Prevention and treatment of stress urinary incontinence during pregnancy: Global perspective, research to practice

Abstract

Stress urinary incontinence (SUI), the complaint of involuntary loss of urine on effort, physical exertion, sneezing or coughing, is the most common type of urinary incontinence (UI) in pregnant women. The prevalence of SUI during pregnancy is reported by approximately 18.6% to 75% of all pregnant women.It is well known that SUI is related to reduced muscle strength, as well as the supportive and sphincteric function of the pelvic floor such as the pelvic floor muscles (PFM), connective tissue and fascia. Pregnancy is one of the main risk factors for the development of SUI. The physiological changes during pregnancy may lead to reduced strength of supportive and sphincteric function of the PFM. SUI in pregnant women can be prevented and improved by intensive pelvic floor muscle exercise (PFME).Pregnant women who regularly and correctly perform PFME will have hypertrophy of muscle fibers with strengthening of the PFM and periurethral muscles leading to improvement of the sphincteric function efficiency and decreased urine leakage.However, some physicians suggest that intensive exercise by a therapist cannot be implemented into clinical practice. It is likely that the success of randomized controlled trials reported in the many research cannot be repeated in a `real clinical situation'. Most pregnant women tend to consider SUI a common discomfort of pregnancy. Although they are often inconvenienced and troubled by SUI symptoms, they are reluctant to seek help from health professionals. The majority of pregnant women are not provided with information on SUI. During pregnancy, 55% percent of women receive some form of instruction in PFME. This means that not all pregnant women receive instruction about SUI and PFME during pregnancy.Moreover, the information is provided by a variety of health professionals and no single profession appears to undertake the responsibility of providing this service. Thus, it is suggested that midwives may not have a direct responsibility to provide this knowledge to pregnant women despite the fact that nurses or midwives are health professionals most closely involved with most pregnant women.Thus, to be effective in the prevention and treatment SUI during pregnancy by PFME, there is a need for the service to be reorganized to ensure that all pregnant women receive high-quality instruction during pregnancy. Midwives should assess the SUI symptoms in pregnant women and provide instruction about SUI and PFME during pregnancy in addition to emphasizing the need for regular and correct PFME. These midwives need to be regularly updated with new information and encouraged to communicate with one another in the ongoing antenatal and postpartum care of women. Thus, midwives need to be actively involved in educating and demonstrating to pregnant women about SUI during pregnancy and how to perform PFME while encouraging the women to adhere to recommended PFME regimens.The purpose of this chapter is to discuss knowledge about SUI and PFME during pregnancy. This information can be useful for midwives and healthcare professionals when informing and counseling pregnant women in SUI prevention during pregnancy. © 2015 by Nova Science Publishers, Inc. All rights reserved.