After childbirth, urine does not hold well. How to cure urinary incontinence in women after pregnancy and childbirth? Diagnosis of postpartum incontinence

About a third of all women experience urine leakage after childbirth. Someone spontaneously secretes only a few drops, while some have very significant volumes of urine. Most women consider urinary incontinence after childbirth to be normal and do not go to their doctor about it. Some people even consider the problem to be delicate and prefer to get rid of it using folk methods. It is important to understand that this postpartum condition is pathological and requires correction.

Urinary incontinence: concept

This disease is characterized by the spontaneous secretion 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 quality of life and negatively affects the psychoemotional state. Many women believe that urinary incontinence after childbirth is normal. Contrary to popular belief, it definitely needs to be treated.

Symptoms

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

The following symptoms are the basis for the diagnosis:

Involuntary discharge of urine occurs regularly, including at night. It is impossible to control it.
The amount of urine that flows out is usually substantial.
Episodes of incontinence occur during sports, sexual intercourse, and stress.
After emptying the bladder, residual secretions continue to flow out.
Frequent and sudden urge.

Nevertheless, even if the involuntary discharge 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 ailment, each of which has characteristic symptoms.

Urinary incontinence is of the following types:

Urgent. It cannot be controlled, the urge to urinate is very strong and appears suddenly.
Stressful. Urine leakage is observed even at low voltage. For example, urinary incontinence appears after childbirth when sneezing, laughing, coughing, during physical activity, both low and high intensity, etc.
Paradoxical ishuria. Spontaneous excretion of urine occurs when the bladder fills. At the same time, it is impossible to control the process.
Reflexive. The act of involuntary urination is the result of fright. It can also occur if a person hears the sound of pouring water.

Typically, postpartum women experience stressful urinary incontinence.

Causes

The occurrence of a complication is associated with changes in the woman's body during pregnancy and its completion.

The main causes of urinary incontinence after childbirth are:

Weak ligaments. During gestation, changes occur in the pubic and ilio-sacral joints. They are characterized by a gradual relaxation of the ligaments, which is the norm during pregnancy.
Weak pelvic muscles. The closer the childbirth process, 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.
Dilation of the pelvic tissue. Divergence of bones during labor is necessary so that the child does not get injured.
Breaks. They are not uncommon during childbirth. In addition, doctors may resort to episiotomy, a method to facilitate 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 a complication:

hereditary predisposition;
overweight;
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;
previously, surgery was performed in the pelvic organs.

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

Which doctor should I go to?

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

It is important to understand: 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 multiply.

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 anamnesis, he should receive answers to the following questions:

how many childbirth the woman underwent, whether there were complications;
whether she has chronic diseases;
whether hormonal imbalance has ever been detected;
whether surgery was performed;
whether the patient suffers from pathologies of the nervous system.

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

Diagnosis of urinary incontinence consists of several stages:

Examination on a gynecological chair. The doctor assesses 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 perineal region. After that, he takes biomaterial for examination from the urethra, cervix and vagina. These analyzes are necessary in order to confirm or exclude the presence of inflammatory processes. A general urine test and bacterial culture are also prescribed without fail.
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 released at one time, how many acts of urination and incontinence episodes were in 24 hours ., how many pads were used, what kind of 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.
Instrumental research. As a rule, the patient is assigned a transvaginal ultrasound, during which the state of the urethra, the bladder itself is analyzed, and sphincter insufficiency is detected or excluded.

After completing 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 psychoemotional disorders, etc., a comprehensive urodynamic examination is indicated. It includes: uroflowmetry, cystometry, cystoscopy.

If, in the process of diagnosis, a woman's nervous system disorders are identified, she is referred for consultation to a psychotherapist or neuropathologist. Often it is necessary to consult an endocrinologist.

Conservative treatment

Postpartum urinary incontinence in women is a pathology for which medications are rarely prescribed. The exception is when the patient is diagnosed with enuresis. To reduce the severity of symptoms, the intake of vitamins and drugs is shown, which have a positive effect on the state of blood vessels, the blood circulation process and the work of the nervous system.

The main conservative treatments for urinary incontinence after childbirth are:

Strengthening the muscles of the organ itself and the pelvic floor. Your doctor may recommend exercise with weights and vaginal cones. Holding on to foreign objects gradually strengthens the muscles in the vagina and those involved in 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, you need to constantly strain the muscles of the rectum and vagina. For best results, do at least 200 reps per day.
Implementation of acts of urination on a 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.
Physiotherapy. As a rule, treatment with electromagnetic waves is prescribed. When combined with exercise, this method yields the best results.

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

Duration of treatment

Postpartum urinary incontinence is a complication that requires an individualized 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 ailment persists, the woman is sent to the hospital with a referral for surgery.

Surgery

In practice, several methods are used to get rid of pathology. Typically, the operation 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 to her no earlier than 2 weeks after the operation.

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

If not treated?

