Leaking Urine During the Third Trimester
Written by Dr. Karah Charette, PT, DPT, RYT
Are you in your third trimester of pregnancy and experiencing new or sudden onset of urinary incontinence?
Urinary leakage (or incontinence) during pregnancy is common but that does not mean it is normal.
This is a frequent issue in late stages of pregnancy that is often temporary. However you can lessen the severity of it and improve postpartum outcomes through quality pelvic floor physical therapy.
In this blog, you will learn the causes, implications, and solutions for urinary leakage during the third trimester.
What is Urinary Leaking During Pregnancy?
Any involuntary loss of urine, small or large, is considered urinary incontinence. There can be different kinds of incontinence and this can be important diagnostically.
One common form of incontinence during pregnancy is stress urinary incontinence. In stress incontinence, usually you leak because of increased pressure on the bladder and the pelvic floor. If you are unsure what your pelvic floor muscles are, you can read all about them in our comprehensive guide here.
With stress incontinence during pregnancy, this can occur for many reasons. One major reason is poor pressure management. Your abdomen (and your core) have the primary job of managing intra-abdominal pressure. When you have a growing baby inside you, pressure increases on the bladder wall. Your core muscles also lengthen to accommodate the growth of the baby. This is a normal and adaptive change, however when those muscles lengthen it is harder for them to generate as much strength to help manage load and pressure on your system. This in addition to potentially poor postural habits and breathing patterns can contribute to increased likelihood for leakage when performing activities with increased pressure such as sneezing, coughing, laughing, jumping, lifting, and running. Luckily, this is all easily managed with specific and targeted pelvic floor physical therapy.
Another form of incontinence is urge incontinence. This type of incontinence during pregnancy usually manifests as a sudden urge to urinate met with a loss of urine before you can make it to the bathroom. There can again be various causes to urge incontinence. One can be the increased pressure on the bladder coupled with a tight pelvic floor. If the pelvic floor muscles become tight and over-recruited during pregnancy, they can pull on the urethra or the fascia that connects to the bladder and create a false or increased intensity in the urge to urinate. Tight muscles are also not strong muscles, so in the rush to the bathroom the muscles can struggle to keep the urethra closed and keep urine in. Another important aspect of urge incontinence is the nervous system. The bladder is a reflexive organ that responds to signals from the brain and nervous system. A nervous system that is more chronically stressed, has a history of trauma, or has hyper fixation on the bladder sensations can actually contribute to increased sensitivity and leakage. This is not to say “it is all in your head”, but rather it provides insight into the evidenced based ways we can approach working with your nervous system to address and change symptoms in your body. At Bodyful, we are somatic in our approach to care for this exact reason. You can read more about our approach here.
When Should I Seek Help?
While occasional leaking may not feel like a big deal, it is the first sign of pelvic floor dysfunction. If you want to be proactive and get ahead of any worsening symptoms, even just one assessment with a pelvic PT may be enough to get you started on a preventative program to lessen symptoms and improve postpartum outcomes.
In general, if the leaking persists or worsens the recommendation for seeking professional help becomes stronger. If leaking begins to be paired with pelvic pain, discomfort, or overall is affecting your quality of life, these would all be legitimate reasons to seek care from a skilled pelvic floor physical therapist.
If you find you experience full bladder leakage regularly and are not aware of it or do not feel it, this would be an indication to report to your MD. Any perineal numbness, lack of sensation, or passive full bladder leakage should be medically assessed immediately before consulting with a physical therapist.
Pelvic Floor Therapy:
The Key to Managing Leaking
When it comes to leaking during pregnancy, a pelvic floor specialist should be the primary choice for treatment. Pelvic floor physical therapists are experts in the pelvic floor muscles that play a key role in urinary incontinence.
There are many aspects to consider when trying to address urinary leakage. At Bodyful, we focus on three essential elements:
Pelvic Floor Strength
Contrary to popular belief, strength is not just about being able to do 100 kegels. Kegels are usually done incorrectly and with not enough emphasis on relaxation. A healthy muscle needs to have its full range of motion in order to be functional. If your pelvic floor muscles are too tight, they are also going to be weak. Most clients walking through our doors have pelvic floor muscles that are too over-recruited and they do not know how to coordinate relaxation. At Bodyful, we work with your pelvic floor muscles to train efficient neuromuscular coordination so that you can have good length and good strength in order to keep you continent.
2. Breathing Techniques
If you are someone who constantly holds their breath during difficult tasks or focuses mostly on belly breathing strategies, your breathing patterns may be driving your urinary symptoms. The respiratory diaphragm heavily influences the pelvic floor and plays a role in pressure management on the bladder. If your breathing patterns do not fully involve the respiratory diaphragm efficiently, your pelvic floor muscles may not have that nice length and coordination we talked about earlier. Poor breathing and breathing holding patterns can also increase pressure in the abdominal cavity and onto the bladder, so even if you have a strong pelvic floor you may still experience leakage. We always want to assess what is happening above the bladder to be holistic and effective in our treatment.
