extend the time between trips to the bathroom each day.
  • Try to minimize constipation during pregnancy, so that your full bowels don’t put added pressure on your bladder.
  • Keep drinking at least 12 or 13 glasses of fluids every day. (Cutting back on water to control the peeing only makes you vulnerable to dehydration and urinary tract infections.)
  • Avoid coffee, citrus, tomatoes, soft drinks and alcohol — all of which can irritate your bladder and make it harder to control those leaks.
  • Pads can help absorb leaking urine (no tampons, please — they don’t block the flow of urine and they’re off-limits during pregnancy anyway).

Can I prevent urinary incontinence during pregnancy?

Some research suggests that women with strong pelvic floor muscles are less likely to leak urine during pregnancy. But don’t kick yourself if you didn’t do your Kegels; there’s a lot you can’t control during pregnancy, and your bladder just might be one of those things.

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When can I expect urinary incontinence to end?

After you have your baby, the incessant urge to pee will cease, and your bladder should snap back to normal along with the rest of your body. But it might take longer.

Women who had especially long, protracted vaginal births or have difficulty losing weight may continue to deal with involuntary peeing. If that’s the case, it just might be time to enlist your practitioner’s help.

When should I call the doctor?

A little dribbling can be a big nuisance, but most women report no more than a few episodes of leaking per day during pregnancy. A quick smell test should confirm it; urine smells of, well, urine (grassy and slightly ammonia-like). Call your practitioner right away if the liquid is flowing, not leaking, and clear and odorless. There’s a chance you might be leaking amniotic fluid.

Even if you’re sure it’s urine, mention your urinary incontinence issues to your practitioner at your next visit and ask for his or her recommendations.

If you have any risk factors for postpartum urinary incontinence, let your practitioner know so he or she can discuss your treatment options. There are prescription medications and even surgical approaches for an overactive bladder and incontinence, but they should be avoided during pregnancy in favor of exercises and behavior modification. After your baby is born, there are other options you may want to consider, including postpartum pelvic floor physical therapy.

Is it okay to hold your pee when you don’t have the time or can’t find a toilet?

There may be a long queue snaking from the washroom. Or the boss caught you for a quick update on your way to the bathroom. Maybe you simply couldn’t bring yourself to use the public toilet (we completely understand). Or perhaps you’re lying in bed debating whether or not you’re too tired to get up and relieve yourself.

Yes, we’ve all held our pee from time to time.

On average, people urinate five to 10 times a day, and once or twice a night, said Dr Tan Yung Khan, Mount Elizabeth Novena Hospital’s urologist. A few factors can determine how much and how often you have to visit the bathroom. As you may already be aware, working or exercising in a warm environment makes you lose fluid more from perspiration, and less from urination.

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Conversely, diuretics such as beer, coffee, tea and certain artificial sweeteners can increase your body’s production of urine. Irritation to the bladder, such as a urinary tract infection (UTI), bladder tumour or urinary stone, can also cause you to visit the loo more frequently, said Dr Tan.

But is it okay to hold your pee? Doesn’t that cause the stones? First, a lesson in biology.

HOW YOUR PLUMBING WORKS

Anatomically, an adult’s bladder capacity such as yours is about 300ml to 400ml (roughly one-and-a-half to two cups), up from just 30ml when you were a child. It’s no wonder that very young children are constantly asking to visit the bathroom or wetting their pants as their bladder capacity only starts to increase from around age two.

On average, people urinate five to 10 times a day, and once or twice a night.

Your urine is more than the drink you had a few hours ago. Sure, the yellowish liquid has excess water that your body doesn’t need but it also contains waste that your kidneys filter from the blood, such as urochrome, a pigmented blood product that gives urine its colour, as well as urea (a waste product when protein gets broken down), creatinine (another waste product but from the normal breakdown of muscle), the by-products of bile from the liver, ammonia, and salts.

(Photo: Unsplash)

When the bladder fills up with urine, it sends a signal to the brain that it is time to pee. The brain creates the urge to urinate, and at the same time, instructs the bladder to hold on. That usually works out fine while you go in search of a bathroom. But with age, hormonal changes, pregnancy and muscle laxity, especially in the pelvic floor muscles, leakages can sometimes happen despite your best effort to hold it in.

READ: What your poo says about your health

Interestingly, you could also set yourself up for urinary incontinence if you often go to the bathroom before you feel the urge to urinate. Over time, your body learns that even with less volume in the bladder, you feel the urge to go, leading to more frequent visits to the toilet, according to an article by Harvard Medical School.

Conversely, you can condition your bladder to hold your pee for longer. Bladder training, where you follow a schedule to urinate, may sound ridiculous but it is used by patients who have been diagnosed with overactive bladders, said Dr Tan. By delaying going to the toilet in longer and longer intervals, you’ll train your bladder to gradually increase the amount of urine it can comfortably hold. The schedule can be paired with medication and exercises to strengthen the pelvic floor muscles.

CAN YOU OVER-STRETCH OR BURST YOUR BLADDER?

