Simple, easy acts in pregnancy and childbirth might protect against incontinence

November 06, 2002

ANN ARBOR-U-M researchers are looking at the effectiveness of simple, free activities during pregnancy and childbirth to prevent midlife urinary incontinence.

The study, which is recruiting participants, eventually will include 400 women in their first pregnancy, working with them throughout pregnancy and following them for at least one year after birth.

Research has shown that giving birth vaginally can increase a woman's risk of suffering from unwanted urine loss. About 10 million women 25 and older suffer from urinary incontinence, according to the American Urological Association. It's an embarrassing condition that can lead to social isolation and depression, said Carolyn Sampselle, associate dean for research at the U-M School of Nursing.

Sampselle helped launch the Promoting Effective Recovery from Labor project in 1995 to look at the risk factors in pregnancy that lead to incontinence.

Based on that earlier work, PERL recently began studying the benefits of spontaneous pushing, following the woman's contractions instead of directions from health professionals, and daily massage of the perineum starting in the 34th week of pregnancy to increase the elasticity of tissues surrounding the opening of the vagina. In addition, all participants are taught and encouraged to do pelvic muscle exercises.

Sampselle hopes the activities will prevent damage to the pelvic floor, a group of muscles that form a sling across the opening of the pelvis and that, among other things, help restrict urine flow out of the bladder. The pelvic floor can be stretched or damaged in childbirth, giving women less muscle control to hold back urine.

Treatment for incontinence can range from Kegel exercises for the pelvic muscles to surgery, but Sampselle hopes prevention will prove easy and successful enough that treatment isn't necessary as often. Women can be reluctant to discuss incontinence with their health care providers, leaving them undiagnosed and untreated.

Sampselle, who describes herself as having a feminist understanding of birth, says giving women tools to have a baby in a way that's best for their bodies is empowering.

"There's not a lot of confidence that women can do this," she said. "The standard expectation is that a woman will have to be told how to push her baby through the birth canal. Why should a woman have to be told how to do this when the process is as natural as a cough or a sneeze?"
National Institutes of Health is providing $2 million for the research, to run through 2004. Collaborators include John DeLancey, professor of obstetrics and gynecology; James Ashton-Miller, director of the Biomechanics Research Laboratory in engineering, and Terri Murtland, a U-M Hospital nurse midwife.

Information about volunteering for the PERL study:

Note: Volunteers must be planning to give birth at the U-M Health System or St. Joseph Mercy Hospital.

The PERL project:
Carolyn Sampselle's faculty profile:
The National Kidney and Urologic Diseases Information Clearinghouse, under the umbrella of the National Institutes of Health: U-M has professional TV studios and uplink capabilities. Women who have participated in past studies are available for interviews.

University of Michigan

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