ISSN 0300-9092 (Print)
ISSN 2412-5679 (Online)

Urinary incontinence during pregnancy: prevalence, pathogenesis, risk factors, treatment and prevention

Belyi L.E.

Ulyanovsk State University, Ulyanovsk, Russia

Urinary incontinence in women is a significant public health issue, as it affects 25–45% of the adult female population. This condition has a negative impact on various aspects of a woman’s life, including social, professional, and sexual well-being. Different types of urinary incontinence are based on various pathogenetic mechanisms, but the correlation between urinary incontinence and obstetric factors is well known. Anatomical and metabolic changes that occur in a pregnant woman increase the risk of urinary incontinence, both during pregnancy and in the postpartum period. Urinary disorders during pregnancy and after childbirth are predictors of urinary incontinence in subsequent periods of a woman’s life. 
This review presents new scientific data on the prevalence of urinary incontinence among pregnant women and its impact on the quality of life during pregnancy. The article discusses the pathogenetic mechanisms leading to urinary incontinence during pregnancy (increased pressure of the growing uterus and fetus on the pelvic floor muscles, increased mobility of the neck of the bladder and urethra, urethral sphincter insufficiency, increased progesterone levels, decreased levels of relaxin and collagen).
The article presents the results of studies aimed at identifying risk factors for urinary incontinence during pregnancy and after childbirth.
Clinical studies have been analyzed and their results show that pelvic floor muscle training is essential for the prevention and treatment of urinary incontinence in pregnant women.
Conclusion: It is necessary to conduct further research into the mechanisms of development and risk factors for urinary incontinence in pregnant women, as this will contribute to improving and developing both existing and new preventive and treatment strategies for this medical condition.

Conflicts of interest: The author declares lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Belyi L.E. Urinary incontinence during pregnancy:  prevalence, pathogenesis, risk factors, treatment and prevention.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (11): 5-14 (in Russian) 
https://dx.doi.org/10.18565/aig.2025.244

