(trigger warnings: discussion of pregnancy & childbirth complications)
If you gave birth, you may have urinary incontinence (UI) later on in life, especially post-menopause. Maybe you weren’t planning for that, sorry!
Pregnancy and childbirth can damage the pelvic floor and muscles associated with bladder control, which could lead to UI. Menopause can be associated with UI because of how bodies produce less estrogen during and after menopause. What you may not have known is that the hormone estrogen helps to keep the bladder and urethra linings healthy, so post-menopause bladders and urethras are weakened, which could lead to UI.
The frequency and type of UI may vary by different race and ethnicity, according to one study that looked at UI for people aged 40-69 years old who had given birth earlier in life. (1)
Rates of urge UI (aka overactive bladder where you have the sensation of needing to pee; likely caused by nerve damage and/or bladder muscle issues) in this study were about the same across all groups. (2) But Hispanic individuals in this study reported higher general UI frequency on a weekly basis out of the four groups of people (Hispanic, non-Hispanic white, Black, and Asian-American) while Black individuals and Asian-American individuals reported less stress UI (where UI occurs due to physical pressure, like when sneezing, laughing, physical exertion, etc;
(3)) than white cohorts; note, that this study does not talk about method of delivery. Separately, when we look at data about “unnecessary C-sections,” we do see that Black individuals and Asian American individuals are given unnecessary C-sections at higher rates than Hispanic and non-Hispanic white individuals (4).
How is this related? For people who gave birth for the first time, those who had a C-section were half as likely twenty years after giving birth to develop stress UI than those who had given birth vaginally (5).
So, it would then make sense that fewer Black and Asian-American individuals are experiencing stress UI. Different studies disagree about whether the number of vaginal births increases risk for UI or not (6, 7). While it may be tempting to say that everyone should get a C-section to avoid UI later in life, research shows that unnecessary C-sections increase risk of infections and respiratory issues for the newborn and infections and blood clots for the birthing parent (8). So let’s not get too hasty.
Other health issues that cause UI can be triggered during pregnancy and childbirth as well, in addition to the potential pelvic floor damage and weakening of bladder. Someone who gets gestational diabetes, for example, is more likely to get diabetes in the future (9) which can be another cause of UI. That being said, there are specific racial differences in the data: while Black birthing parents in the US are least likely to develop gestational diabetes, when they do, they are way more likely to develop type 2 diabetes after the pregnancy than people of other races who had gestational diabetes (10).
Researchers don’t know if childbirth is directly causing post-childbirth, non-gestational diabetes, or if the individual was already predisposed and the pregnancy and childbirth are a “stress test”.
Diabetes is one of those chronic illnesses that is linked to a lot of other chronic conditions. In the incontinence context, there are several studies that show a relationship between having type 2 diabetes and developing Alzheimer’s or other kinds of dementia (11). And dementia is another illness that can cause UI and fecal incontinence (FI).
So the question of “does giving birth cause diabetes in some people” can feel quite pressing when seeing how type 2 diabetes is linked to dementia, but that’s a family of questions we don’t know the answers to yet. There has been at least one study looking at the cognitive functions of people with gestational diabetes, with the purpose of building a research foundation that can better assess if and how gestational diabetes is eventually linked with dementia (12). To read about additional chronic health issues that could cause UI, please see our previous blog post!
All of this to reiterate: pregnancy and childbirth, regardless of method of delivery, put huge physical strains on birthing parents that can have long-term effects, including UI. If you or someone you know is pregnant, really try to get good prenatal care, including getting screened for gestational diabetes. Make sure you try to get good follow-up care, especially if you do have gestational diabetes, to try to reduce risks of getting type 2 diabetes.
Healthcare providers can also teach you about exercises to strengthen your pelvic floor for post-childbirth and to answer questions you may have about any post-partum complications, including UI. While we don’t see UI or FI as embarrassing symptoms to have, we encourage you to take UI prevention seriously and talk to your doctors about it so that UI doesn’t become another thing you have to worry about.