Postpartum urinary incontinence is generally related to these five factors! How to check and treat it?

Author: Gao Guolan, Chief Physician, West China Second Hospital, Sichuan University

Reviewer: Lin Guole, Chief Physician, Peking Union Medical College Hospital

After giving birth, many mothers will have difficulty holding their urine, which is called postpartum urinary incontinence. This is mainly due to the long-term pressure on the pelvic floor area during pregnancy, which causes the pelvic floor muscles to become loose and weak, which may cause the vagina and pelvic organs to sag or prolapse. This series of changes is the main cause of postpartum urinary incontinence.

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Urinary incontinence is divided into three types: stress urinary incontinence, urge urinary incontinence, and mixed urinary incontinence. Postpartum stress urinary incontinence is more common.

Stress incontinence usually occurs when abdominal pressure is increased. Mild patients usually do not leak urine when they are not carrying heavy loads (such as not holding a child, not coughing, or not doing actions that increase abdominal pressure); while moderate to severe patients will leak urine even during light activities, such as walking on flat ground or going up and down stairs. In contrast, urge incontinence is not related to abdominal pressure and is characterized by a strong urge to urinate. Once the patient feels the need to urinate, he must go to the toilet immediately, otherwise he will leak urine. Mixed urinary incontinence is a situation where both of the above symptoms exist at the same time.

1. Which women are prone to urinary incontinence after childbirth?

Under normal circumstances, the uterus is very small. As the pregnancy weeks increase, the uterus gradually increases, which will gradually increase the pressure in the abdominal cavity, and the burden on the pelvic floor muscles and urethral sphincter will also become greater and greater.

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First of all, the increase in abdominal pressure is closely related to the weight of the fetus. A fetus weighing more than 8 kilograms is considered macrosomia. Another example is multiple pregnancies, such as twins or triplets. Such pregnant women are more likely to develop postpartum urinary incontinence.

Second, it is related to the delivery process. For example, vaginal delivery, coupled with the heavy fetus, will cause more damage to the pelvic floor muscles during delivery.

Third, it is related to the number of births. For example, giving birth to only one child will cause different damage and pressure to the pelvic floor than giving birth to two or three children.

Fourth, it is related to the age at the time of pregnancy. The older you are, the worse the function of your pelvic floor muscles will be. The incidence of urinary incontinence in older primiparas is higher than that in younger primiparas.

Fifth, it is related to the weight of the pregnant woman herself. If a woman is obese before pregnancy, the pressure on the pelvic floor will be greater than that of a woman of normal weight.

The above factors are likely to lead to the occurrence of postpartum urinary incontinence.

2. What examinations and assessments are needed for postpartum urinary incontinence?

There are now instruments that collect and detect pelvic floor electromyography to evaluate pelvic floor muscle function, which can understand the functional state of pelvic floor muscle contraction and relaxation. Patients can also record their daily water intake, urination time, frequency and urine volume. Doctors use this urination diary to assist in determining the classification and severity of urinary incontinence.

There is also a specific stress test used to evaluate stress incontinence. During this test, the patient lies flat on the bed with the bladder in the lithotomy position, and then increases abdominal pressure (such as by coughing) to observe whether urine leaks out of the urethra involuntarily. If this test is positive, that is, urine leakage is observed, the next step is a digital pressure test, also called a bladder neck lift test, to further determine whether the incontinence is caused by the relaxation and downward movement of the bladder neck.

In addition, you can also perform residual urine measurement, which is to do an ultrasound examination immediately after urinating to see how much urine is left in the bladder. If it is more than 100 ml, it means that the urine has not been completely discharged, which means that there is a problem with the function of the bladder itself.

Of course, the doctor will also ask for a urine routine test to rule out whether the urinary incontinence is caused by inflammation, stones, tumors, etc. Through cystoscopy, we can understand whether there are organic problems with the bladder and urethra, and help rule out organic diseases causing urinary incontinence.

3. How to treat postpartum urinary incontinence?

Stress urinary incontinence can be divided into three levels according to the main manifestations of urinary incontinence. In mild cases, urine leakage occurs only when abdominal pressure is increased, and daily life is not affected; moderate cases are characterized by urine leakage even when standing or walking with slight effort; severe cases are characterized by urine leakage even when not doing any activity and in a natural state. For mild urinary incontinence, non-surgical treatment is usually used; for moderate to severe urinary incontinence, surgical treatment should be considered after non-surgical treatment is tried and failed.

Among non-surgical treatment methods, the most commonly used one in clinical practice is pelvic floor muscle training, also known as Kegel training, which mainly trains the pelvic floor muscles through contraction and relaxation. In addition, there are pelvic floor muscle training with vaginal dumbbells, biofeedback electrical stimulation, magnetic stimulation therapy, low-temperature radiofrequency therapy, etc. In addition, the importance of changing unhealthy lifestyles should be emphasized, such as losing weight, quitting smoking, preventing and treating constipation, and reducing activities that increase abdominal pressure.

Patients who do not respond well to conservative treatment or have severe pelvic organ prolapse need surgical treatment. There are many surgical methods, and doctors will choose the appropriate surgical method based on age and pelvic floor conditions, such as mid-urethral suspension, anterior and posterior vaginal wall repair, and sacroiliac ligament suspension.

In general, treatment includes three aspects: lifestyle intervention, physical therapy, and surgical methods.