Keywords

pregnancy
urinary incontinence
pelvic floor muscles
bladder
urethra
biofeedback

References

  1. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Недержание мочи. 2024. [Ministry of Health of the Russian Federation. Clinical guidelines. Urinary incontinence. 2024. (in Russian)].
  2. Ильина И.Ю., Чикишева А.А., Доброхотова Ю.Э. Особенности течения недержания мочи в разные периоды жизни женщины. Акушерство и гинекология. 2020; 10: 195-202. [Ilina I.Yu., Chikisheva A.A., Dobrokhotova Yu.E. Features of urinary incontinence in different periods of a woman's life. Obstetrics and Gynecology. 2020; (10): 195-202 (in Russian)]. https://dx.doi.org/10.18565/aig.2020.10.195-202
  3. Сенча А.Н., Аполихина И.А., Тетерина Т.А., Федоткина Е.П. Современные возможности ультразвуковой диагностики дисфункции тазового дна. Акушерство и гинекология. 2022; 3: 138-47. [Sencha A.N., Apolikhina I.A., Teterina T.A., Fedotkina E.P. Modern possibilities of ultrasound diagnosis of pelvic floor dysfunction. Obstetrics and Gynecology. 2022; (3): 138-47 (in Russian)]. https://dx.doi.org/10.18565/aig.2022.3.138-147
  4. Beyazıt A., Hakverdi A.U., Gözükara K.H. The effect of pregnancy on urinary symptoms. Cureus. 2023; 15(8): e44232. https://dx.doi.org/10.7759/cureus.44232
  5. Elbiss H.M., Osman N., Abu-Zidan F.M. Risk factors for urinary incontinence during pregnancy among nulliparous women in the United Arab Emirates. Medicine (Baltimore). 2023; 102(4): e32738. https://dx.doi.org/10.1097/MD.0000000000032738
  6. Михельсон А.А., Лазукина М.В., Семенов Ю.А., Вараксин А.Н., Константинова Е.Д., Маслакова Т.А. Результаты персонифицированного алгоритма ведения женщин после родов в аспекте профилактики дисфункции тазового дна. Вестник охраны материнства и младенчества. 2025; 2(1): 64-78. [Mikhelson A.A., Lazukina M.V., Semenov Yu.A., Varaksin A.N., Konstantinova E.D., Maslakova T.A. Results of a personalized algorithm for managing women after childbirth in terms of preventing pelvic floor dysfunction. Bulletin of Maternal and Child Care. 2025; 2(1): 64-78 (in Russian)]. https://doi.org/10.69964/BMCC-2025-2-1-64-78
  7. Варламова А.Л., Михельсон А.А., Лазукина М.В., Нестерова Э.А., Константинова Е.Д., Маслакова Т.А. Предиктивные инструментальные маркеры несостоятельности тазового дна у первородящих женщин. Вестник охраны материнства и младенчества. 2025; 2(1): 41-50. [Varlamova A.L., Mikhelson A.A., Lazukina M.V., Nesterova E.A., Konstantinova E.D., Maslakova T.A. Predictive instrumental markers of pelvic floor dysfunction in primiparous women. Bulletin of Maternal and Child Care. 2025; 2(1): 41-50 (in Russian)]. https://doi.org/10.69964/BMCC-2025-2-1-41-50
  8. Moossdorff-Steinhauser H.F.A., Berghmans B.C.M., Spaanderman M.E.A. Bols E.M.J. Urinary incontinence during pregnancy: prevalence, experience of bother, beliefs, and help-seeking behavior. Int. Urogynecol. J. 2021; 32(3):695-701. https://dx.doi.org/10.1007/s00192-020-04566-0
  9. Jung H., Hwang D.W., Chun K.C., Kim Y.A., Koh J.W., Han J.Y. et al. Prevalence and risk factors of urinary incontinence in pregnant Korean women. Obstet. Gynecol. Sci. 2024; 67(5): 481-8. https://dx.doi.org/10.5468/ogs.24156
  10. Dinc Kaya H., Gunaydin S., Dogan E. Prevalence of urinary incontinence in pregnant women in Turkey: a systematic review and meta-analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2023; 284: 162-8. https://dx.doi.org/10.1016/j.ejogrb.2023.03.019
  11. Moossdorff-Steinhauser H.F.A., Berghmans B.C.M., Spaanderman M.E.A., Bols E.M.J. Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: a systematic review and meta-analysis. Int. Urogynecol. J. 2021; 32(7): 1633-52. https://dx.doi.org/10.1007/s00192-020-04636-3
  12. Berhe A., Alamer A., Negash K., Assefa B. Urinary incontinence and associated factors among pregnant women attending antenatal care in public health facilities of Mekelle city, Tigray, Ethiopia. Womens Health (Lond). 2020; 16: 1745506520952009. https://dx.doi.org/10.1177/1745506520952009