Postpartum urinary incontinence is a complication that is not dangerous at the initial stage. But it significantly impairs 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 auspicious. The overwhelming majority of women forget about the problem of urinary incontinence after childbirth. Very rarely, conservative treatment methods do not bring the desired result; surgical intervention is prescribed only in isolated cases. But even after it is carried out, the likelihood of relapse is minimal.

Preventive measures

In order to prevent the appearance of a complication, you must follow simple recommendations throughout your 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 alcoholic beverages, do not smoke;
keep body weight under control;
emptying your bowels regularly;
observe the drinking regime.

An attentive attitude to one's 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 regimen will be drawn up. In most cases, it is enough to do specific exercises and go to physical therapy. If these methods are ineffective, surgical intervention is indicated.

Many women experience urinary incontinence to varying degrees during pregnancy. This is due to an increase in the mechanical pressure of the uterus on the bladder and pelvic floor muscles, as well as an altered hormonal background. Such urine leakage normally occurs immediately after childbirth or during the first weeks after the baby is born. But for some young mothers, a delicate problem is delayed indefinitely. In this case, doctors advise not to ignore the inconvenience, hoping that the condition will resolve itself. It is recommended to contact a specialist and act together in hot pursuit.

What is urinary incontinence after childbirth?

The tissues and muscles of the pelvic floor (pelvic floor) that support the uterus, intestines, and bladder stretch during pregnancy. This is due to the hormonal background of the expectant mother and the weight of the growing child. The process of childbirth further weakens the pelvic floor, which makes it difficult to contract the small muscles of the fundus and the sphincter of the bladder.

Normally, the nerves, ligaments and muscles of the pelvic floor work together to support the bladder and ensure that the urethra (urethra) closes tightly, so urine does not leak

The sphincter is a muscle valve located at the bottom of an organ that controls the flow of urine. Disruption of his work causes the woman to have problems with urination control. With any exertion - coughing or sneezing, while laughing, running - a small part of the urine flows out involuntarily. This type of incontinence is called stress incontinence.

Urinary incontinence is common among women who have recently given birth. In the first year after the birth of a child, this problem affects about a third of young mothers. The use of maternity pads helps to absorb drips. It is recommended to choose dense, soft urological pads as they absorb urine better than ultra-thin menstrual hygiene products.

Causes and risk factors

Women who have problems with bladder control during pregnancy, especially in the first or second trimester, are more likely to develop stress incontinence. Obese women are also at increased risk - many studies show this condition to be the most important factor.

Women with moderate to severe stress urinary incontinence during or before pregnancy are more likely to develop persistent - sometimes years - of urinary incontinence after childbirth.

Postpartum stress incontinence most often develops as a result of natural childbirth. But even young mothers after a planned cesarean section, who completely managed to avoid contractions, are also not immune from such disorders.

Damage or weakening of the ligamentous apparatus of the urethra during pregnancy or childbirth can lead to intermittent urine leakage

The following factors increase the likelihood of developing postpartum incontinence:

a long period of pain during childbirth;
large size of the child;
assisting in natural childbirth by using obstetric forceps;
a history of gestational diabetes, or pregnancy diabetes;
the presence of several previous births;
damage to the nerves that control the bladder;
episiotomy - an incision in the pelvic floor muscle to facilitate the exit of the child;
epidural anesthesia - may temporarily numb the nerves that control the sensation of the bladder.

Recent studies show that genetic predisposition can also play a role in the development of pathology.

Symptoms and Duration of Postpartum Incontinence

The duration of incontinence varies from woman to woman, depending on many individual factors. This is the elasticity of tissues, their regenerative capacity, the age of the woman in labor, the presence of chronic diseases, the general state of health of the body. Incontinence may resolve on its own within a few weeks after delivery. If this did not happen after six or eight weeks and the control over urination in the young mother during this period has not been fully restored, then it is necessary to inform the attending physician about this.

Associated symptoms may indicate a urinary tract infection, which is also the cause of incontinence. Infectious signs are:

soreness or burning when urinating;
cloudy urine;
unpleasant smell of urine;
increased body temperature;
the need to urinate frequently.

Urinary incontinence is not the norm for the postpartum period and requires appropriate medical measures, so do not hesitate to visit a specialist.

Diagnosis of pathology

The diagnosis of the disease is carried out by the urogynecologist. The doctor may suggest a stress test. A patient whose bladder is full of water is asked to cough or strain to the extent that it would normally leak urine. A physical examination and testing will be needed to rule out a urinary tract infection. Depending on the specific details of the medical history, the following types of research may be required:

Required laboratory tests:

a general urine test for blood, sugar, salt crystals, or signs of infection;
urine culture (if the general analysis showed signs of infection) - a urine sample is sent to the microbiology laboratory, and after about 24-48 hours, bacterial growth can be detected and a specific strain (type of pathogen) determined.

Treatment of the disease

The treatment of incontinence is developed by the doctor, taking into account the peculiarities of the diagnostic results. As a rule, in the case of postpartum incontinence, conservative therapy is indicated, consisting of special exercises to strengthen the muscles of the pelvic floor and the use of physiotherapy methods. Early onset is essential for successful treatment.