So what if you have to cross your legs real tight because the bathroom is occupied, or have to finish some urgent work and can’t nip off to the loo? Should you be concerned if you often hold your pee?

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“Actually, there is little evidence to say you cannot hold your pee. In most instances, there are no complications,” said Dr Tan. “But there are some possible ill effects. Firstly, there may be an increased risk of urinary tract infections (UTIs). I have seen this in patients who take long-haul flights and who are not keen to use the in-flight toilets.”

You’ll know you have an UTI if you experience a burning sensation during urination, increased frequency and urgency of urination, fever, and see blood in the urine, said Dr Tan.

“Women tend to be more prone to UTIs. The infection can be treated with antibiotics,” he said.

Actually, there is little evidence to say you cannot hold your pee. In most instances, there is no complications.

Those with diabetes may also be more susceptible to health issues if they delay going to the bathroom. “In patients with poorly controlled diabetes, I have encountered diabetic cystopathy, where the affected nerves to the bladder don’t let the bladder contract well, leading to incomplete emptying. This can be due to a number of factors, one of which is postulated to be the over-stretching of the bladder when it is too full,” said Dr Tan.

What about non-diabetics? Can the bladder over-stretch if you hold your pee for too long, too often? According to Medical News Today, “regularly holding in pee can cause the bladder to stretch” in the long term. “This may make it difficult or impossible for the bladder to contract and release pee normally.”

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As for the notion that the bladder may burst, that’s less likely to happen. The same website noted that it is much more likely that the bladder will override the muscles holding the urine in, causing the person to have an accident instead.

In short, if you are healthy, not pregnant, and do not have diabetes, you shouldn’t worry if you have to hold it in once in a while. If you have to, don’t do it for more than three hours in the day. At night, your body secretes a hormone that pauses the kidneys’ production of urine when you sleep.

Of course, this doesn’t work 100 per cent as you sometimes still get up in the middle of the night to visit the loo.

Pregnancy and Bladder Control

Is urine leakage common during pregnancy?

Many women experience urine leakage, which is also called incontinence, during pregnancy or after giving birth.

The bladder is a round, muscular organ that is located above the pelvic bones. It is supported by the pelvic muscles. A tube called the urethra allows urine to flow out of the bladder. The bladder muscle relaxes as the bladder fills with urine, while the sphincter muscles help to keep the bladder closed until you are ready to urinate.

There are other systems of the body that help to control the bladder. Nerves from the bladder send signals to the brain when the bladder is full, and nerves from the brain signal the bladder when it needs to be emptied. All of these nerves and muscles must work together so the bladder can function normally.

How do pregnancy and childbirth affect bladder control?

During pregnancy, you may leak urine between trips to the bathroom. You may find that this is especially true when you cough, laugh, sneeze, or do other physical activities that put stress on the pelvic floor muscles. This type of leakage is called stress incontinence. During pregnancy, the unborn baby puts pressure on the pelvic floor muscles, bladder, and urethra. The extra pressure can make you feel the urge to urinate more often. Stress incontinence may be only temporary and often ends within a few weeks after the baby is born.

Pregnancy, the type of delivery, and the number of children a woman has are factors that can increase the risk of incontinence. Women who have given birth, whether by vaginal delivery or cesarean section, have much higher rates of stress incontinence than those who never have had a baby.

Loss of bladder control may be caused by pelvic organ prolapse that sometimes occurs after childbirth. The pelvic muscles can stretch and become weaker during pregnancy or vaginal delivery. If the pelvic muscles do not provide enough support, your bladder may sag or droop. This condition is known as a cystocele. When the bladder sags, it can cause the urethra’s opening to stretch.

Pelvic nerves that regulate bladder function may be injured during a long or difficult vaginal delivery. Delivery with forceps can result in injuries to the pelvic floor and anal sphincter muscles. Prolonged pushing during a vaginal delivery also increases the likelihood of injury to the pelvic nerves and subsequent bladder control problems.

How are bladder control problems diagnosed?

Although most problems with bladder control during or after pregnancy disappear over time, you should visit your doctor if they persist for six weeks or more after you have given birth. It is a good idea to keep a diary to record your trips to the bathroom, how often you experience urine leakage, and when it occurs.

The doctor will perform a physical examination to rule out various medical conditions and see how well your bladder is functioning. Your doctor may order various tests, which might include:

  • Urinalysis: You will be asked to provide a urine sample to be analyzed for possible infections that could cause incontinence.
  • Ultrasound: Images produced by ultrasound waves can show the kidneys, bladder and urethra.
  • Bladder stress test: Your doctor will check for signs of urine leakage when you cough forcefully or bear down.
  • Cytoscopy: A thin tube with a miniature camera at one end is inserted into the urethra so the doctor can examine your bladder and urethra.
  • Urodynamics: A thin tube is inserted into the bladder to fill it with water so the pressure inside the bladder can be measured.

How are bladder control problems treated?

There are several techniques for treating bladder control problems. Practicing Kegel exercises may help to improve bladder control and reduce urine leakage. In addition, changing your diet, losing weight, and timing your trips to the bathroom may help.