  13. Артымук Н.В., Хапачева С.Ю. Распространенность симптомов дисфункции тазового дна у женщин репродуктивного возраста. Акушерство и гинекология. 2018; 9: 99-105. [Artymuk N.V., Khapacheva S.Yu. The prevalence of pelvic floor dysfunction symptoms in reproductive-aged women. Obstetrics and Gynecology. 2018; (9): 99-105 (in Russian)]. https://dx.doi.org/10.18565/aig.2018.9.99-105
  14. Du Y., Wang P., Chen Y., Liu Q., Wang L., Jin H. et al. Fetal birthweight and maternal urinary incontinence in Chinese primiparas: a population-based study. BMC Public Health. 2025; 25(1): 754. https://dx.doi.org/10.1186/s12889-025-21849-7
  15. Caruso F.B., Schreiner L., Todescatto A.D., Crivelatti I., Oliveira J.M. Risk factors for urinary incontinence in pregnancy: a case control study. Rev. Bras. Ginecol. Obstet. 2020; 42(12): 787-92. https://dx.doi.org/10.1055/s-0040-1718951
  16. Rathore A., Suri J., Agarwal S., Mittal P. Antenatal and postnatal assessment of pelvic floor muscles in continent and incontinent primigravida women. Int. Urogynecol. J. 2021; 32(7): 1875-82. https://dx.doi.org/10.1007/s00192-021-04846-3
  17. Xu Z., He H., Yu B., Jin H., Zhao Y., Zhou X. et al. Application of transperineal pelvic floor ultrasound in changes of pelvic floor structure and function between pregnant and non-pregnant women. Int. J. Womens Health. 2022; 14: 1149-59. https://dx.doi.org/10.2147/IJWH.S361755
  18. Cattani L., Van Schoubroeck D., Samešova A., Packet B., Housmans S., Deprest J. Pelvic floor ultrasound findings and symptoms of pelvic floor dysfunction during pregnancy. Int. Urogynecol. J. 2024; 35(12): 2423-30. https://dx.doi.org/10.1007/s00192-024-05931-z
  19. Van Geelen H., Ostergard D., Sand P. A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. Int. Urogynecol. J. 2018; 29(3): 327-38. https://dx.doi.org/10.1007/s00192-017-3540-z
  20. Безменко А.А., Староверова А.С. Тазовые дисфункции у женщин как следствие анатомо-функциональных изменений тазового дна во время беременности и отражение адаптации к родам. Гинекология. 2024; 26(4): 326-30. [Bezmenko A.A., Staroverova A.S. Pelvic dysfunction in women as a consequence of anatomical and functional changes of the pelvic floor during pregnancy and a reflection of adaptation to childbirth: A review. Gynecology. 2024; 26(4): 326-30 (in Russian)]. https://dx.doi.org/10.26442/20795696.2024.4.203015
  21. Баянова С.Н., Александров Л.С., Ищенко А.И., Плетников М.В., Никонов А.П., Ищенко А.А., Бокарев М.И., Жолобова М.Н., Беришвили М.В., Будникова К.А., Проклова Г.Ф. Механизмы ремоделирования соединительной ткани тазового дна во время беременности, родов и в послеродовом периоде. Вопросы гинекологии, акушерства и перинатологии. 2021; 20(2): 85-93. [Bayanova S.N., Aleksandrov L.S., Ishchenko A.I., Pletnikov M.V., Nikonov A.P., Ishchenko A.A., Bokarev M.I., Zholobova M.N., Berishvili M.V., Budnikova K.A., Proklova G.F. Mechanisms for remodeling of connective tissue of the pelvic floor during pregnancy, childbirth and in the postpartum period. Gynecology, Obstetrics and Perinatology. 2021; 20(2): 85-93 (in Russian)]. https://x.doi.org/10.20953/1726-1678-2021-2-85-93
  22. Pires T.F., Pires P.M., Costa R, Viana R. Effects of pelvic floor muscle training in pregnant women. Porto Biomed. J. 2020; 5(5): e077. https://dx.doi.org/10.1097/j.pbj.0000000000000077
  23. Catanzarite T., Bremner S., Barlow C.L., Bou-Malham L., O'Connor S., Alperin M. Pelvic muscles' mechanical response to strains in the absence and presence of pregnancy-induced adaptations in a rat model. Am. J. Obstet. Gynecol. 2018; 218(5): 512.e1-9. https://dx.doi.org/10.1016/j.ajog.2018.02.001
  24. Burnett L.A., Boscolo F.S., Laurent L.C., Wong M., Alperin M. Uncovering changes in proteomic signature of rat pelvic floor muscles in pregnancy. Am. J. Obstet. Gynecol. 2019; 221(2): 130.e1-9. https://dx.doi.org/10.1016/j.ajog.2019.04.025
  25. Ferizovic A., Winder M., Sato M., Aronsson P. 293-Anti-contractile effects and recovery time after progesterone in the rat urinary bladder. Continence. 2025; 15 Suppl.: 102217. https://dx.doi.org/10.1016/j.cont.2025.102217
