Incontinence

INFORMATION FOR WOMEN WHO HAVE INCONTINENCE DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is incontinence during pregnancy?

Incontinence is a lack of, or impaired, control over your urination, or bowels. For each of these categories, there are different types of incontinence. Urination incontinence, for instance, includes stress incontinence (urine leaks during activities that increase the pressure in your abdomen, such as sneezing, coughing, laughing, and exercise), urge incontinence (you have sudden urges to urinate and large amounts of urine come out), overflow incontinence (urine dribbles out frequently), and reflex incontinence (filling and stretching of the bladder triggers urine outflow), plus there are various combinations of incontinence types.

Bowel (fecal, anal) incontinence can develop for a variety of reasons and exists in various forms. These include urge incontinence, which like urinary urge incontinence, gives you a sudden urge to go, and you cannot hold it in. There is passive incontinence, in which you are unaware that the anus is opening, releasing stool, which is somewhat analogous to urinary overflow incontinence.  There is anal/rectal incontinence in which you cannot control the rectal canal muscles and anal sphincter muscle, but you are aware of when you are defecating. You may have enough control to prevent defecation, but not prevent gas from coming out (flatulence); similarly, there is flatus (wind) incontinence, in which you can feel pressure of the rectum filling with something, but you cannot sense whether it is stool or gas. With both urinary and fecal continence, we can distinguish a condition of urgency, in which you feel a strong need to urinate or defecate, but can hold it in for a short time, so that you are not technically incontinent. Incontinence can happen during pregnancy. There are many reasons why a person can develop incontinence, but both pregnancy and delivery and sometimes also surgery can strain tissues in the pelvis, leading to incontinence during pregnancy, after delivery, and over many years and decades as you age.

How common is incontinence during pregnancy?

Different studies have reported incidence of incontinence reaching as high as 39.1 percent of pregnancies for urinary incontinence and as high as 10.3 percent of pregnancies for fecal incontinence. Some researchers suspect many women, particularly with urinary incontinence, do not report their symptoms, thinking that some leaking is normal, so the actual number of affected women could be higher. As noted above, incontinence also occurs outside of pregnancy. Urinary incontinence is particularly common in older women, and pregnancy is the major risk factor. Another risk factor, obesity, elevates your risk for urinary urge incontinence. At the same time, smoking increases the risk for stress incontinence because it relaxes the urinary sphincter muscle that controls the exit of urine from the bladder and also because smokers have an increased prevalence of lung conditions that make them cough. After you are finished having babies, increasing age is another risk factor for urinary incontinence, because the hormone estrogen helps keep the urinary sphincter and other parts of the urinary system strong, so they weaken as estrogen production drops.

How is incontinence during pregnancy diagnosed?

A workup of your urinary incontinence will start with an analysis of urine samples to test for a urinary tract infection (UTI), a most common reason for urinary urgency and frequency. You also will be screened for diabetes mellitus and diabetes insipidus with tests performed on urine and blood, plus your kidney function will be checked. If UTI and other common conditions are ruled out, your urinary system will be evaluated with tests such as ultrasonography, cystoscopy (the bladder is examined with a camera and light inserted through a tube through the urethra). More specialized tests may be conducted to evaluate how well the bladder voids itself of urine, changes in bladder pressure, and the strength of the sphincter.

Tests to evaluate and reveal the causes for fecal incontinence include ultrasonography, anal electromyography (EMG) and manometry (tests the function of the anal sphincter), flexible sigmoidoscopy (examines the inside of the rectum and the part of the colon close to the rectum), and a test called pudendal nerve terminal motor latency test (tests function of the nerves involved in bowel control). Your pelvic organs may also be examined with magnetic resonance imaging (MRI).

Does incontinence cause problems during pregnancy?

Both urinary and fecal incontinence can be a tremendous source of discomfort, inconvenience, and embarrassment, harming your quality of life.

Does incontinence cause problems for the baby?

Maternal incontinence has no impact on the baby.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the incontinence
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat incontinence during pregnancy?

Different medications are effective, depending on the type of incontinence. Anticholinergics medications, for instance, can be helpful against urge incontinence, as they relax an overactive bladder. Mirabegron helps the bladder relax and expand and is useful against urge incontinence, and can help improve voiding (emptying most of the urine from the bladder). These drugs have not been studied well during pregnancy, so typically are avoided, but they are often given to non-pregnant women whose urinary incontinence may have been triggered by pregnancy and delivery. Vaginal estrogen cream, or patches or rings with estrogen, are treatments that can help promote the tone of the muscles and other tissues around the urethra and vagina, but this treatment should not be used during pregnancy.

Fecal incontinence sometimes is treated with anti-diarrhea medications. One example is loperamide, which is probably quite safe in pregnancy (although there is some concern since it has not been studied much during pregnancy). The other is a combination of diphenoxylate and atropine sulfate (Lomotil), whose pregnancy safety is not certain, but generally, you can take it if you need it. If the incontinence is due to constipation or irritable bowel syndrome, it can be treated with bulk laxatives, such as methylcellulose (Citrucel) or psyllium (Metamucil), neither of which is harmful during pregnancy.

Who should NOT stop taking medication for incontinence during pregnancy?

Issues surrounding medications for incontinence in pregnant women are a matter of weighing benefits against risks. Generally, if a medication is helping with your condition, you need not stop taking it.

What should I know about choosing a medication for my incontinence during pregnancy?

It is important to stay in communication with your health care provider as the release of new
studies over time can change the outlook on the role of specific medications during pregnancy.

You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.

What should I know about taking a medication for my incontinence when I am breastfeeding?

If you are taking an anticholinergic medication, it may decrease your milk production to the point that you wont be able to nurse. Mirabegron has not been studied adequately in the setting of human lactation, but studies on laboratory animals suggest that it may be excreted at high levels into milk, making it a drug that should be avoided in nursing mothers, until more is known. Some concern surrounds the use of diphenoxylate/atropine (Lomotil) in nursing mothers, but you can take loperamide.

What alternative therapies besides medications can I use to treat my incontinence during pregnancy?

For both urinary incontinence and fecal incontinence, there is a range of exercises and devices that you can perform and learn in the setting of specialized physical therapy. In the case of urinary incontinence, for instance, there are bladder and urethral inserts, vaginal support devices, and catheters. There also are implantable nerve stimulators and injectable therapies, including Botulinum toxin type A (Botox), to calm an overactive bladder and bulking materials to make tissues around the urethra more firm. For both fecal and urinary incontinence, there are pads, and finally, there is a range of surgical procedures.

What can I do for myself and my baby when I have incontinence during pregnancy?

Follow the instructions of your physician. Be assured that you are not alone as this is a very common condition, and there are many therapies available.

Resources for incontinence in pregnancy:

For more information about incontinence during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

Read the whole report
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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