Ask Dr. K: Strategies to control urinary incontinence

DEAR DOCTOR K: I’ve had urinary incontinence ever since I gave birth last year. Why?

DEAR READER: Many women who give birth vaginally go on to develop loss of bladder control. This is called urinary incontinence.

How does vaginal delivery lead to incontinence? Your urinary system and reproductive organs are supported, in part, by your pelvic floor. This is a network of muscles that extends from your pubic bone to your tailbone. The pelvic floor muscles are the muscles you tighten when you are trying to avoid urinating.

As a baby makes his way through the vaginal birth canal, he may stretch – or even tear or damage – the pelvic floor muscles.

You are more likely to have pelvic floor damage if your baby weighs more, if you’ve had more than one vaginal birth and if you spend more time in the “pushing” stage of labor. Having an episiotomy (a surgical cut made to expand the vaginal opening during delivery) also increases the risk of pelvic floor damage.

Delivery by cesarean section protects against severe incontinence. But some women do develop incontinence even if they have had only cesarean sections.

The following strategies can help you manage your incontinence:

• Bladder training. This program of urinating on schedule enables you to gradually increase the amount of urine you can comfortably hold.

• Fluid management.

• Pelvic floor exercises. • Cognitive behavior therapy. This type of “talk therapy” is used to help people cope with, and control, both physical and psychological disorders. It is sometimes used in addition to bladder training and pelvic floor exercises.

• Avoiding certain beverages. I’ve had patients who discovered that their incontinence improved if they avoided alcoholic and carbonated beverages, coffee and tea. I don’t think scientific studies provide strong support for this practice, but if it helps a patient, I urge them to continue it.

• Losing weight. If you are overweight, losing weight may help improve your incontinence.