Reducing fluid intake may seem like a good option for some women. The less you drink, the less you want to go to the toilet. In reality, this approach is fraught with dehydration.

You need to drink a lot, especially for young mothers during breastfeeding. But in other cases, it is necessary to strive to comply with the daily rate of fluid intake, which is approximately equal to eight glasses of water for a woman of average build. However, it is recommended to refrain from drinks containing caffeine. They are irritating to the bladder wall.

A young mother should drink enough fluids.

In late pregnancy, the bladder gets used to a slight fullness, this is facilitated by the pressure of the enlarged uterus. After childbirth, the organ must retrain and gradually get used to the increased load (full filling of the bladder). It is recommended to start with a short-term postponement of going to the toilet when there is a desire to urinate. If the bladder is very sensitive, then at first it is recommended to delay the urge to empty it for just a few minutes, trying to gradually increase the time from the appearance of the urge to going to the toilet, bringing it to 30-60 minutes. The bladder becomes accustomed to retaining more and more fluid, while the pelvic floor muscles are trained.

Exercises

A set of Kegel exercises helps to regain control of the bladder after giving birth. They promote blood circulation in the perineal area, which effectively eliminates any swelling, bruising and sprains. Performing the complex daily, you can achieve a sustainable effect in the treatment of the disease, as well as prevent the development of pathology, if there is an increased risk. It is allowed to start practicing soon after childbirth, provided that the general well-being is good. The sooner the better.

Don't worry if you can't keep the contraction for more than a few seconds at first. Increase the compression time gradually, starting at four or five seconds. With regular practice, it is necessary to achieve fixation of muscle tension for 10 seconds during normal breathing, alternating contractions with ten-second relaxation. It is useful to vary the rate of stress, from slow to fast. As a result, it is ideal to perform 10 long muscle contractions and 10 short muscle contractions, three sets per day.

The result is not immediately noticeable, and many women can abandon the exercise, not giving them due importance. But doctors insist not to interrupt classes, and then, after 3 months of daily training, the muscles will become so strong that the difference will be obvious. When women stop exercising, they risk re-experiencing incontinence, as muscles can weaken over time.

Drug therapy

There are currently no medications specifically designed to treat stress urinary incontinence. Medicines are used only when tests show an infection, which can sometimes be the reason for loss of urinary control. In this case, depending on the type of pathogen, the woman will be prescribed an appropriate antibacterial drug. The safest for women during the feeding period are antibiotics of the penicillin group of a wide spectrum of action, such as Amoxiclav, Ampicillin + Sulbactam, which have a minimum number of side effects.

Pessary

For the prevention and treatment of stress urinary incontinence and prolapse of the pelvic organs, a urogynecological pessary is used. It is a ring-shaped silicone device that is inserted into the vagina to lift and support the vagina and bladder. For the first time, the ring is installed by a gynecologist, having previously selected its shape and size in accordance with the patient's anatomy. The procedure does not require anesthesia, lasts only a few minutes, but can be unpleasant. However, during use, the device does not bring any discomfort or painful sensations.

Pessary - a silicone or plastic device that is inserted into the vagina to lift and support the vagina and bladder

In the future, the woman learns to install the pessary on her own, as well as to remove it for cleaning with running water and soap, and, if necessary, disinfection with a solution of Chlorhexidine or Miramistin in order to avoid irritation of the vaginal wall. The frequency with which the device is removed is determined by the physician. You usually need to clean the pessary at least once a week, sometimes more often.

Surgical intervention

Severe incontinence after childbirth is rare. But if conservative therapy has not yielded positive results for a year or longer, surgery is indicated. The aim of the surgery is to create additional tone to the bladder sphincter to compensate for the relaxation of the pelvic diaphragm. The choice of method is dictated by the severity of the clinical picture:

Physiotherapy

Various physiotherapeutic procedures restore the function of the sphincter apparatus of the bladder. Regular sessions of electrical stimulation can complement pelvic muscle training:

electromyostimulation - electrical stimulation, with the help of which neuromuscular regulation in the area of the pelvic organs is restored; during the procedure, a tampon-like sensor, which is connected to a portable adjustable device, is inserted into the vagina with a predetermined current value;
amplipulse therapy - treatment with pulsed currents, leading to a rhythmic contraction of muscle fibers and increased blood flow to the bladder;
galvanotherapy - treatment with direct current of low voltage and low strength.

Herbal infusions for urinary incontinence

Herbal infusions according to folk recipes are used to improve the tone of the pelvic floor muscles and reduce the sensitivity of the bladder. However, it is important to remember that any remedy, even natural, has its own contraindications and side effects. This must be considered before starting home therapy.

