Pregnancy
When you are pregnant you get a lot of advice from many people - but something few people talk about are bladder and bowel control problems in pregnancy and after the birth.
How do I know if I have a problem?
Many bladder and bowel problems, particularly during pregnancy can be caused by weak pelvic floor muscles. If you have weak pelvic floor muscles you may:
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leak urine when you cough, sneeze, lift, laugh or do exercise
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not be able to control passing wind
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feel an urgent need to empty your bladder or bowel
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leak bowel motion after you have been to the toilet
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have trouble cleaning yourself after a bowel motion
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find it hard to pass a bowel motion unless you change position or use your finger to help, or
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feel a lump in your vagina or a feeling of dragging (mostly at the end of the day), which could mean that one or more of your pelvic organs might be sagging down into your vagina. This is called pelvic organ prolapse.
You may also have sexual problems. Just after your baby is born, you will be very tired and busy with your baby. Vaginal birth can cause weakness around the vagina or a lack of feeling. Vaginal tears and trauma can cause pain for many months. While breast feeding, oestrogen levels may be low and so the vagina may be dry, which can cause more problems. It may be helpful for you and your partner to talk about these issues with a health professional.
How can I tell if I might get bladder and bowel problems?
Some women seem more likely to have bladder and bowel problems, even if they have had quite an easy birth. We can't yet tell who these women will be.
Women who already have bladder or bowel symptoms, such as irritable bowel syndrome or an urgent need to pass urine (also called overactive bladder) will be more likely to have this problem worsen or to gain new problems.
Certain things about the birth that can make a woman more likely to have bladder and bowel problems include:
- having your first baby
- having a large baby
- having a long labour, chiefly the second stage of labour, or
- a difficult vaginal delivery, when you have stitches or a tear just outside your vagina when the baby is helped out by the vaccuum cap or forceps.
What if I have a caesarean birth?
Choosing a caesarean birth might seem like a way to avoid these problems, but it is not that simple. A caesarean birth might reduce the risk of severe bladder control problems from 10% to 5% for a first baby, but after the third caesarean there may be no benefit at all.
In many cases, a vaginal birth runs just as planned and is a lovely event for parents, so this type of birth is best when possible. But problems can still happen. Research is now looking at how we can better know about and stop harm to the pelvic floor during birth. For now, pregnancy and birth involves making a choice between different kinds of risk. You and your partner need to think about these risks and discuss them with your pregnancy care professional.
What can I do about weak pelvic floor muscles?
The birth of your baby might have stretched your pelvic floor muscles. Any 'pushing down' action in the first weeks after the baby's birth might stretch the pelvic floor again. You can help to protect your pelvic floor muscles by not pushing down on your pelvic floor. Here are a few ideas to help you:
- try to squeeze, lift and hold your pelvic floor muscles before you sneeze, cough, blow your nose or lift
- cross your legs and squeeze them tightly together before each cough or sneeze
- share the lifting of heavy loads
- don't do bouncing exercises, and
- do pelvic floor muscle training to strengthen your pelvic floor muscles.
Will things get better?
Don't lose heart. Even very poor bladder or bowel control just after giving birth will often improve in the first six months, as the pelvic floor tissues, muscles and nerves mend.
Regular pelvic floor muscle training kept up over the long term, as well as the right advice will help.
Don't forget to look after yourself at a time when it is easy to neglect your own needs.
If things are not getting better after six months, speak to your doctor, physiotherapist or continence nurse advisor. To find a service provider in your area visit our service directory.
For futher information and advice contact the National Continence Helpline on freecall 1800 33 00 66.