Drinking beverages such as carbonated drinks, coffee, and tea might make you feel like you need to urinate more often. Switching to decaffeinated beverages or water can help to prevent urine leakage. Limit your consumption of fluids after dinner to reduce the number of trips to the bathroom during the night. You should consume foods high in fiber to avoid being constipated, since constipation may also result in urine leakage.

Excess body weight can put additional pressure on the bladder. Losing weight after your baby is born can help to relieve some of the pressure.

Keeping a record of the times during the day when you are most likely to experience urine leakage, you may be able to avoid leakage by planning trips to the bathroom ahead of time.

After you have established a regular pattern, you might be able to extend the time between trips to the bathroom. By making yourself hold on longer, you will strengthen your pelvic muscles and increase control over your bladder.

How can loss of bladder control due to pregnancy or childbirth be prevented?

Labor and vaginal delivery have an impact on the pelvic floor muscles and nerves that affect bladder control, so you should discuss your options with your healthcare provider.

Cesarean sections are associated with a lower risk of incontinence or pelvic prolapse than vaginal deliveries, but they may present other risks. Large babies who weigh more than nine pounds at birth may increase the risk of nerve damage during delivery.

Exercising pelvic floor muscles with Kegel exercises can help prevent bladder control problems. Bladder control problems might show up months to years after childbirth. Talk to your healthcare team if this happens to you.

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How to Manage Pregnancy Incontinence

Urinary incontinence affects some 10-13 million Americans — and the condition is twice as common in women. Women are more likely to have bladder control issues, largely because of the changes the body experiences during pregnancy and childbirth. According to the National Association for Continence, 63 percent of stress-incontinent women say their symptoms began during or after pregnancy. In one study, most of the 500 otherwise healthy participants experienced urinary incontinence at some point from the first through the third trimester.

“I would say virtually all pregnant women experience some type of incontinence,” says Anthony Atala, MD, a spokesman for the American Urological Association and director of the Institute for Regenerative Medicine at Wake Forest University Baptist Medical Center in Winston-Salem, N.C.

But incontinence problems don’t have to rule your life during pregnancy.

Why Pregnancy Incontinence Occurs

First, understand the urination process. You’re able to urinate when the muscles around your urethra relax, which allows urine to flow from your bladder out of your body. When you’re finished urinating, the muscles around your urethra contract, holding off any urine flow until you’re ready to empty your bladder again.

Pregnancy can interfere with the normal way your urethra relaxes and contracts. Hormone changes during pregnancy and added pressure on the bladder from your uterus can cause stress incontinence, Dr. Atala says. When you have stress incontinence, you may urinate when you sneeze, cough, or laugh. Walking, running, or exercising can also cause leakage.

Researchers have also discovered that women who have a family history of incontinence, have a higher body mass index, gain more than the recommended amount of weight during pregnancy, and are over 35 when they get pregnant also have a higher risk of experiencing incontinence.

How to Avoid Pregnancy Incontinence

Urinary incontinence doesn’t have to make your life miserable when you’re pregnant. Here’s what to do to avoid leakage:

Schedule your bathroom breaks. There’s no way around it: When you’re pregnant, you’re going to have to excuse yourself to use the lady’s room more often. Being more cognizant of that will help you avoid leakage. Atala suggests planning to use the bathroom at least every two hours. That may mean scheduling bathroom breaks into your day so you don’t get caught with a bladder that’s too full when you can’t get to a restroom.

Practice Kegels. Kegel exercises help to strengthen the pelvic floor and help you avoid leakage, but you need to practice in order to do them properly, Atala says. If you’ve never done a Kegel before, start by stopping the flow of urine the next time you urinate. The contraction of those muscles is how you do a Kegel, and you can do Kegel exercises any time throughout the day, whether your bladder is full or empty.

Simply contract the same muscles you would to stop the flow of urine, hold the contraction for a count of 10, and then release. The American Congress of Obstetricians and Gynecologists suggests doing Kegel exercises 10 to 20 times in a row two or three times a day.

Kegel exercises really do help with incontinence. In a review of studies, researchers found that women who practiced pelvic floor muscle training when they were pregnant with their first baby prevented leakage later in pregnancy and after giving birth. Kegel exercises also helped women who had persistent incontinence problems after giving birth. Keep in mind that it takes about four to eight weeks of doing them regularly before you’ll see results, Atala says.

Watch the weight gain. Studies show that women who weigh more when they get pregnant or who gain an excessive amount of weight during pregnancy are more likely to experience urinary incontinence.

Incontinence: Will It Continue After Pregnancy?

Pregnancy and having a vaginal delivery can stretch the muscles that support the pelvis, making them weaker. As a result, you may leak urine or have trouble urinating even after you’ve given birth.

In a recent study of pregnant women, researchers found that 62 percent had incontinence during the pregnancy. And 50 percent continued to have problems with leaking urine after childbirth. Women who didn’t have problems with incontinence during pregnancy had a lower risk of postpartum incontinence compared to women who experienced incontinence at any point during their pregnancy.