The following plants can be used to prepare an infusion for ingestion in a proportion of 10 g of dry herb or crushed root to 250 ml of boiling water:

Raspberry Leaves - This plant can be taken in the last weeks of pregnancy with a doctor's permission to prepare the uterus for childbirth. The product has astringent properties, strengthens the muscles of the uterus and pelvis, and is useful for lowering the pelvic organs.
Yarrow is another astringent and bitter herb that, along with toning the bladder and uterus, disinfects urine. Yarrow also promotes good circulation in the pelvic area and cleanses the intestines, which can be helpful in some cases of incontinence.
Althea root - This herb is excellent at soothing the walls of an irritated bladder.
St. John's wort - This herb normalizes the nerve endings that supply the bladder and also relieves the symptoms of anxiety and depression that often go hand in hand with this anxiety condition.

The agent is insisted for 15–20 minutes, filtered and cooled. Take 2-3 times a day.

Folk remedies for urinary incontinence - photo gallery

Infusion of raspberry leaves strengthens the pelvic floor muscles Yarrow tones the ligamentous apparatus of the urethra and disinfects urine Marshmallow root soothes the walls of an irritated bladder St. John's wort normalizes the nervous regulation of the bladder

Treatment of stress urinary incontinence: video

Prognosis and complications

Fortunately, postpartum urinary incontinence rarely lasts longer than a few weeks and is successfully treated conservatively. For more severe cases, effective surgical techniques have been developed. All a woman with incontinence needs is to seek medical attention as early as possible. In advanced cases of incontinence, the following types of complications can often be observed:

Skin infections - A person with urinary incontinence is more likely to have skin ulcers, rashes, and infections because the skin is moist most of the time. it is bad for wound healing, and also promotes fungal infections;
prolapse of the pelvic organs - part of the vagina, bladder and urethra can be displaced from their anatomically intended place. It is usually caused by a weakening of the pelvic floor muscles.

Prevention of postpartum urinary incontinence

It is possible to avoid damage to the pelvic tissues of the expectant mother by timely assessing the risks associated with the large size of the baby, narrow pelvic bones, improper position of the baby, and taking measures in the form of a planned cesarean section.

Other measures to prevent urinary incontinence include:

maintaining a healthy body weight - excess fat burdens the pelvic floor and can lead to bladder and bowel problems;
smoking cessation - a chronic (long-term) cough associated with smoking can weaken the pelvic floor muscles and lead to bladder and bowel problems;
physical activity and walking for at least 30 minutes a day, including regular pelvic floor exercises;
control of timely bowel emptying - constipation affects the function of the bladder and intestines; with frequent tension during bowel movements, the pelvic diaphragm stretches and weakens over time;
developing the habit of going to the toilet not "just in case", but only when the bladder is full;
timely treatment of urinary tract infections.

Pregnancy, and then childbirth, has a very strong burden on the woman's body. It takes time to fully recover. Often a woman notices that urine leaks after childbirth. In this case, they speak of incontinence.

After childbirth, urine leakage is understandable. This happens most often with exertion caused by coughing, laughing or sneezing, especially if the bladder is full.

In this case, a small amount of urine is excreted. Lifting weights, alcohol abuse (after childbirth, it is unlikely that a healthy woman will drink alcohol, but still), sexual intercourse, physical activity can provoke a "leak".

Young mothers are ashamed of such a problem and do not go to the doctor, expecting that the situation will be resolved without intervention. As a result, the disease progresses. And then it will accompany the woman not only after childbirth. Involuntary urination will become a part of later life. If in the future such a patient wants to still have children, then with each subsequent delivery, the pathology will intensify.

Experts call this problem stress urinary incontinence. And they designate it as a complication after childbirth. Urinary incontinence during sneezing and other exertion is the main symptom of the disease. It is worth noting that the postpartum period is quite difficult both in the physical sense due to lack of sleep, and in the psycho-emotional, when the maternal instinct is raging. If you add urine leakage to all this, then depression is not far from here.

Of course, urine leakage is not a disaster. Pathology does not pose a threat to life, the body does not suffer from it and there are no debilitating pain sensations. Just a few inconveniences and constant wearing of pads.

Mechanism of occurrence

In order to retain urine, the main conditions must be met. Here they are:

the bladder should be in a certain position in the lower abdomen;
the urethra should be motionless and also in its place;
organs must be properly supplied with nerves;
muscles and sphincters must be complete.

During gestation, the bladder is compressed, it is compressed by the uterus, which increases with the growth of the fetus. As a result, the position of the organ is disturbed, the muscles are in constant tension. During delivery, the load increases even more. You don't even need to be a specialist to answer the question of whether there can be urinary incontinence after childbirth.

The pelvic floor muscles not only support the baby in the womb, but with their help the baby is pushed out. So it turns out that due to the heavy load, they are injured, stretched. The more often a woman gives birth, the worse things are with these long-suffering muscles. As a result, all the conditions mentioned above are violated.

