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Actress Kristen Bell was pregnant with her first child when she mistakenly thought her water broke. “[My doctor] got me on the examination table and she goes, ‘Huh? So you said your water broke?’" she recounted in an episode of Momsplaining with Kristen Bell. "I said, ‘Yeah, definitely, it was a big splash on my bathroom floor.’ She says, ‘OK. Your water didn’t break, but it is quite possible you peed your pants.’”
While many celebrities have been blamed for the over-glamorization of pregnancy and childbirth and the shame and unrealistic expectations this creates for “normal” women, some have started using their spotlight to normalize the parts of pregnancy that aren’t so pretty. Among these less-talked about but commonly experienced “side-effects” are pregnancy incontinence.
What is incontinence and what causes it, both during and after pregnancy?
Involuntary urine leakage, or urinary incontinence, affects more than one-third of women during a first pregnancy, and more than three-quarters of women who have had multiple pregnancies. “It happens when we jump rope, and when we laugh, cough, run, or sneeze,” Lynn Shattuck wrote for Mom.com. “Sometimes it’s just a dribble — other times, an unstoppable gush.”
For women who are pregnant or have given birth, Dr. Amy Rosenman of UCLA Health gave a number of potential causes for urine leakage:
- You have a growing baby sitting on top of your bladder. “As the baby grows, the enlarging uterus causes pressure on the bladder below it. This extra stress on the bladder makes it easier for any additional exertion, such as laughing, sneezing or exercising, to push urine out of the bladder,” wrote Dr. Rosenman.
- Your pelvic floor muscles are being stretched and strained as your uterus expands. This may lead to pelvic floor dysfunction, which occurs when your body keeps tightening your pelvic floor muscles instead of tightening and relaxing, as it should.
- You have experienced prolonged pushing in labor, use of forceps, or a difficult vaginal delivery… or all of the above. All of these can cause nerve damage, tearing of pelvic tissue, or straining of pelvic muscles, which can lead to weakened nerve signals or even prolapse (when the pelvic organs slip down from their normal position into the vagina). In cases where anal nerves and muscles are damaged, the result may be involuntary loss of gas or stool.
Incontinence: What to do if you're experiencing symptoms (Do Kegel exercises really work? Should I wear pads? Can I prevent incontinence?)
If you’re experiencing incontinence, here are some things to do — including going easy on yourself.
Shame off you!
Incontinence is a common problem that affects one in four women and has a number of causes, none of which are your fault.
Experiment with some behavior changes.
Incontinence is not your fault, but you may be able to tame or prevent it with these non-surgical changes. Cleveland Clinic, a non-profit academic medical center, recommends eliminating carbonated drinks, coffee, and tea; eating high-fiber foods; maintaining a healthy body weight; drinking less liquid before bedtime; and keeping a record of when you experience urine leakage, so you can plan out your bathroom trips.
Start Kegeling.
Created by Dr. Arnold Kegel, these exercises strengthen your pelvic floor muscles and may stop or prevent incontinence. Try stopping the flow of your urine when you are sitting on the toilet — those are your pelvic floor muscles. Cleveland Clinic recommends that you do one set — tighten for three seconds then relax for three seconds, 10 times in a row — at least twice a day. If you’re doing them correctly, no one should be able to tell what you’re doing!
Wear pads. Or diapers.
The internet applauded pregnant Pretty Little Liars star Shay Mitchell for sharing on her YouTube channel about her decision to wear diapers. “In like half an hour I went to the bathroom probably 22 times last night, to the point where I was like, I’m … wearing diapers,” Mitchell explained. (Just be sure to practice good hygiene habits, or your incontinence could lead to a UTI!)
If none of the above work, try medicine or surgery. Mom of three Elizabeth Pagel-Hogan spoke candidly about both of these options, and how surgery ended up being the best option for her. “For some types of SUI, medicines and exercises won't work and surgery is the only way to alleviate the leaking. That was definitely the case for me,” Pagel-Hogan wrote for Mom.com.
When to call your doctor (Can incontinence cause UTIs in women?)
If you think you are experiencing incontinence and are in your final weeks of pregnancy, call your doctor right away (even if you feel silly about it!).
In my experience, the trickle that I thought was incontinence was actually a small tear in my amniotic sac; technically, my water broke, but I didn’t know this until I finally went to the hospital, almost 20 hours later. (Everything turned out okay, but it was definitely not a smart decision!)
If you are experiencing incontinence after pregnancy, it is important to let your doctor know, so it can be monitored. Incontinence can lead to a UTI (urinary tract infection), due to the bacteria that can build up in the urine left in the bladder, or the bacteria that develops around the genital area, which can then creep up into the urinary tract.
It is especially important to talk to your doctor if it is limiting your daily activities. Pagel-Hogan also shared about how incontinence after the birth of her first child invaded every part of her life “I cut back on running, playing with my children, and I didn't feel free to be intimate with my husband,” she wrote. “I held back at work … I didn't dance at weddings, and I hated shopping and trying on clothes. … Sometimes, I barely even laughed.” Five years and two kids later, she went to see a urologist, and gained her life back.
Incontinence is no fun, but talking about it with your doctor and trusted friends can keep it in its place and let you live your life — wet pants and all.