An Unspoken Epidemic?

Unfortunately, many women with incontinence don’t tell their doctors. Some experts suggest this may be because women don’t consider just a few drops of leakage anything to worry about, or they may feel embarrassed to discuss incontinence with their doctor.

But no amount of urinary incontinence needs to be tolerated. If urinary incontinence becomes a problem during your pregnancy or doesn’t go away after pregnancy, be sure to tell your doctor so you can be treated for it. In the meantime, take comfort in knowing that there are strategies to minimize the risk of those embarrassing and uncomfortable leaks from occurring in the first place.

Last Updated on June 29, 2018



As you progress with your pregnancy, your bathroom visits may increase! This is due to the increased pressure building up on your bladder. But if there is an accidental urine leakage, you may find it little embarrassing. Wondering why urine leakage happens in pregnancy? Here’s everything you need to know about urine leakage in pregnancy.



Is Urine Leakage Common During Pregnancy?

Yes, urine leakage or stress incontinence is one of the most common pregnancy problems. One in every three woman experiences this problem during pregnancy. In some women the leakage is very little or minimal but for other women it may be a cause of concern.

Why Does It Happen?

This common side effect of pregnancy happens due to the increased pressure on the bladder. In pregnancy, your growing belly and various hormonal changes make your pelvic floor tissues and muscles to expand. These expanding tissues and muscles weaken the sphincter muscles, which are responsible for controlling the release of urine from the bladder. This may cause urine leakage when you cough, sneeze or laugh.




Thus, your increasing pregnancy weight, hormonal changes and constipation in pregnancy are some of the causes related to urine leakage, as these all put pressure on your pelvic floor muscles.

How Long Does Urinary Incontinence Last?

Urinary incontinence or urine leakage may get worse in the third trimester because of the increased pressure on the pelvic area. Some women may experience urinary incontinence even after birth. In most cases this problem gets better within three to six months after your baby is born.





Treatment

The first line treatment for bladder leakage during pregnancy may include the following:

  • Keeping up a bladder diary: Maintaining a bladder diary will help you establish the frequency of leakages, which will help you in planning your bathroom visits.
  • Practising pelvic exercises: Pelvic exercises will strengthen your pelvic muscles, thus helping you to have better control over your urinary bladder.
  • Include more fiber in your diet: High fiber diet helps in constipation, which means lesser pressure on your pelvic muscles in pregnancy.
  • Keep your weight under control: More weight in pregnancy means more pressure on your pelvic region, therefore keep your weight under check.
  • Refrain from having caffeinated and carbonated beverages: These drinks will make you pee more, thus more chances of urine leakages.

How to Manage Urine Leaking?

Here’s how you may effectively manage your urine leakage in pregnancy:




1. Scheduled Bathroom Visits

If you are facing urine leakage in pregnancy, it will be extremely helpful if you make a schedule for your bathroom visits. You may plan an hourly or two hourly visits to the bathroom. The aim is to not let your bladder feel too full, to avoid any leakage. Keeping track of your loo visits in an effective way of managing urine leakage in pregnancy.

2. Absorbent Pads

Another good option to manage your urine leakage in by wearing an absorbent pad or panty liners. These are very effective in saving you from any embarrassing urine leakages. If you are working or going out of the house for a longer duration, it will be a good idea to carry an extra pad for changing.





Prevention

You can prevent urine leakage in pregnancy by adopting some of the following measures:

1. Kegel Exercises

Kegel exercises are a very effective way of preventing urine leakage in pregnancy. Urine leakage happens because of weakened pelvic tissues and muscles. Doing three sets of ten repetitions a day of Kegel exercises, is a good way of strengthening the pelvic muscles. The strong pelvic muscles will hold urine and avoid any urine incontinence. Kegel exercises are absolutely safe and can be done in pregnancy. However, it is suggested that you consult your doctor to know which Kegel exercises you may do in pregnancy.




2. Stay Hydrated

It is very important to stay hydrated in pregnancy as dehydration in pregnancy may lead to complications such as pregnancy related headaches, preterm labour and other such complications. It is recommended to consume at least six to eight glasses of water in a day to avoid dehydration. Many women may cut of water and other fluids thinking it will avoid the problem of urine leakage. But cutting down water and other fluids is not an effective solution to battle with urine leakage; rather it may cause bladder irritation and other serious medical issues.

3. Pelvic Floor Exercise

Many researchers feel that if a pregnant woman begins with pelvic floor exercises early in pregnancy, it may be helpful in keeping the problem of urine leakage at bay. These exercises strengthen your pelvic floor muscles and thus help you control the flow of urine. Regular practising of pelvic floor exercise refrain the muscles from becoming flaccid.





How Can Accidents be Avoided?