Types of incontinence

Stressful under exertion. After giving birth, when coughing, urinary incontinence is one of the most common. As soon as the pressure inside the abdominal cavity changes sharply, drops of urine will be released.
Reflex. This includes some sounds that are “recorded” in the subconscious. Most often, urine leaks when a woman hears water pouring monotonously.
Sharp urge. In this case, it is difficult to hold urine due to the strong urge.
Night leaks. It is about the loss of control of urination during sleep. This also happens after a cesarean section. In this case, you can try to eliminate urinary incontinence with the help of special alarms.
Overflow. If childbirth was with complications, and the pelvic organs are affected by neoplasms, then paradoxical ischuria occurs. In this case, you want to urinate, but you can't. As a result, there is no way to efficiently empty the bladder and urine leaks regularly.

Tissue hypoxia

When the head passes through the birth canal, the urethra may swell. This is due to the fact that the fetus presses on the soft tissues, therefore, the nerves and muscles are affected.

Prolonged pressure occurs when it is difficult for a woman to push correctly and the child seems to get stuck for a while. Tissues begin to experience hypoxia, turn white, losing their natural function.

In this case, the causes of urinary incontinence after childbirth are temporary. While recovery is taking place, the bladder does not seem to be felt, which is why urine flows out. After giving birth, midwives monitor the amount of urination of young mothers and regularly ask them to urinate.

The problem does not always disappear by itself. There are situations when a reflex is fixed due to severe birth stress.

Negative factors

There are a number of other factors due to which urinary incontinence occurs after childbirth. How to treat? Depends on the pathogenesis.

Operations. Various kinds of surgical interventions damage the nerves and blood vessels, as well as muscles. Childbirth aggravates the situation.
Heredity. If someone in the family had problems, then the woman can inherit them.
Injuries. Fractures or bruises of the spine affecting the lower parts of the spine lead to problems with urination.
Neurological pathologies. In this case, a neurologist prescribes therapy, since the work of the nervous system is disrupted.

Diagnostics

So, you have long-term persistent urinary incontinence after childbirth. Causes and treatment are the responsibility of the physician.

The specialist will collect anamnesis, prescribe additional examination and tests. Some doctors use a questionnaire, I suggest that my patient honestly answer a few questions.

The doctor will need accurate data on the number of leaks and urination per day. For these purposes, a diary is used, where you should record the amount of fluid you drink, the frequency of urination, their quality and volume. You need to keep records for two or three days, no more.

With urinary incontinence in women after childbirth, treatment is most often carried out by a gynecologist. Therefore, an examination on a chair to study the conditions of the organs of the genitourinary system is mandatory. In addition to the examination, the doctor also conducts a cough test. If the test is positive, then the diagnosis is confirmed. Why after childbirth urinary incontinence, further research will show. These include:

cystoscopy, which allows you to examine the inside of the bladder and see if there are diverticulums or inflammation;
An ultrasound scan to determine how much urine remains in the bladder after urinating;
urodynamic study.

Treatment

The treatment tactics will be chosen together with the doctor. Particular attention is paid to exercise. They can help strengthen your pelvic floor muscles.

A rather effective technique involves keeping weights of different shapes in the vagina. The duration of treatment is at least one year. In parallel, electrostimulation should be carried out, as well as influence on the pelvic floor with an electromagnetic field.

It is worth noting that when urinary incontinence is diagnosed after childbirth with jumping, as well as with other activity, the treatment will be long. There is no magic pill. And not every medicine can be prescribed to a woman who is breastfeeding.

Surgical

In difficult cases, the doctor may suggest surgery. With its help, you can create support for the urethra, limiting its mobility. Usually a special gel is used for these purposes. The procedure can be done under local anesthesia.

A very serious operation is performed to fix the cervix, bladder and urethra. This is a rare case.

Loop operation is quite common. It is quite safe for the body, and its effectiveness is high. Synthetic slings are used that support the urethra with a mesh. The intervention lasts about 45 minutes. The recovery period is short. Local anesthesia is often used.

If your urine leaks after childbirth, you need not wait for a miracle. Go to a specialist! The sooner treatment is started, the more chances of getting rid of the problem completely.

The female body is exposed to great stress during the carrying of a baby, which subsequently affects its life. Violations in the activity of some organs of a woman during and after childbirth are often observed. One of these disorders is postpartum urinary incontinence.

Postpartum urinary incontinence is a violation of the physiological mechanisms of the bladder, resulting in uncontrolled urine flow.

After childbirth, the most common type of incontinence is stress urinary incontinence. This is the involuntary flow of urine when you cough, sneeze, or laugh.

This problem is not only physiological, but also psychological. Often women, keeping silent about this problem, oppress themselves for inferiority, their self-esteem falls, which affects their way of life.

Pregnancy is stress and stress on a woman's body. Within 9 months, the load on the pelvic muscles increases with the growth of the fetus. As a result, there is a violation of the functions of the muscles of this area and a violation of the entire anatomy between the pelvic organs.

High pressure on the pelvic muscles, their participation in the formation of the birth canal - disrupts blood circulation in the muscles that are responsible for keeping urine in the bladder.

Birth trauma, a large fetus, the imposition of gynecological forceps and repeated childbirth - can provoke the development of urinary incontinence after childbirth.

