When Edna Kaplan gave birth to her two sons some 20 plus years ago, her body changed in some rather unexpected ways. When she exercised, her muscles were unable to combat a slight leakage of urine. "After my boys were born, I had mild incontinence when I laughed or jumped or did aerobics," Kaplan says. "I would wear a pad when I went for a run."

Kaplan found herself in the company of a large, but relatively silent group, of more than 20 million women. Statistics show that up to 63 percent of women with stress urinary incontinence (SUI) – accidental loss of urine during coughing, laughing or exercise – report their problem began during or after pregnancy, according to Dr. Roger Goldberg.

A Common Issue
Dr. Goldberg practices urogynecology and reconstructive pelvic surgery at the Evanston Continence Center of Northwestern University Medical School. He is the author of Ever Since I Had My Baby (Three Rivers Press, 2003), which explains what women can do to prevent or treat SUI and other related problems.

According to Dr. Goldberg, SUI is the most common form of urinary incontinence and also one of the most common medical problems faced by women during the years, and even decades, after childbirth. "Unfortunately, many of them begin to abandon their fitness routines and avoid activities they previously enjoyed for fear of accidents," he says. "Withdrawing from a healthy and active lifestyle is one of the most unfortunate aspects of this condition. Until recently, women tended to view SUI as an 'inevitable cost of motherhood' or just a normal part of aging – but in today's world, this is not the case."

Dr. Lawrence Lind, chief of urogynecology and pelvic reconstructive surgery at North Shore University Hospital in Manhasset, N.Y., reports that even if a woman had no incontinence with pregnancy, every advancing decade of her life increases the chances that she will become incontinent. For example, by age 65 about 40 percent of all women have incontinence. "Research has shown that less than half of incontinent women seek help for the condition despite the fact that most patients can be cured," he says. "Many women are embarrassed or are taught that it is a normal part of aging. While it is incredibly common, it is not normal to have poor bladder control, and every woman has the right to seek help and regain control and dignity."

Uncovering Causes
During pregnancy and childbirth, the body goes through a profound change. Dr. Goldberg refers to the pelvic floor – a group of muscles, nerves and connective tissues that supports all the pelvic organs including the bladder. Pregnancy and birth can weaken the supports around the bladder and vagina, so the nerves and muscles become less effective at holding urine within the bladder, resulting in SUI.

"Vaginal birth is certainly one life event which is a significant risk factor," says Dr. Lind. "Cesarean delivery decreases but does not eliminate the chances of becoming incontinent and carries with it other risks. Pushing for very long periods of time (more than three hours) and forceps deliveries are associated with increases in incontinence. Other conditions which are associated with incontinence include connective tissue weakness, asthma, tobacco use and long-term constipation."

Seeking Treatments
The first battle against SUI is prevention, and Dr. Goldberg believes it is imperative women learn how to prepare for labor and delivery, including such important procedures as episiotomy, forceps and Cesarean section to reduce their risk of incontinence later on. "The way you have your baby is tremendously important to your bladder control, pelvic and sexual function afterwards, and these issues have unfortunately been overlooked until now," he says. "Avoiding unnecessary procedures, learning the best pushing styles, understanding your risk for pelvic injury, these are factors that need to be discussed right alongside Lamaze breathing and prenatal vitamins."

Sometimes the onset of urinary incontinence cannot be helped, and if symptoms don't resolve by three to six months after childbirth, they're unlikely to disappear without some sort of treatment. Dr. Goldberg reports a wide array of options for sufferers, including Kegel exercises, lifestyle and dietary changes, physiotherapy and biofeedback, and office procedures such as collagen injections.

"For women past childbearing age who are seeking a more complete and lasting cure, remarkable new minimally invasive procedures such as the Gynecare 'TVT' can be performed in a 20-minute outpatient procedure, resulting in complete cures in over 90 percent of cases," Dr. Goldberg says. "The TVT has revolutionized the treatment of SUI, a major step forward from the more invasive surgical procedures of years past."

Another important change is found in drug manufacturing. In previous decades most medicine was not effective in countering incontinence (although drugs available do work on overactive bladders). According to Dr. Lind, this may be about to change. "One drug, Duloxetine, is not yet FDA approved but is expected to be approved in the near future," Dr. Lind says. "This will be the first FDA-approved drug for stress incontinence."

According to reports released by pharmaceutical companies Eli Lilly and Company and Boehringer Ingelheim Pharmaceuticals Inc., women who tried the drug (called Yentreve®) in clinical trials showed significant improvement in the frequency of SUI episodes.

Is there another solution? As with any muscle group, sometimes a little work out does wonders. "Pelvic strengthening (Kegel exercises) have been proven to decrease the chance of incontinence if performed during and after pregnancy," says Dr. Lind. "One-on-one teaching for pelvic strengthening, usually in an urogynecologist's office or at a dedicated physical therapist's, results in better results with pelvic strengthening."

One Woman's Cure
For Kaplan, who rejected her doctor's offer to fix her incontinence surgically, the end to her symptoms was found in a surprising place. After knee surgery she was instructed to use an exercise machine to keep the muscles around her knees strong. "Nothing happened at first, but then my incontinence went away," she says. "It's been gone for a long time and hasn't returned!"

Kaplan believes two weight machines were responsible for her cure: one in which you sit and use your knees to push against resistance and the other where you pull the knees together.

"Maybe a year later it dawned on me that when I laughed, even when I laughed really hard, I wasn't leaking any more," she says. "Saturday the weather was nice in Boston and I decided to take a walk. I didn't even put a protective pad on. A few years ago, that would have been wetville."

Kaplan was fortunate to find success in such a simple solution. Most women must find relief in more traditional methods. Still, the relief and freedom felt at regaining control is something that cannot be measured. And this freedom is a distinct possibility, today more than ever.

"In generations past, women were provided with little information about incontinence and remained unaware of the various ways that bladder problems can be prevented or treated," says Dr. Goldberg. "The good news for today's mom-to-be? Attitudes are changing fast. Incontinence is no longer regarded as the 'inevitable cost' of having a baby. If you're pregnant, learning 'what to expect while you're expecting' is certainly important, but knowing what to expect afterward is the key to maintaining your healthy lifestyle."

Want to see more?

• Active Living: Managing Urinary Incontinence
• A Cure for Incontinence: One Woman's Story of Hope
• When Laughing Makes You Leak: Fast Facts About Stress Urinary Incontinence
• Pregnancy Today
• Talk about it!