Here’s how you may avoid urine leakage accidents from happening:

  • Keep tabs on your diet: Do not eat spicy food, which may irritate your bladder. Refrain from aerated drinks, tea and coffee. Eat food items which irritate your bladder.
  • Keep constipation under control: Drink plenty of water to ward off constipation. The problem of constipation puts pressure on your pelvic region, thus making you more susceptible to have weaker pelvic floor muscles.
  • Maintain adequate of water: Make sure you drink plenty of water as inadequate amounts of water in pregnancy may lead to concentrated urine, which may irritate the bladder.
  • You may also try sitting in a cross legged position if you feel the urge to sneeze or cough. Sitting in this position helps in controlling the urine to an extent.

Bladder Training

You may even opt for bladder training to manage the urine leakage in pregnancy. Bladder training helps you to manage the gap between two bathroom visits. It effectively teaches you how to hold the urine in the bladder until your next bathroom visit. You may get in touch with your doctor to know more about bladder training program and your doctor may advise a program that is best suited for your condition.




Urine leakage is a very common pregnancy problem and can be effectively managed with the above-mentioned tips. However, if you feel that you are not able to manage this problem on your own or you experience tingling sensation, notice blood, unusual odour or any other symptom in your urine, consult your health care adviser at once.

I Pee When I Sneeze—What Can I Do About It?

For many women, peeing while sneezing is more than a common occurrence—it’s a frequent annoyance and often an embarrassment that many experience in silence.

What they might not realize is that urinary incontinence is normal: About a quarter to a third of Americans experience it. And though many might think it’s a permanent issue, it’s treatable.

Stress incontinence, a form of urinary incontinence, happens when physical activity such as coughing, sneezing or running puts pressure on the bladder, explains Samantha Pulliam, MD, director of UNC Urogynecology and Reconstructive Pelvic Surgery.

Stress incontinence is caused by weakened pelvic floor muscles or other physical changes in the body. For women, bodily changes such as pregnancy, childbirth, menopause or hysterectomies are main causes of stress incontinence.

Other risk factors include:

  • Being female
  • Age
  • Being overweight
  • Smoking
  • Family history
  • Other diseases, such as diabetes or neurological conditions and illnesses that cause chronic coughing or sneezing

So, what can you do to treat stress incontinence? Dr. Pulliam recommends the following treatments to help prevent leakage:

Vaginal Pessaries

A pessary is a ring device that sits in the vagina. “The vagina is just underneath the urethra, so the pessary pushes underneath the urethra to support it,” Dr. Pulliam says. With this extra support, there is an increased outflow from the urethra and a corrected angle between the urethra and bladder, both of which can help stop leakage.

Pelvic Floor Physical Therapy

“Seeing a physical therapist can help to ensure that the pelvic floor muscles are working properly and are strong enough either to inhibit leakage or to calm the bladder to resist an urge,” Dr. Pulliam says. Along with this more formal training, at-home Kegel exercises can also help strengthen the pelvic floor muscles.

Urethral Bulking

This procedure involves injecting a bulking substance, such as collagen, around the urethra to either close a hole or build thickness in the urethral wall. This added thickness helps the urethra withstand extra pressure from physical activity.

That said, the effects of urethral bulking aren’t as long-lasting as other treatment options, Dr. Pulliam says. As a result, this procedure is used less often and is usually reserved for older patients.

If the above treatments don’t help, surgery could also be an option. Dr. Pulliam says, in most cases, surgery should only be explored if less invasive treatments don’t work.

Surgical options for urinary incontinence include:

  • Vaginal sling procedure, where a piece of tissue or synthetic material is used to create a sling around the urethra, which helps keep the urethra closed
  • Sacral nerve stimulation, which requires implanting a neurostimulator device in the body to help control muscle function

Talk with your doctor about which treatment is right for you.

Do you need to see a urogynecologist? Find one near you.

Samantha Pulliam, MD, is director of Urogynecology and Reconstructive Pelvic Surgery and an assistant professor at the UNC School of Medicine.

How can I Identify if I have pregnancy incontinence?

If you’re carrying, or have recently had a child, there’s a chance you may experience pregnancy related incontinence. The weight of a baby and the stress of labour both contribute to a weak pelvic floor. Many women experience symptoms such as:

  • Leaking urine when coughing, sneezing, lifting, laughing or exercising
  • Inability to control passing wind
  • An urgent need to empty the bladder or bowel
  • A leaky bowel motion after going to the toilet
  • Difficulty passing a bowel motion
  • The feeling of a lump or dragging sensation in the vagina (this may indicate a prolapse)

Urine or amniotic fluid?

It may be difficult to tell the difference between stress incontinence and leakage of amniotic fluid (your ’waters’) during your last few weeks of pregnancy.

When your waters break, amniotic fluids leak from your vagina — it may be a gush or just a trickle. Even though you’re probably moving slowly and carefully, amniotic fluid usually leaks out when you stand after being lying or sitting for a long time and unable to control it. Amniotic fluid doesn’t usually smell and is usually colourless (although it may contain specks of mucus or blood).

Urine, however, tends to leak when you cough, laugh, sneeze or move suddenly, even if you’re lying down. It can be clear, or straw coloured but usually has a distinctive odour.

