What is bladder and bowel incontinence?

Incontinence is the involuntary leakage of:

• urine (wee) from your bladder
• faeces (poo) from your bowel
• excess wind (farting)

You are more likely to have incontinence when you're pregnant.

Incontinence can be a small leak or total loss of control of your bladder or bowel.

Having some urine leaks during pregnancy is very common. About 1 in every 3 women experience urinary incontinence in pregnancy and or, after birth.

Bowel incontinence of faeces or wind is less common. It happens to about 1 in 4 women in late pregnancy, and less commonly, in about 1 in 25 people, after birth.

What symptoms are related to incontinence during pregnancy?

Some symptoms are:

• leaking urine when you cough, sneeze, laugh or exercise
• not being able to control when you pass wind
• having a strong need to use the toilet (urgency)
• soiling your underwear with liquid poo
• constipation

As your pregnancy goes on, the chance of incontinence gets more likely.

What causes incontinence during pregnancy?

The cause of incontinence is not always known. However, changes that happen to your body during pregnancy can cause your pelvic floor muscles to weaken.

Your pelvic floor muscles support your bladder, uterus and bowel. If your pelvic floor muscles are weakened, these internal organs are less well-supported. This can make it harder for you to control your bladder or bowel.

The chance of having urinary incontinence is highest in the third trimester of pregnancy. As your baby grows bigger, there is added strain on your pelvic floor muscles.

Sometimes, the nerves and muscles in your pelvis that control your bladder and bowel are damaged when you give birth (birth injury).

If you already have problems with bladder or bowel control, it's likely to get worse during pregnancy.

Some other things that make incontinence more likely are:

• constipation
• living with obesity or overweight
• smoking and vaping
• poor mobility — making it difficult to reach the toilet in time
• neurological (nerve) and musculoskeletal (muscle) conditions — such as multiple sclerosis (MS) or arthritis
• other health conditions — such as diabetes, heart disease and sleep apnoea

Your chance of bladder incontinence also increases if you:

• have drinks containing caffeine or sweeteners
• take medicines that affect your bladder

Could incontinence be a sign of something more serious?

Incontinence can be a sign of a prolapse — where your internal organs are no longer supported by your pelvic floor. This lets your bladder or uterus slide down into your vagina.

A prolapse may cause a bulge in your vagina or deep vaginal aching.

If you think you could have a prolapse, see your doctor or speak to your maternity care provider.

How is the cause of incontinence during pregnancy diagnosed?

Your midwife or doctor will talk with you about your symptoms and medical history. You might need to describe how often you need to go to the toilet and exactly what happens. They may also ask to examine you.

If you have bladder or bowel leaks that you can't control, ask your doctor or midwife for advice.

Many people find it hard to talk about incontinence. Your healthcare team are used to these problems and can offer valuable advice and support. To make sure you get the right care, it's important that you share your experience in full. This way your healthcare provider can help find the right care for you.

When to seek urgent care

See your doctor if, when you go to the toilet, if you have any:

• burning
• stinging
• pain

Amniotic fluid is the liquid around your baby. When your waters break, it can feel like a gush or like a slow trickle. If you think amniotic fluid is leaking, check with your midwife or doctor to find out if your waters have broken early.

If you notice any changes in your vaginal or anal area, get an urgent check-up.

How is incontinence during pregnancy treated?

There are some ways to prevent or reduce incontinence during pregnancy.

One of the main things is doing pelvic floor or Kegel exercises.

If you still experience some bladder or bowel leakage, you can plan how to manage it. Depending on the cause, your doctor may suggest medicines or surgery.

Self-care at home

Support your bladder and bowel health by:

• eating a healthy diet
• doing regular exercise
• doing pelvic floor exercises each day
• cutting back on coffee, tea and sweet drinks — have water instead

If you continue to have incontinence, think about how you can manage your symptoms.

You may also want to wear incontinence pads or underwear. These can be single use or reusable. You can buy them from a supermarket or pharmacy.

When you go out, bring a change of clothes and some wipes in case you need them. Find out where the toilet is before you need it.

Medicines for incontinence

Your doctor may suggest medicines to help manage your incontinence. This is typically a medication that helps to relax the muscle of your bladder.

Other treatment options

Pelvic floor exercises can help strengthen the muscles of your:

• vagina
• urethra
• anus

Your doctor or midwife may suggest some simple exercises for you. You can also see a physiotherapist for a personal exercise program.

Watch the Continence Foundation of Australia video on how to do pelvic floor exercises.

Before beginning to exercise these muscles, it's important to make sure you are using your pelvic floor muscles correctly. It should feel like you are lifting and squeezing inside.

Speak to a continence professional or a physiotherapist for guidance.

They can also provide guidance on bladder or bowel training.

You can benefit from pelvic exercises throughout your pregnancy. You can do them lying down, or while sitting or standing. After week 16 of your pregnancy, it's best to lie on your left side, not flat on your back. Ideally, you should aim for 3 to 6 sessions daily.

What are the complications of incontinence during pregnancy?

If you have bladder or bowel incontinence during pregnancy, you may also:

• get a rash or skin irritation
• feel self-conscious
• not want to socialise or go out in case you have an accident
• continue to have bladder weakness after your baby's birth

Will my incontinence continue after I've had my baby?

Most people's pelvic floor muscles go back to normal within 3 to 6 months of childbirth. But if you have incontinence during pregnancy, it might not get better on its own.

Some things about the birth can make it more likely to have bladder and bowel problems, such as having:

• your first baby
• a large baby
• a long second stage of labour
• a difficult vaginal delivery
• an episiotomy (cut to the perineum) or a perineal tear
• sutures (stitches) near your vagina
• an assisted birth where your baby was helped out by a vacuum forceps

Can bladder and bowel incontinence be prevented?

You can't prevent all the changes to your body when you are pregnant. Planning for pregnancy and living a healthy lifestyle can help things go more smoothly.

If a previous birth has caused damage to your anal sphincter muscle, you can ask about a caesarean delivery.

Resources and support

If you are concerned about incontinence during and after pregnancy speak with your doctor or midwife.

To learn more, call the Continence Foundation of Australia on 1800 33 00 66. They also have information and resources in languages other than English.

You can also visit Jean Hailes for Women's Health.

Read more about different types of incontinence and bladder or bowel problems.