Dear Dr Mitchell,
Something embarrassing happened to me the other day. I sneezed and urine came down, and my bladder wasn't even full. A few days later I had symptoms of a bladder infection, and I'm currently on antibiotics to treat it. Are the two related, or am I developing incontinence? I had a baby by C-section a year ago, and have had no other issues with my health.
The involuntary loss of urine on sneezing, laughing or coughing may be a sign of urinary stress incontinence. However, if you have an underlying bladder infection this can cause the bladder to become irritable and for the leakage of urine on coughing, sneezing or laughing. Usually the course of action is to do a urine culture and get treatment with antibiotics. If the loss of urine is entirely due to a baseline urinary tract infection then the problem should resolve completely.
In some women a mixed picture might present itself. This means that the pelvic floor is weak and there is also a bladder infection on board. As women get older and especially after the menopause, the low oestrogen levels can cause the muscles of the pelvic floor to weaken. Other predisposing factors include traumatic vaginal deliveries and the delivery of big babies, diabetes mellitus, chronic cough, cigarette smoking, chronic constipation and obesity.
In order to effectively manage the problem of urinary incontinence secondary to a weak pelvic floor, it is necessary to address some of these risk factor that are reversible with lifestyle changes. If this is not done then any attempt to correct the problem will fail.
In mild degrees of pelvic floor weakness, kegel exercises with lifestyle changes might be all that is required. When you do kegel exercises you should make sure that the bladder is empty, then sit or lie down. You should then tighten your pelvic floor muscles, hold tight, then count to three to five seconds. This is then followed by relaxing the muscles and counting to three to five seconds. This process should be repeated 10 times, three times a day (morning, afternoon and night). These exercises will definitely help to strengthen the pelvic floor and improve the problem.
In severe cases the use of a ring pessary and surgery might be necessary to relieve the urinary incontinence and the pelvic floor prolapse.
The fact that you had a caesarean section does not prevent prolapse and incontinence from occurring, especially if you have other risk factors. You should get a proper evaluation done by your doctor once you have completed the course of antibiotics to determine if you have any other additional problems that need to be dealt with.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to email@example.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.