Symptoms of urinary incontinence

discharge of urine when standing up, squatting, sneezing and coughing;
involuntary discharge of urine drops during intercourse or simply in a horizontal position;
a constant feeling of incomplete emptying of the bladder;
a feeling of something foreign in the vagina;
uncontrolled flow of urine after drinking a small amount of alcohol.

Diagnosis of postpartum incontinence

The diagnosis of this problem should be carried out by a specialist urologist. After giving birth, a woman must visit a gynecologist, who needs to be told openly about all the delicate problems that have arisen. When diagnosing, it is required examination on a gynecological chair ... The specialist can do the following test to make the correct diagnosis: ask the patient to cough while she is in the chair. If urine leakage is detected, then the test is considered positive.

For a more accurate diagnosis, use Ultrasound kidneys, small pelvis, laboratory tests, uroflowmetry, cystometry and profilometry.

A timely examination allows you to choose the correct and most effective tactics for treating the problem of urinary incontinence after childbirth.

Postpartum urinary incontinence: what to do

Many women today do not even suspect that the treatment of urinary incontinence after childbirth is quite possible. If the problem is diagnosed on time, the degree of violation of the mechanism of the bladder is small, then non-surgical treatment is carried out. In more severe cases, surgery is possible.

Conservative treatment

Conservative treatments are primarily aimed at training the muscles of the pelvic floor and bladder. The first are the Kegle exercises and exercises for holding small weights by the vaginal muscles. With the help of these exercises, the normal activity of the vaginal muscles is restored.

The most convenient for the treatment of incontinence after pregnancy are Kegle exercises, which can be done even in a public place. These exercises involve tensing the muscles around the bladder and rectum 200 times a day. To find these muscles, you can hold back the stream of urine while urinating.

Postpartum incontinence can also be treated with physical therapy. Physical therapy alternates with exercise.

The method of training the bladder is effective. In this case, the doctor develops a specific urination schedule for the patient. A woman tries to empty her bladder even with the slightest filling. This program runs from a minimum period between urinations to a maximum: 3 to 3.5 hours.

Medication is prescribed in conjunction with exercise and muscle training. There are no drugs that address the cause of urinary incontinence. If such a problem occurs, the doctor may prescribe a sedative, a drug to improve blood circulation, strengthen the walls of blood vessels, or vitamins.

Surgery

An operation in solving such a problem is prescribed only if conservative methods of treatment are ineffective. These operations are:

Loop operation, during which a loop is applied to the middle part of the urethra. The operation lasts only 40 minutes, and the patient is discharged after 2 days. Sexual life is allowed after 6 weeks, and return to work after 2 weeks. Such an operation is performed for any degree of incontinence. The only contraindication is a planned pregnancy. After childbirth, the effect of the operation is reduced to nothing.
Operation with the introduction of the gel... In this case, with the help of a gel that is injected near the urethra, additional support is created in its middle part. The operation is performed under local anesthesia and lasts less than 30 minutes.
Urethrocystocervicopexy- the least common surgical type of solution to the problem of postpartum incontinence in women. This operation helps to strengthen the pubic-vesical ligaments. But it is difficult in terms of execution technique and requires long-term rehabilitation. For these reasons, this method is rarely used.

In general, surgery is used in extremely rare cases. Postpartum urinary incontinence can be cured by conservative methods if there are no more serious disorders in the mechanism of the bladder.

Prophylaxis

To avoid serious problems that will lead to irreversible consequences, you need to follow the recommendations that will help to avoid urinary incontinence after childbirth. Even during pregnancy, meet and do muscle training exercises vagina, pelvic floor (Kegl gymnastics is even useful, it will help during childbirth, and not only to eliminate the occurrence of incontinence).

If such a problem arises after childbirth in its minor manifestations, be sure to regularly do the above exercises. But do not postpone the visit to the doctor either.

Prevention of this problem is avoiding bladder overflow(especially during pregnancy). “Can't be tolerated,” our parents often told us. If you endure for a long time, the muscles will stretch, which leads to their uselessness.

To avoid incontinence problems give up alcohol, caffeine (including caffeinated drugs), smoking, etc. Eat more raw vegetables and fruits to promote timely stomach emptying.

After giving birth, any woman wants to quickly return to her prenatal weight - this will also help solve the problem of incontinence. A adherence to dietary rules during pregnancy will be a good prevention of urinary incontinence after childbirth.

Experts say that, by and large, urinary incontinence after childbirth is a psychological problem. Women are ashamed of this and hide the problem from doctors. Stealth leads to more serious consequences.

There is no shame in the fact that you are faced with this problem. Regular exercises, consultation with a gynecologist, monitoring your body - all this will help you cope with troubles quickly and easily.

Postpartum urinary incontinence is considered a dysfunction of the mother's body. Nocturnal enuresis, or the inability to control urine flow during the day, is a problem familiar to 40% of women who have recently given birth. Some young mothers consider her to be too delicate, therefore, they do not inform the attending physician about the occurrence of incontinence. This worsens the quality of life of women giving birth, who are unable to control urine discharge. The difficulties associated with postpartum incontinence affect the physiological and psychological spheres of life. Young mothers feel their inferiority, and therefore wonder what to do and how to treat pathology.