If you think you’re leaking amniotic fluid, or your fluid has meconium in it (generally a dark green), contact your midwife, doctor or labour ward immediately.

How can I manage incontinence?

Poise has a range of discreet and comfortable Liners and Pads that can help with light bladder leakage and pregnancy incontinence.

To learn more about the products available, and find the right product for you, visit our Poise products page.

This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek advice from a qualified health care professional with any questions regarding your concerns.

While you might hear way more about post-pregnancy incontinence, changes to your bathroom habits, or what I’m calling “pregnancy peeing,” while you’re still expecting are certainly just as legit. According to the Mayo Clinic, the cause for the constant need to pee is likely from hormones and, later in pregnancy, the baby pushing against your bladder.

Dr. Christine Carter Sterling, “your body produces more urine when pregnant, which of course, in turn means you have to use the bathroom more, and in addition to making more urine your bladder capacity decreases,” she explains. Involuntary loss of urine or incontinence is very common in women, Dr. Sterling adds. In fact, “by the third trimester, half of women have experienced an unwanted loss of urine.” so don’t be embarrassed if it happens to you! Here, five women who had very different levels of incontinence during pregnancy open up about the experience:

1. “My husband and I used to always go for long walks through the park. Once I reached a certain stage in my pregnancy, I had to make sure I was close to a bathroom at all times. We started walking on the boardwalk and not through the park, so I could take pitstops at Starbucks. I definitely had a few incidents where I sneezed and leaked a bit. There was also one time on a walk where I tripped on my sandal, fell down, and peed myself a half block from our building. During the later stages of my pregnancy, the pressure in my bladder became harder to describe…it was different than the normal sensation of a full bladder, but in the end, it was just pee. I also started wearing more dresses, as dresses allowed the easiest access to relief. “—Georgeanna, 30

2. “Out of all the joys pregnancy brings you, no one ever tells you that along with the ‘beautiful glow,’ you’ll be visiting the bathroom every .97673 seconds. Coming from a non-frequent pee-er, this is a huge change to my daily life. Some of the most inconvenient times are when I’m watching tv, have to go pee, sit back down, finally get comfortable, only to realize I have to pee again and haven’t even gotten to the next commercial. The absolute best is when your dear husband tells you the next morning how annoying it is that you got up this many times to go pee in the night. My advice would be that if you see a toilet you might as well go use it, because either way, you’ll be back in five minutes.”—Alana, 26

3.”Every time I would sneeze, cough, or laugh, it would result in a sudden urination surprise. Early in the pregnancy would be something I could ignore, but the further I got in my pregnancy I had to go and take care of it as soon as possible. It was very embarrassing because it was my first time being pregnant and I didn’t know what to expect. I would find myself in these awkward moments at church, at family gatherings, and even going on dates with my husband. To accommodate, I would make sure to be equipped with pads at all times and sit closer to the restrooms whenever I was out in public.”—Veonne, 26

4. “During the beginning and last four months of my pregnancies I needed to go to the bathroom the most — at least every 15 minutes if not more frequently. When I was in my third trimester, anytime my daughter moved inside me, I coughed, sneezed, or even laughed, I would leak a bit. It honestly felt like sometimes I lived in the bathroom. Anytime we would go out anywhere, I would scan the building to know where the bathrooms were because I knew it was only a matter of time before I need to use one. “— Mariana, 27

5. “No one talks about . You have to cross your legs when you sneeze or cough or laugh too hard. It got so bad during the end of my pregnancy that I ended up peeing the bed. I had to wear a Poise pad at work so I wouldn’t have an accident.”—Becky, 39

6. “My more frequent bathroom visits during pregnancy actually changed my fashion choices permanently. Where before I might have fumbled with buttons and zippers, I fell in love with the ease of maternity jeans and, post-pregnancy, jeggings. Just push your pants down in one, simple movement and you’re set! It was much easier than searching for the fly hiding beneath the curve of my pregnant belly. As for leakage, then and now, it was easily triggered by a heavy sneeze or coughing fit. I would feel myself pee, just a little bit, into my underpants. It wasn’t enough to leak through my pants, but definitely enough to dampen the undergarments and necessitate a change. I began wearing pantyliners daily.”—Steph, 37

7. “When I was pregnant, I went to the bathroom so much that I would wake up thinking ‘It’s been too long since I last urinated,’ even if I didn’t have the urge to go. I shopped at malls more often than cute shopping neighborhoods and streets because I could always count on Nordstrom’s to have a clean bathroom. I avoided drinking for an hour before bed time minimize waking up right after falling asleep to pee.”—Christine, 32

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Carina Hsieh Sex & Relationships Editor Carina Hsieh lives in NYC with her French Bulldog Bao Bao — follow her on Instagram and Twitter • Candace Bushnell once called her the Samantha Jones of Tinder • She enjoys hanging out in the candle aisle of TJ Maxx and getting lost in Amazon spirals.