  26. Lim M.K., Ku C.W., Tan T.C., Lee Y.H.J., Allen J.C., Tan N.S. Characterisation of serum progesterone and progesterone-induced blocking factor (PIBF) levels across trimesters in healthy pregnant women. Sci. Rep. 2020; 10(1): 3840. https://dx.doi.org/10.1038/s41598-020-59452-y
  27. Molinet Coll C., Martínez Franco E., Altimira Queral L., Cuadras D., Amat Tardiu L., Parés D. Hormonal influence in stress urinary incontinence during pregnancy and postpartum. Reprod. Sci. 2022; 29(8): 2190-9. https://dx.doi.org/10.1007/s43032-022-00946-7
  28. Bertucci E., Ricciardiello F., Guariglia G., Cannistrà F., Oliverio M., Sileo F.G. et al. Relaxin in pregnancy: a narrative review of a pleiotropic molecule. Minerva Obstet. Gynecol. 2025; 77(3): 237-46. https://dx.doi.org/10.23736/S2724-606X.24.05630-6
  29. Михельсон А.А., Мальгина Г.Б., Лукьянова К.Д., Лазукина М.В., Луговых Е.В., Вараксин А.Н., Лукач М.А., Нестерова Э.А. Ранняя диагностика и профилактика тазовых и уродинамических дисфункций у женщин после родоразрешения. Гинекология. 2022; 24(4): 295-301. [Mikhelson A.A., Malgina G.B., Lukianova K.D., Lazukina M.V., Lugovykh E.V., Varaksin A.N., Lukach M.A., Nesterova E.A. Early diagnosis and prevention of pelvic and urodynamic dysfunctions in women after delivery. Gynecology. 2022; 24(4): 295-301 (in Russian)]. https://dx.doi.org/10.26442/20795696.2022.4.201782
  30. Okunola T.O., Olubiyi O.A., Omoya S., Rosiji B., Ajenifuja K.O. Prevalence and risk factors for urinary incontinence in pregnancy in Ikere-Ekiti, Nigeria. Neurourol. Urodyn. 2018; 37(8): 2710-6. https://dx.doi.org/10.1002/nau.23726
  31. Lin Y.H., Chang S.D., Hsieh W.C., Chang Y.L., Chueh H.Y., Chao A.S. et al. Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: an observational cohort study. Taiwan. J. Obstet. Gynecol. 2018; 57(3): 340-5. https://dx.doi.org/10.1016/j.tjog.2018.04.003
  32. Хапачева С.Ю., Артымук Н.В. Факторы риска дисфункции тазового дна и компьютерная программа его прогнозирования у женщин в послеродовом периоде. Медицина в Кузбассе. 2021; 20(2): 59-64. [Khapacheva S.Y., Artymuk N.V. Risk factors of pelvic floor dysfunction and the computer program of its prediction in women in the permanent period. Medicine in Kuzbass. 2021; 20(2): 59-64 (in Russian)]. https://dx.doi.org/10.24411/2687-0053-2021-10024
  33. Zhou H.H., Shu B., Liu T.Z., Wang X.H., Yang Z.H., Guo Y.L. Association between parity and the risk for urinary incontinence in women: a meta-analysis of case-control and cohort studies. Medicine (Baltimore). 2018; 97(28): e11443. https://dx.doi.org/10.1097/MD.0000000000011443
  34. Dinç A. Prevalence of urinary incontinence during pregnancy and associated risk factors. Low. Urin. Tract Symptoms. 2018; 10(3): 303-7. https://dx.doi.org/10.1111/luts.12182
  35. Коваль М.В., Бодунова Л.А., Митягина Я.Р., Росюк Е.А. Ультразвуковая анатомия тазового дна у рожавших и нерожавших женщин. Вестник СурГУ. Медицина. 2023: 16(1): 8-13. [Koval M.V., Bodunova L.A., Mityagina Ya.R., Rosyuk E.A. Ultrasonic anatomy of the pelvic floor in parous and nulliparous women. Vestnik SurGU. Meditsina. 2023; 16(1): 8-13 (in Russian)]. https://dx.doi.org/10.35266/2304- 9448-2023-1-8-13
  36. López-López A.I., Sanz-Valero J., Gómez-Pérez L., Pastor-Valero M. Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews. Int. Urogynecol. J. 2021; 32(7): 1663-73. https://dx.doi.org/10.1007/s00192-020-04550-8
  37. Ahlund S., Rothstein E., Radestad I., Zwedberg S., Lindgren H. Urinary incontinence after uncomplicated spontaneous vaginal birth in primiparous women during the first year after birth. Int Urogynecol J. 2020; 31(7): 1409-16. https://dx.doi.org/10.1007/s00192-019-03975-0
  38. Wang K., Xu X., Jia G., Jiang H. Risk factors for postpartum stress urinary incontinence: a systematic review and meta-analysis. Reprod. Sci. 2020; 27(12): 2129-45. https://dx.doi.org/10.1007/s43032-020-00254-y
  39. Nestor S., Brynhildsen J., Hiyoshi A., Jansson M.H. Bothersome pelvic floor dysfunction and quality of life during pregnancy and postpartum in primiparous women. Int. Urogynecol. J. 2025; 36(3): 635-46. https://dx.doi.org/10.1007/s00192-024-06038-1