Urinary incontinence in women after childbirth is a pathology associated with the involuntary discharge of urinary fluid (and this process cannot be controlled). The volumes of urine flowing out are meager (just a few drops) or abundant (when fluid from the bladder constantly flows out). Gas and urinary incontinence after childbirth is often manifested as a result of severe stress to which the woman's body was subjected at the time of childbirth. Involuntary flow of urine is provoked by a strong overstrain of the abdominal muscles when the body is under stress (when jumping, sneezing, coughing or having sex). If the pathology has become severe, urine flow occurs even with a sharp change in body position or at night, in a dream.

In addition, women note the appearance of the following symptoms:

a feeling of the presence of a foreign object in the vagina;
incontinence that occurs while taking alcoholic beverages;
the patient feels that there is fluid in the bladder.

The problem of bedwetting occurs in women who have given birth. The first childbirth increases the likelihood of incontinence up to 10-15%, and with repeated labor, involuntary leakage of urine occurs in 40% of cases.

Doctors associate the occurrence of postpartum incontinence with the fact that functional disorders appear in the muscles that penetrate the pelvic floor. The appearance of such a pathology after childbirth as incontinence is also caused by an incorrect ratio of organs located in the small pelvis. The muscles of the pelvic floor form a support for the uterus, and therefore, in late pregnancy, when the fetus is quite large, they are subjected to enormous stress. It should be noted that it is from them that the birth canal is formed from them before the onset of labor, through which the baby moves forward. When the child moves through the birth canal, the muscles of the pelvic floor are compressed, the processes of blood circulation and the nervous connection with the central nervous system are disrupted.

Urinary incontinence sometimes occurs in response to traumatic situations that have arisen during childbirth (tears of the muscles, perineum, inaccurate use of forceps). A large child, high water or multiple pregnancies, and having many children are risk factors that, to some extent, provoke urinary incontinence after childbirth.

Traumatic factors that occur during childbirth sometimes provoke the occurrence of such pathological conditions:

violation of nerve muscle connections in the areas where the bladder and urethra are located;
the urethra and bladder become mobile;
the locking muscles in the urethra and bladder function poorly.

There are certain risk groups when the likelihood of developing postpartum enuresis increases.

The negative process is caused by the following factors:

Poor heredity, predisposition to the development of postpartum incontinence.
Pregnancy, childbirth (especially if he is not the first).
Excess weight.
Abnormal development of organs in the small pelvis, improper placement of the pelvic floor muscles.
Surgical manipulations carried out in the pelvic area, during which the nerve communication between the muscles is disrupted or damaged.
Hormonal disruptions when the body of a young mother lacks the female sex hormone estrogen.
Urinary tract infection.
Mental illness.
Radiation exposure.
Neurological pathologies, which include multiple sclerosis, Parkinson's disease, spinal injuries, diseases of the nervous system.

Excessive stretching and weakening of the pelvic muscles is a major contributor to incontinence. In an elastic state, they serve as a good support for the uterus throughout pregnancy.

But under the weight of the unborn child, such muscles lose their elasticity, weaken and become stretched. A too large fetus, complicated childbirth or injuries that occur during labor are also bad for their condition.

When a woman gives birth to a child, her body is rebuilt again, the hormonal background changes, and the result of such changes is the appearance of additional problems. For example, urinary incontinence may develop after childbirth.

This pathology is divided into the following types:

Stressful. Urine is excreted involuntarily if a woman strains her abdominal muscles, coughs, laughs hard, or cries violently. Stress incontinence is the most common postpartum problem in many women.
Uncontrolled. All day long, a woman who has given birth excretes urine in small quantities.
Urgent. Intense urge to urinate, there is no way to restrain the urge to "urinate".
Enuresis. Involuntary leakage of urine at night.
Reflexive. External, irritating causes (for example, rain noise or splashing water) contribute to the separation of urine.
Urinary fluid begins to leak when the bladder is full, and these processes are influenced by internal factors (for example, benign neoplasms, infectious urogenital diseases, uterine fibroids, tumors in the small pelvis).

Regardless of the type of involuntary urination, the problem must be addressed in a comprehensive manner. A woman should consult with her healthcare professional about therapy for postpartum urinary incontinence. To achieve the best effect, it is necessary to combine drug therapy with exercises and traditional methods that will restore elasticity to the muscles.

Postpartum incontinence symptoms

Postpartum urinary incontinence is accompanied by the following symptoms:

systematic flow of urine, occurring uncontrollably;
urinary fluid is excreted in large quantities;
urine flows out when doing serious physical work while having sex.

If a woman suffers from urinary incontinence after childbirth, she should definitely consult a doctor and get medical help. Only timely detection of an ailment will make it possible to correct the condition and prevent the development of undesirable consequences.

Diagnosis of urinary incontinence after childbirth is performed by a urologist.