What No One Will Tell You You About Stress-Induced Incontinence During Pregnancy

When you’re hunched over the toilet tossing your pregnant cookies, it can feel like nothing could possibly be worse. But I’m here to say: it can be. When you lift your head from that porcelain bowl only to discover that your bladder has betrayed you, well, there’s no greater treachery. Pregnant women are fairly educated when it comes to first trimester discomforts like morning sickness and nausea, or even the phenomenon of “snissing,” but you’d be hard pressed to find a book or article that tells you about stress-induced incontinence during pregnancy. Consider yourself warned.

After my first pregnancy, I thought I knew everything there was to know about vomiting. After all, I’d thrown up damn near everything just about everywhere at all hours of the day. I knew that Zofran didn’t help me, but that peppermint oil could keep the nausea at bay, at least until I found an appropriate receptacle for my vomit. I knew what to expect from a pregnancy, and I’d even come to grips with some incontinence postpartum. It wasn’t so bad. In my mind, then and always, not being able to jump in the bouncy house was a small price to pay for my beautiful baby.

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Enter second fetus. It was a few days before the six week mark, and I could feel it coming. I braced myself for the coming barf, but I got more than I bargained for. When I stood up after an unpleasant second encounter with my lunch, I was surprised to find a tiny puddle at my feet. I’d thrown up with such force that I lost control of my bladder. That’s right. I puked so hard I peed myself. The worst part was I hadn’t even realized it. I continued the peeing and puking pattern for the next five weeks, until the vitamin B6 and Unisom combo finally kept me from vomiting daily.

This explains why, as in my case, stress incontinence did not present until a subsequent pregnancy.

So what exactly is this fresh hell? It’s called stress-induced incontinence. According to WebMD, stress incontinence occurs when the pelvic floor muscles (those that support the bladder) and urinary sphincter muscles (those that regulate the release of urine) weaken. In a normally functioning bladder, valve muscles in the urethra will keep you from leaking urine as your bladder expands until you can get to a bathroom. If those muscles are weak, then anything that puts pressure on the abdominal muscles (like laughing, sneezing, or yes, vomiting) can cause leakage.

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While men are most likely to suffer from stress incontinence as a result of prostate surgery, in women, the pelvic floor muscles typically lose strength due to childbirth. Delivering a child vaginally can cause tissue or nerve damage, resulting in poor sphincter or pelvic floor muscle function. This explains why, as in my case, stress incontinence did not present until a subsequent pregnancy. Experienced obstetrician Dr. Yuri Lee explains, however, that a C-section doesn’t give you a free pass on incontinence because you still carried a baby in your pelvis. Other risk factors, according to Dr. Lee, include obesity and advanced age. A forceps-assisted birth also appears to put you at higher risk for stress incontinence.

Incidentally, I can now throw up between my legs.

What’s a pregnant lady to do if she’s habitually urinating when she vomits? The first thing is to get the morning sickness itself under control. If it’s the violent retching that’s causing you to throw up, then reducing its frequency will also help cut down on the pants peeing. WebMD suggests changing eating patterns to lessen vomiting. That means eating small meals throughout the day, sipping fluids, and avoiding fried, greasy, or spicy foods. Home remedies such as ginger and lemon may help assuage your queasiness as well. Your provider may also consider medical interventions such as the B6/Unisom combo mentioned above, acid reflux blocker Protonix, or bowel stimulant Reglan.

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If you can’t get the vomiting under control, brave women who have been in the trenches are a great source of hacks. Morning sickness warrior Lindsey Morrow suggests grabbing a towel to put between your legs (drop trou first!) to salvage your clothes. Sometimes changing your position can help. Try sitting with your legs around the bowl instead of squatting or kneeling. If you’re at all able to control your puking, you can also try voiding your bladder before dealing with the other end. Incidentally, I can now throw up between my legs. #Skills

Unfortunately, due to the stigma, many women are reluctant to report incontinence to their doctors.

Great. Now how the hell do you keep it from happening to you? Well, turns out that when your OB, midwife, pregnancy app, expectant mother book, mom, and best friend encourage you to do your Kegels, they really mean it. The American Congress of Obstetricians and Gynecologists suggests doing Kegel exercises two to three times a day at 10-20 repetitions. Dr. Lee tells her patients to do them at every stoplight while driving. They really are easy. All you have to do is contract the same muscles you would to stop the flow of urine for a count of 10. They work, too. Kegels are effective at both preventing urine leakage if you do them during pregnancy and as a reactive measure if you’re already postpartum.

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According to EverydayHealth, urinary incontinence affects 10-13 million Americans. Women are more than twice as likely to experience bladder control issues (you know, because we’re the ones having the babies). Unfortunately, due to the stigma, many women are reluctant to report incontinence to their doctors. I get it, ladies. It’s embarrassing, but I’m not going to let a little awkwardness stand in the way of my health or sharing my story so other women don’t have to suffer in silence. Soiled sweatpants solidarity, sisters. Knowledge is power.