3. Posture
Just as you read above with the diaphragm affecting the bladder and pelvic floor, your posture can also work for you or against you with incontinence. If you have postures where your ribcage is not directly stacked over your pelvis, there is a chance that there is increased load and strain on your abdomen and contents within the abdomen (i.e.; the bladder). Like a balloon being kinked at the top, when there is tension or folds in the system, the pressure increases at the bottom of the balloon. We want to avoid postures that create downward pressure on the bladder and the pelvic floor. Having your posture individually assessed and addressed can make a big difference in your incontinence symptoms.
Pelvic Floor Muscles Involved In Urinary Leakage
Manual Therapy, Therapeutic Exercise,
& Body Awareness
At Bodyful, we believe the true magic of change happens when quality, nervous system informed manual therapy occurs in addition to targeted therapeutic exercise. When indicated and with consent, we can assess your pelvic floor directly with internal techniques that allow for direct palpation and diagnosis of specific pelvic floor muscles that may be contributing to your incontinence.
We are also trained in specific and gentle visceral fascial mobilization techniques that allow us to assess structure in the abdomen, including the fascia of the bladder and the ligaments of the bladder. This can be very helpful for people who do not want internal manual therapy or who are in need of a different approach.
For exercise, we are trained in a unique and evidenced based movement modality called Dynamic Neuromuscular Stabilization (DNS). This work focuses specifically on intra-abdominal pressure management which is essential when treating incontinence. If you have tried kegels or pelvic floor therapy before but have not had your core and pressure management strategies thoroughly assessed, there may still be room for improvement.
With both manual therapy and exercise, we are incredibly somatic in our approach. We are sensitive to stories of trauma, and have the evidenced based belief that the nervous system drives our experiences in our body. We value attunement, pacing, and collaboration to ensure that the environment in which you learn and heal is suited to your nervous system’s unique needs.
Lifestyle Changes and Strategies to Reduce Leakage
It is important to also consider daily habits and behavioral patterns that can contribute to urinary leakage:
If you are someone who has decreased water intake to stop the leakage, you may want to reconsider. Not only does this promote dehydration, but it can also make the urine in your bladder more acidic which can irritate it further. This strategy is not effective in stopping incontinence and the cons outweigh the pros.
You may want to consider scheduled bathroom breaks. If you are someone who goes a long time with urinating and then feels the sudden urge, try to schedule more frequent breaks. If you are someone who constantly feels like they need to pee and you are going all the time (even if it is small dribbles), consider spacing the bathroom breaks out a bit more. Your bladder urges can be trained to become more or less frequent depending on your habits. In general, every 2-3 hours is considered the “norm” and your stream should be at least 8 seconds long. With pregnancy, these values can and will change, but you can use this as a general guideline to bring some awareness to what your patterns are and what feels reasonable for you.
Do not push to pee! If you are someone who rushes and pushes to eliminate urine, you are actually creating a relative strain on your pelvic floor. The pelvic floor needs to relax when you urinate to open the urethra and let out the fluid. Try to relax your body, breathe, and zen your pee!
Try to avoid having too many bladder irritants in your diet. What you eat and drink can also affect your bladder sensitivity. Common bladder irritants include caffeine, carbonated drinks, alcohol, and more acidic foods. This does not mean you need to cut everything out, but if your diet consists heavily of these types of food and drink, you may want to reduce a few irritants when you can to decrease the load on your bladder.
The Importance of Postpartum Pelvic Floor Care
If you are reading this now and are experiencing leakage in your third trimester, you may want to seriously consider getting postpartum pelvic floor care as well. Every birth person deserves rehab after the major event of birth occurs. However, if you already have signs and symptoms of some pelvic floor dysfunction via leakage, you may want to support your postpartum recovery early to get ahead of worsening symptoms, including pelvic organ prolapse. Read more about that here.
You can get pelvic floor PT now, even when pregnant, as long as you are cleared for intercourse and exercise. If you would rather wait until you are postpartum, the recommendation is to go after your 6 week check up with your OBGYN. This is so you can receive clearance for internal work and have a pelvic floor assessment.
However, you can also see a pelvic PT before the 6 weeks, we just will not perform an internal assessment. At Bodyful, we can still make a difference by assessing your abdomen fascia, breathing patterns, core coordination, and posture. The sooner you address symptoms and begin your recovery, the more time, money, and energy you will save in the long run. Even just one session can make all the difference.
Even though urinary leakage can be uncomfortable and inconvenient, it is very manageable with the right approach.
A pelvic floor specialist can perform an individualized assessment and get you on track with a unique, efficient, and evidenced based plan of care.
Want to work with a pelvic floor specialist at Bodyful?
Bodyful Physical Therapy and Wellness is located in Oakland, CA and can help anyone in the Bay Area with an in person visit. Telehealth is a great option for those in the state of CA who cannot come in person. Virtual Somatic Wellness visits are available to folks both in and outside of CA.
Want to learn more?
Read this blog about the Top 5 Prenatal Pelvic Floor Exercises you should be doing!
