25.10.2020

Incontinence in women after childbirth

Recovery after childbirth can take several months. During the rehabilitation phase, a woman may face many problems. For example, a patient is often worried about urinary incontinence after childbirth. This is a phenomenon that causes a lot of inconvenience. It occurs in women against the background of natural childbirth and after cesarean. 

Postpartum urinary incontinence is a pathological condition resulting from a weakening of the muscles of the pelvic floor and a change in the position of the pelvic organs. The problem requires medical supervision. In some cases, pathology can be eliminated only surgically.

There are several types of postpartum incontinence:

Type of pathology Description
Stressful Involuntary urination occurs when coughing, sneezing, exercise. This form of pathology is characteristic of women giving birth in a natural way.
Imperative Occurs with a sudden urge to urinate. At the same time, the woman does not have time to react in time and finds herself in an awkward situation.
Involuntary This urinary incontinence is observed throughout the day. In this case, urine can be released in small drops, as well as trickles.
Enuresis This form of pathology is extremely rare in adults. However, it can be observed in women who have just given birth. In this case, urination occurs during sleep.
At overflow In this case, urine is excreted in small portions and only when the bladder is full. A similar condition indicates pathology. For example, the phenomenon is often diagnosed with uterine fibroids or infections.
Reflex Confusion can occur with a loud sound or unexpected action. Any external factor can cause urinary incontinence.

In addition to the above, urine in women can also be released after emptying the bladder. Usually women observe small drops. This condition lasts about a couple of minutes, then passes until the next urination.

Causes

Involuntary urination occurs as a result of dysfunction of the muscles of the pelvic floor. During childbirth, they stretch, become less elastic.

Various factors can provoke urination disorders:

  • twin pregnancy;
  • too large fruit;
  • excess weight in the mother;
  • perineal tears that occurred during childbirth;
  • repeated birth;
  • mental abnormalities in a woman;
  • infections
  • hormonal disruptions;
  • the presence of a similar problem in close relatives.

In order to choose an effective treatment, it is necessary to determine the exact cause of the development of pathology. To do this, you need to visit a gynecologist. The doctor will perform the necessary examination and prescribe a referral for tests.

Post-birth urinary incontinence: what to do

Postpartum urinary incontinence occurs in approximately 30–40% of women. Most often, the pathology occurs with repeated birth. You cannot ignore the problem. Also, do not wait for the condition to normalize on its own. The sooner the problem is discovered, the faster the woman will get rid of it.

If the problem does not disappear within a few weeks after delivery, experts suggest several ways to solve it:

  • conservative;
  • surgical;
  • physiotherapy.
Pathology Diagnostics

Before treatment, a woman should undergo a comprehensive examination.

It includes a number of examinations and analyzes:

  • history taking – the gynecologist asks the woman questions about her current condition, finds out when the problem arose. The doctor must be informed about the presence of concomitant symptoms, such as pain during urination, etc.
  • examination on a chair allows you to assess the condition of the birth canal of a woman, as well as to identify the pathology that caused urinary incontinence;
  • cystoscopy is a procedure that allows you to assess the condition of the walls of the bladder and identify foci of inflammation. In this case, an effective treatment is selected. Sometimes a course of antibiotics is required;
  • Ultrasound The procedure is necessary to assess the general condition of the pelvic organs. Ultrasound also determines deviations in the arrangement of organs relative to the norm;
  • urodynamic research. It includes a wide range of procedures. These include profilometry and cystometry;
  • the appointment of a general urinalysis is necessary to identify inflammatory processes in the urinary tract and bladder.

Treatment of incontinence is selected depending on the results of the tests and the general condition of the woman.

Conservative therapy

In this case, you need to make sure that the problem was not provoked by inflammatory processes. If the tests confirm the presence of infection, the woman is prescribed appropriate medications. In all other cases, medication is not practiced.

The main method of conservative therapy is special gymnastics. Kegel exercises help strengthen muscles and normalize the condition of perineal tissues. Fitball exercises are also recommended. Some exercises can be done only after a complete recovery of the body. That is why before starting classes, you need to talk with a gynecologist. Exercises can be performed at home or sign up for special courses.

If conservative treatment of urinary incontinence is ineffective, a woman is prescribed surgery.

Surgery

There are several ways to eliminate involuntary urine output.