  40. Barzak B., Jankowska E., Baura B., Parmar S. Urinary incontinence due to pregnancy – the impact of hormones and biofeedback therapy. Med. J. Cell Biol. 2024; 12(3): 73-8. https://dx.doi.org/10.2478/acb-2024-0011
  41. Jinapun P., Sangnucktham T. Effects of pelvic floor muscle training on urinary incontinence during the third trimester of nulliparous pregnant women: a randomized controlled trial. Int. Urogynecol. J. 2024; 35(2): 401-6. https://dx.doi.org/10.1007/s00192-023-05700-4
  42. Ryhtä I., Axelin A., Parisod H., Holopainen A., Hamari L. Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development. JBI Evid. Implement. 2023; 21(4): 394-408. https://dx.doi.org/10.1097/XEB.0000000000000391
  43. Davenport M.H., Nagpal T.S., Mottola M.F., Skow R.J., Riske L., Poitras V.J. et al. Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis. Br. J. Sports Med. 2018; 52(21): 1397-1404. htttps://dx.doi.org/10.1136/bjsports-2018-099780
  44. Piernicka M., Błudnicka M., Bojar D., Kortas J., Szumilewicz A. Improving the technique of pelvic floor muscle contraction in active nulliparous women attending a structured high-low impact aerobics program-a randomized control trial. Int. J. Environ. Res. Public Health. 2022; 19(10): 5911. https://dx.doi.org/10.3390/ijerph19105911
  45. Díaz-Álvarez L., Lorenzo-Gallego L., Romay-Barrero H., Prieto-Gómez V., Torres-Lacomba M., Navarro-Brazález B. Does the contractile capability of pelvic floor muscles improve with knowledge acquisition and verbal instructions in healthy women? A systematic review. Int. J. Environ. Res. Public Health. 2022; 19(15): 9308. https://dx.doi.org/10.3390/ijerph19159308
  46. da Silva J.B., de Oliveira Sato T., Rocha A.P.R., Driusso P. Inter- and intrarater reliability of unidigital and bidigital vaginal palpation to evaluation of maximal voluntary contraction of pelvic floor muscles considering risk factors and dysfunctions. Neurourol. Urodyn. 2021; 40(1): 348-57. https://dx.doi.org/10.1002/nau.24566
  47. Aparecida Salbego Lançanova A., Chaida Sonda F., Cristine da Silva Gomes D., Mallmann S., Aurélio Vaz M., Laureano Paiva L. et al. Is there correlation between perineometry and Modified Oxford Scale in women? Systematic review with meta-analysis and grade recommendations. Eur. J. Obstet. Gynecol. Reprod. Biol. 2023; 288: 160-9. https://dx.doi.org/10.1016/j.ejogrb.2023.07.011
  48. Hagen S., Bugge C., Dean S.G., Elders A., Hay-Smith J., Kilonzo M. et al. Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: the OPAL RCT. Health Technol. Assess. 2020; 24(70): 1-144. https://dx.doi.org/10.3310/hta24700
  49. Ромих В.В., Кукушкина Л.Ю., Казаченко М.А. Современные возможности применения тренировочных методик с использованием биологической обратной связи в лечении стрессового недержания мочи у женщин. Акушерство и гинекология. 2022; 6: 26-32. [Romikh V.V., Kukushkina L.Yu., Kazachenko M.A. Modern possibilities of using biofeedback training methods in the treatment of stress urinary incontinence in women. Obstetrics and Gynecology. 2022; (6): 26-32 (in Russian)]. https://dx.doi.org/10.18565/aig.2022.6.26-32
  50. Woodley S.J., Lawrenson P., Boyle R., Cody J.D., Mørkved S., Kernohan A. et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst. Rev. 2020; 5(5): CD007471. https://dx.doi.org/10.1002/14651858.CD007471.pub4
  51. Höder A., Stenbeck J., Fernando M., Lange E. Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth – a systematic review. BMC Womens Health. 2023; 23(1): 618. https://dx.doi.org/10.1186/s12905-023-02765-7
  52. Zhu D., Xia Z., Yang Z. Effectiveness of physiotherapy for lower urinary tract symptoms in postpartum women: systematic review and meta-analysis. Int. Urogynecol. J. 2022; 33(3): 507-21. https://dx.doi.org/10.1007/s00192-021-04939-z

Received 04.09.2025

Accepted 02.10.2025

About the Authors

Lev E. Belyi, Dr. Med. Sci., Professor at the Department of Hospital Surgery, Anesthesiology, Reanimatology, Urology, Traumatology, Orthopedics, Ulyanovsk State University, 432017, Russia, Ulyanovsk, Leo Tolstoy str., 42, +7(917)605-97-19, lbely@yandex.ru, https://orcid.org/0000-0003-0908-1321

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