The attending physician conducts the following activities:

examines the patient;
invites her to tighten her abdominal muscles or cough (testing to check for spontaneous urine flow);
if the test is positive, the specialist asks the woman to continue to control her own urination, write down the cause and time of the problem;
the doctor uses the records to develop the correct treatment plan.

To speed up the diagnosis, to make it effective and accurate, the following procedures are prescribed for a woman who has given birth:

laboratory tests of urine and blood;
ultrasound examination of the pelvic organs and kidneys;
cystometry (research work that contributes to the detection of pathological work of the bladder);
uroflowmetry (testing the urodynamic characteristics of the female body);
urethral profilometry (urodynamic tests to check the condition of the urethra).

A woman after childbirth should promptly examine the genitourinary system. Based on the results of the diagnosis, the doctor will develop an effective treatment tactics that will help to quickly get rid of postpartum urinary incontinence.

Many women, faced with postpartum urinary incontinence, do not know that such a pathology can be successfully treated. True, success depends on timely diagnosis. In this case, the mechanism of functioning of the bladder is disturbed to an insignificant extent, which means that there are all possibilities for treating pathology without surgical intervention. But if the case is serious, the patient is offered the help of a surgeon.

Conservative treatment of female urinary incontinence involves the use of exercises to help train the muscles of the urinary system.

Below is a list of recommended procedures for women with postpartum urinary incontinence:

Kegel exercises. During the day, the woman should contract the muscles surrounding the bladder and rectum. You need to do this exercise 100-200 times, keeping the muscles in tension for several seconds.
Retention of conical weights in the vagina. The weights have different weights, and the woman's task is to keep these elements. Doctors recommend starting exercises with small weights, gradually increasing weight indicators. It is recommended to perform this procedure at least 3-4 times a day, and devote 15-20 minutes for each approach.
Physiotherapy treatment. To strengthen the pelvic muscles, the specialist recommends a woman to undergo physiotherapy, which includes electromagnetic stimulation. A good effect is given by a combination of physiological procedures with exercises to increase muscle tone.
Bladder training sessions. The urologist develops a special plan, recommending the patient to go to the toilet "in a small way" at a certain time, which is indicated in the plan. Gradually, the interval between visits to the toilet increases. A prerequisite for a woman is to urinate, strictly following the scheme suggested by the doctor. This treatment helps the woman learn to control her own urination. The duration of the therapeutic course reaches 2 months.
Medical treatment. If a woman is diagnosed with incontinence, she is prescribed special sedative medications. They improve blood circulation, help to strengthen the vascular walls, saturate the body weakened by childbirth with vitamin complexes. But it should be noted that in pharmacology there are no drugs that would help to cope with the very problem of urinary incontinence. Medicines offered by urologists act only indirectly, strengthen the immune system and muscles.

Conservative therapy does not always help to eliminate the problem of incontinence in a woman who has recently given birth to a child. What to do if the developed drug treatment regimen did not give results? In this case, the patient is offered surgery.

Surgical therapy for postpartum urinary incontinence is represented by a variety of operations:

Surgical intervention using a gel. A gel formulation is used to create a support that surrounds the urethra. In terms of its duration, such an operation takes no more than 30 minutes, it is carried out in a hospital or on an outpatient basis. Local anesthesia is used to relieve pain.
Urethrocystocervicopexy. Surgery is aimed at strengthening the ligaments located in the pubic region. While normal, these ligaments support the urethra and bladder neck. From a technical point of view, this kind of surgical work is very difficult, therefore, general anesthesia is used to carry it out. The rehabilitation period after surgery is quite protracted, therefore, doctors rarely carry out the urethrocystocervicopexy procedure.
Loop operations. For therapeutic purposes, doctors place a support loop under the urethra. It is made from biomaterial (upper thigh skin). Sometimes the support is made of synthetics, which are not rejected by the body. To perform a surgical procedure, the doctor makes a small incision in the patient's skin. This technique is less traumatic and this is its main advantage. The woman quickly recovers from such a surgical intervention.

The correct tactics for treating urinary incontinence in a woman who has given birth will help eliminate the problem painlessly and quickly. The patient should understand that only with timely access to the urologist will she be able to avoid surgical intervention. In the early stages of development, urinary incontinence is successfully treated with conservative methods.

It is possible to cure urinary incontinence, but it is best not to allow this problem to occur.

A woman carrying a baby must adhere to the following recommendations:

control your body weight (excess weight creates additional stress on the bladder, increasing the manifestations of urinary incontinence);
deal with the treatment of infectious diseases occurring in the genitourinary system, in a timely manner, do not start them;
in late pregnancy, support the abdomen with a bandage;
when carrying a child, adhere to the advice given by the doctor, be regularly examined and tested (this way it will be possible to identify urinary bladder incontinence at an early stage of its development and start therapeutic measures in a timely manner).

The problem of urinary incontinence cannot be called an incurable pathology. A wide arsenal of modern methods of treatment allows you to easily and quickly correct the situation, saving a woman from such a delicate disease.