Minimally invasive techniques avoid injuries and significantly reduce the rehabilitation period:

  • the introduction of a special gel. In this case, a special composition is introduced into the paraurethral space. This method does not give a 100% guarantee of retention of urine. After the procedure, relapses often arise, requiring repeated correction;
  • the use of synthetic loops. Such a loop is inserted under the middle part of the urethra. The design provides additional support and protects against unpleasant situations. This method is more effective.

Urethrocystocervicopexy is a complete surgical intervention. The operation is prescribed if minimally invasive methods do not give the desired result. The essence of the treatment is to fix the bladder, uterus and urinary tract. This method is used very rarely. After the procedure, the woman needs a long rehabilitation period. However, urinary incontinence passes.

Physiotherapy

Physiomethods are optional. They are combined with the main therapy and can achieve better results.

There are several methods of physiotherapy:

  • electrical stimulation;
  • electromagnetic stimulation.

The procedures are aimed at strengthening the pelvic floor muscles in women. As a result, the process of urination is normalized. However, physiotherapy with the allocation of urine have contraindications.

Refuse additional measures of assistance will have women with the following problems:

  • the presence of malignant tumors;
  • benign neoplasms with a high risk of degeneration into malignant;
  • violations and malfunctions of the cardiovascular system;
  • diseases of the liver and kidneys in the acute stage.

In the presence of at least one of the contraindications, the listed methods should be discarded. Before starting the course, you need to consult a gynecologist and therapist.

When will pass

If postpartum urinary incontinence was triggered by natural causes, then it will pass within a few weeks. As soon as the muscles become toned, involuntary urination will stop. However, if the pathology does not disappear within 2-3 weeks, it is urgent to seek help. Perhaps this is precisely the case when surgery is indispensable.

In the absence of timely assistance, complications may develop:

  • prolapse of the pelvic organs – in this case, a part of the vagina, bladder and urethra is displaced. Organs take an unnatural position, which can cause more serious pathologies;
  • the development of skin infections – with constant leakage of urine, irritation of the skin occurs. In case of violation of hygiene rules in the perineum, sores and a rash form. Such wounds heal for a long time and have a high probability of infection.

If a woman resorts to methods of conservative therapy, does regular gymnastics, then you can wait for the final result from treatment after 6-12 months.

Urinary incontinence after cesarean section

Urinary incontinence can occur both after natural birth and cesarean section. The fact is that during the bearing of the child, an increased load is placed on the bladder and pelvic floor muscles. As a result, they are stretched and lose their functionality. To normalize the process of urination, it takes some time.

In addition, during a cesarean section, the urethra of a woman is exposed to an additional load in the form of a catheter. Often, the design injures the mucous membrane, violates the sensitivity of nerve endings. If the catheter is inserted incorrectly, the risk of infection of the urinary organs increases.

Another factor that causes incontinence is the location of the suture on the uterus.

For patients undergoing a cesarean section, individual programs for correcting the problem are selected. The fact is that after the operation, physical activity is prohibited for a long time. Thus, fitball exercises or Kegel exercises are not suitable for such women. Incontinence is eliminated in other ways.

In addition, after cesarean, it is important to assess the condition of the muscles, since it is highly likely that urinary incontinence after childbirth was provoked by violations in surgical intervention.

Pathology prevention

The treatment of urinary incontinence is a long and complex process. In addition, the course of therapy takes time that a woman could spend with her child.

There are prevention methods that prevent the development of pathology:

  • during pregnancy, you must follow a diet. Excess weight increases the load on the pelvic organs. As a result, the risks of developing postpartum urinary incontinence increase;
  • Follow your doctor’s recommendations. This will not only avoid problems with the muscles of the perineum, but also not harm the baby;
  • Use special designs. Postpartum bandage is a must for pregnant women. The device reduces the load on the muscles of the pelvic floor;
  • watch out for food. Frequent constipation increases pressure on the urethra. This contributes to the risk of urinary incontinence;
  • follow hygiene. Urogenital infections can lead to postpartum urinary incontinence. The sooner an infection is detected, the lower the risks of developing pathologies;
  • do special exercises. Exercise strengthens the muscles of the vagina and also reduces the risk of breaks during childbirth. Before starting an exercise course, it is important to consult a gynecologist;
  • do not tolerate urination. This condition leads to stretching of the muscles of the bladder. As a result, incontinence develops.

Postpartum urinary incontinence is common. Despite this, you should not wait for it to pass on its own. Sometimes, to eliminate the pathology, the help of doctors or the implementation of special exercises are required. If the condition worsens, you need to contact a gynecologist. Sometimes a urologist consultation is required. The sooner a problem is discovered, the less complications will arise in the future.

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