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urinary incontinence and postpartum depression
Postpartum Depression and its link to Urinary Incontinence | Image Courtesy of Vitaliy Rigalovsky via Unsplash

What's the Link Between Urinary Incontinence and Postpartum Depression?

Postpartum Depression is a medical illness that negatively affects how you feel, the way you think, and how you act.

It typically arises due to a combination of hormonal changes, psychological adjustment to motherhood, and fatigue. Postpartum depression is said to affect between 5-20% of mothers depending on variable socioeconomic factors. Many people associate urinary incontinence as a common postpartum symptom. Prevalence of postpartum urinary incontinence figures vary due to diverse study formats, however it is predicted that bladder leakage is experienced in a quarter to half of all postpartum women.

In recent years, studies have concluded there is a strong link between both postpartum depression and urinary incontinence postpartum.

In a study by Juraskova et al, of the 3,701 women included in their research, 17.6% reported experiencing stress urinary incontinence and 17.3% reported experiencing depressive symptoms. This was the first birth for 50% of the study and second birth for 40%. This study observed risk factors for urinary incontinence and postpartum depression in the group of women observed. Stress urinary incontinence (urine leaking with an increase in intraabdominal pressure) was significantly associated with vaginal delivery, higher parity (2+), and high pre-pregnancy BMI (body mass index). Postpartum depression was more prevalent in those who had a pre-pregnancy history of depression and those who were divorced or widowed.

The analysis further explored associated conditions for both postpartum depression and urinary incontinence to be self reported poor health, back pain during pregnancy, and those who smoked prior to pregnancy to some degree. All told, the study showed that those with stress urinary incontinence at 6 weeks postpartum had a 1.5x higher risk of postpartum depression by 6 months after delivery. 

Another study from Nam et al. had similar findings linking postpartum depression and urinary incontinence. The study looked at 83,066 women 6 months postpartum, with 6.49% having had urinary incontinence and 0.83% having postpartum depression. The study noted postpartum depression was higher in those women who also had urinary incontinence and spontaneous delivery and women without urinary incontinence who had cesarean delivery (c-section).

Finally, in a study by Lai et al. found that of the women analyzed in their study, 27.5% who had overactive bladder syndrome, concurrently suffered from depression. Those reported depression and overactive bladder experienced more severe urinary incontinence and greater impact of their quality of life compared to those who did not report depression.

With research backing the association between depression and urinary incontinence, you may be curious what you can do. As pelvic floor physical therapists, we help many people combat urinary incontinence. Pelvic floor muscle training, urinary habits, and urge suppression strategies have helped many women combat symptoms of urinary incontinence. From the nulliparous (no births) to the multiparous (2+ births) population, young and old, and the presence of overactive versus underactive pelvic floor muscles, pelvic floor physical therapy has been shown to decrease frequency or severity of urinary incontinence symptoms and is a top line treatment for these conditions. With decreased urinary incontinence symptoms, we hope to decrease risk of developing or prolonging symptoms of postpartum depression.

Screening for postpartum depression:

Screening for postpartum depression is a critical assessment performed by your postpartum care providers. It is the responsibility of your healthcare team to inquire about any changes in mood or thoughts after giving birth. That said, not all providers will actively screen for this. One of the primary screening tools for Postpartum Depression is the Edinburgh Postnatal Depression Scale (EPDS). It is a 10 question questionnaire that goes beyond the PHQ9 which specifically addresses anxiety. If you are diagnosed with Postpartum Depression, there are treatments available. Medical and therapy interventions will be available from either your primary care physician, psychotherapist, or OB-GYN. Some other techniques to help with depressive symptoms include joining a support group for new parents, prioritizing your health and sleep, finding time to exercise, making time to go out, and asking for help from partner, family, and friends. Pelvic health physical therapy can also assist you, as exercise has been linked to improving depression.

Below is a list of ways you can help treat or prevent urinary incontinence, with the first items on each list to be visiting your local pelvic floor physical therapist. We've broken this down between actionable items during pregnancy and after pregnancy - hot tip: they're almost identical!

Urinary Incontinence DURING Pregnancy:

  • See a pelvic floor physical therapist to receive a full assessment and to pinpoint your tissue specific impairments.
  • Train your PFM - mobility is just as important as strength
  • Practice good toileting techniques and fluid intake habits.
  • Education on what changes are happening to your pelvic floor and how that will impact you post pregnancy - be prepared!

Urinary Incontinence POST Pregnancy :

  • See a pelvic floor physical therapist to receive a full assessment and to pinpoint your tissue specific impairments.
  • Train your pelvic floor muscles - mobility is just as important as strength
  • Practice good toileting techniques and fluid intake habits.

You can also check out our article on “5 Things You Can Do To Improve Postpartum Health”. To schedule an appointment with one of our pelvic floor physical therapists, contact us here. 

Written By Carrie Morgan, SPT (DPT Intern) 

References:

  1. Jurášková M, Piler P, Kukla L, et al. Association between stress urinary incontinence and depressive symptoms after birth: The Czech elspac study. Sci Rep. 2020;10(1). doi:10.1038/s41598-020-62589-5
  2. Nam JY, Park E-C, Cho E. Does urinary incontinence and mode of delivery affect postpartum depression? A nationwide population-based cohort study in Korea. Int J Environ Res Public Health. 2021;18(2):437. doi:10.3390/ijerph18020437
  3. Lai HH, Shen B, Rawal A, Vetter J. The relationship between depression and overactive bladder/urinary incontinence symptoms in the clinical OAB population. BMC Urol. 2016;16(1). doi:10.1186/s12894-016-0179-x
  4. OASH Office of Women’s Health. Postpartum depression. Postpartum depression . February 17, 2021. Accessed July 3, 2023. https://www.womenshealth.gov/mental-health/mental-health-conditions/postpartum-depression

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Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

Read more: Testimonial by Ann V.

Testimonial by M.M.

A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

Read more: Testimonial by M.M.

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

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