Dealing with the spritz
Incontinence often starts during pregnancy but can linger long after. Fortunately, Kegels aren’t the only solution.
Contributed by Suzanne Schlosberg
Not long ago, I was bouncing with my 3-year-old twin boys in one of those street fair blow-up castles when — oops! — I felt a bit of urine spurt out. It happens a few times a year, typically during a forceful sneeze, and it’s a reminder that all is not the same, bladder-wise, as before I got pregnant.
Doctors call it urinary incontinence. I prefer “the spritz,” the term used in the TV commercials for Poise pads. Whatever you call it, leakage is incredibly prevalent among moms. “Even a seemingly uneventful pregnancy and delivery can change urinary control for up to 50 percent of women,” says Roger Goldberg, M.D., director of urogynecology research at the University of Chicago NorthShore University HealthSystem and author of Ever Since I Had My Baby (Random House).
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Most cases resolve in the first year postpartum. However, five years after delivery, one-third to one-half of women report some degree of spritzing; 10 percent to 20 percent of women report having leakage that they consider “socially bothersome.” Fortunately, a variety of methods, ranging from do-it-yourself pelvic-floor exercises (Kegels) to a simple surgical procedure, can help you stay dry.
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Who leaks and why
Incontinence comes in two varieties: Stress and urge. If you leak when you forcefully laugh, sneeze, cough, run, jump or lift weights, you have stress incontinence. “It’s really common in the third trimester because of the pressure of the uterus on the bladder,” says Sangeeta Mahajan, M.D., division chief of female pelvic medicine and reconstructive surgery at University Hospital’s Case Medical Center Department of OB-GYN in Cleveland. Compounding the problem are the hormones that make your tissues and joints more elastic for delivery: They also reduce bladder support, allowing urine to leak.
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About two-thirds of women with stress incontinence also experience urge incontinence, which is caused by an overactive bladder. You get the sudden urge to go, even though your bladder may be nearly empty, and leak before you can get to the bathroom.
Women older than 35 and obese women are at greater risk for prenatal leakage of both varieties. After childbirth, the biggest risk factor for stress incontinence is having had a vaginal delivery, especially one involving forceps or other interventions that can injure pelvic nerves and muscles. A Norwegian study of 12,000 women found that among women who did not leak during pregnancy, 20 percent did so six months after a vaginal delivery, compared with 8 percent who had elective Cesarean sections. Among prenatal leakers, half who delivered vaginally were spritzing six months later, compared with 23 percent of those who had a C-section.