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If you’ve read any of my past blog contributions, you know I’m someone who has managed pelvic pain for the past decade, (if you haven’t read them, feel free to check them out here, here, and here) and while I was confident that in that time I had gamely faced and overcome all of the issues, big and small, that come with that, turns out I was wrong. Enter cold and cough season.

This year I got struck early on in the season by a nasty case of bronchitis (basically a fancy word for chest cold). A hacking cough ensued. After a couple of days of heavy coughing where I was sure any minute a lung would come flying out, something…er…interesting happened. During a fit of coughing, I completely lost my bladder. At first I thought it was just the result of a particularly wracking coughing spell, but for the next few days, every time I coughed, bam! I peed my pants.

I panicked. “So is this a new symptom that I’ll have to figure out?!” I wondered. “Are my ‘tight’ pelvic floor muscles now also ‘weak’ pelvic floor muscles?!” “And if so, wouldn’t any efforts to strengthen my tightish pelvic floor be a bad idea?!”

To put my fears to rest I did what I always do when my pelvic floor stumps me: I called Stephanie, my PT.

In this blog post, I’m going to share what I learned from Stephanie because turns out what happened to me is very common for folks with a pelvic floor that runs a little on the tight side or who have pelvic pain.

What I was experiencing is known as “stress urinary incontinence,” something that can happen when the pelvic floor muscles don’t work properly.

You see, when you urinate, urine flows from the bladder through the urethra to the outside, and the pelvic floor muscles are among the structures that support the bladder and urethra. And when the pelvic floor muscles are compromised, urine can escape when pressure is placed on the bladder.

And that’s exactly what was happening to me. When I would let out a real wallop of a cough it put a ton of pressure on my abdominal muscles, which then put pressure on my bladder.

But it wasn’t happening because my muscles were weak, which is what I assumed at the time.

“Your pelvic floor muscles are not necessarily weak, but they are tight. ” Stephanie explained. “Muscles function optimally–meaning they generate maximum force–at a certain length. When muscles are too tight they generate less force. In your case, because your muscles are too tight, the amount of force they were able to generate was not enough to keep your urethra closed against a powerful cough.”

So because my issue was tightness, not weakness, which is what I originally assumed when the leakage began, I didn’t have to strengthen, but needed to continue on the track of lengthening my too tight pelvic floor muscles. Which was a relief because I knew that efforts to strengthen pelvic floor muscles, such as doing Kegels, could have an adverse effect on too tight muscles, making them even tighter and causing pelvic pain.

“Lastly,” Stephanie said, “while leaking urine is a sign that something is not working properly, it’s important NOT to panic and to know that the problem is likely going to be transient. If anything, it’s indicative that you still have tight pelvic floor muscles.

Coughing is similar to doing repetitive Kegels. My patients with pelvic pain may feel an increase in their symptoms after being sick because their muscles could not relax after the forceful pelvic floor contractions that come with coughing. The good news is you can work on improving your pelvic floor muscle function through your continued PT and home exercises. ”

Stephanie advised that I manage the symptoms for as long as they lasted, which turned out to be about a week, which for me meant wearing pads and/or hanging out on the throne when I felt a particularly bad coughing spell coming on. And to counter the muscle tightness, she suggested that I get back into the habit of doing my pelvic floor drops.

However, there was one lingering question that my cough induced leakage brought up that I wanted to run past Stephanie: What happens in situations where someone has both a tight and a weak pelvic floor? Because if there’s one thing I’ve learned in the years I’ve dealt with pelvic floor issues, it’s that the pelvic floor is fixable; if it’s too tight, you can work to loosen it up, and if it’s weak you can strengthen it. But what if you are someone who has both a weak and a tight pelvic floor? What then?

Here’s what Stephanie had to say about this: “While tight pelvic floor muscles result in what appears to be weakness, the fact is that once they’re lengthened to a normal position, they are able to generate more force. So if a tight muscle is returned to its normal resting length, and is still unable to generate adequate force, it is in fact also a weak muscle and it’s time to strengthen it.

Generally speaking, however, women with a history of pelvic pain that are still menstruating and have not given birth likely have tight muscles. On the other hand, peri-menopausal, menopausal and/or women who have given birth may have muscles that are weak. Both groups may leak urine in situations where the abdominal pressure exceeds the capacity of their pelvic floor muscles. My suggestions are different for each group.

Women with weak muscles will benefit from an uptraining program to strengthen their pelvic floor and girdle muscles and improve their motor control. Additionally, this group may reduce episodes of stress urinary incontinence by performing a technique referred to as “the knack” prior to coughing or lifting. The knack is a learned motor skill that involves contracting your pelvic floor muscles when urine is likely to leak.

Conversely, women with tight muscles need to focus on lengthening their pelvic floor muscles, taking the steps mentioned above. The knack technique will not help them because contracting their muscles further just leads to more shortening, which generates even less force.

I hope this post has been helpful to anyone who, like me, thought they had seen it all when it comes to pelvic floor maintenance. If you have any questions about the issues covered in this post, or about incontinence in general, please leave them in the comment section below, and I’ll be sure to pass them along to Stephanie!

Take care,

Molly

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