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Expecting a Baby?

懷孕了嗎?

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When you are pregnant, you get a lot of advice from many people. One issue that few people think about are signs of bladder and bowel control problems in pregnancy and after the birth.

當你懷孕時,許多人會給你意見。然而,人們往往未有想到懷孕期間及孩子出生後可能會發生的大小便控制問題會有甚麽徵狀。

What do my pelvic floor muscles do?

See the picture of the pelvic floor. The pelvic floor muscles do a number of things. They:

  • help to close off the bladder, the vagina (front passage) and the rectum (back passage); and
  • help to hold the bladder, the uterus (womb) and bowel in their proper place.

我的骨盆底肌肉有甚麼作用?

參閱骨盆底圖片。骨盆底肌肉有多種作用。它們:

  • 幫助關閉膀胱,陰道(陰道口) 和直腸(肛門);及
  • 幫助將膀胱,子宮及直腸維持在正常位置。
 

Pelvic Floor

 

Pelvic Floor

How do i know if i have a problem?

There are a few things that might happen if you have weak pelvic floor muscles. You might:

  • leak urine when you cough, sneeze, lift, laugh or do exercise;
  • not be able to control passing wind;
  • feel an urgent need to empty your bladder or your bowel;
  • leak bowel motion after you have been to the toilet;
  • have trouble cleaning yourself after a bowel motion;
  • find it hard to pass a bowel motion unless you change position or use your fingers to help; or
  • feel a lump in your vagina or a feeling of dragging like a period, 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. Prolapse is very common and happens to about one in ten women in Australia.

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.

我如何知道自己是否有問題?

如果你的骨盆底肌肉衰弱,可能會出現一些症狀。你可能:

  • 在咳嗽,打噴嚏,提舉物件,大笑或做運動時漏尿;
  • 無法控制排氣;
  • 感到急需排尿或排便;
  • 去廁所後仍有大便漏出;
  • 排便後不容易擦干凈;
  • 排便有困難,除非改變姿勢或用手指幫忙;或者
  • 覺得陰道內有一塊東西,或有經期那種下墜感,多數於晚上發生,可能表示有一個或多個盆腔器官下垂到了陰道內。這叫作骨腔器官下垂。這種下垂非常普遍,大約十分之一澳洲婦女會出現這種情況。

你可能還會有性方面的問題。嬰兒出生之後,你會很疲累並且要忙於照顧嬰兒。陰道分娩會令陰道周圍組織變弱或缺乏感覺。陰道撕裂或損傷後的疼痛會持續好幾個月。母乳喂養可能導致雌激素水平下降,因此陰道會很乾,從而引起更多問題。你及你的伴侶跟醫護專業人員談談這些問題會有所幫助。

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 easy birth. We can’t yet tell who these women might 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. Constipation, coughing and obesity can also make problems worse.

Certain things about the birth can make a woman more likely to have bladder and bowel problems:

  • 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 after being cut or having a big tear just outside or in your vagina when the baby is helped out by the vacuum cap or the doctor uses forceps.

如何知道我可能患有大小便問題?

有些女性似乎更加可能出現大小便問題,即使她們分娩時相當順利。我們還不知道哪些女性會出現這些問題。

已經出現大小便失常症狀的女性,如腸道功能紊亂症或急需排尿(也叫作尿急),更有可能令這些問題惡化或出現新問題。便秘、咳嗽及過度肥胖亦會令問題更嚴重。

有些分娩情況會令女性更易出現大小便失常:

  • 生第一個孩子;
  • 胎兒過大;
  • 產程長,主要是第二產程長;或
  • 陰道難產,當你被側切或醫生使用真空吸管或產鉗幫助娩出嬰兒時令外陰或陰道嚴重撕裂之後接受縫針。

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. And caesarean births carry their own risks. Babies born this way are more likely to have breathing problems at birth. It can be more risky for the mother and scarring from caesarean births can make pelvic surgery more difficult in the future. So you may be trading one problem for another.

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. No one can promise you and your baby a perfect outcome.

如果我剖腹產又會怎樣?

選擇剖腹產似乎是避免這些麻煩的一種方法,但情況並非如此簡單。生第一個孩子時剖腹產可以將嚴重排尿控制失常的風險從10%降低至5%,但第三次剖腹產之後就可能毫無益處。剖腹產本身也有風險。以這種方式出生的孩子更有可能在出生時出現呼吸困難。產婦可能會面臨更高風險,而且剖腹產留下的傷疤會令將來的骨盆手術更加困難。因此你可能只是換了一種麻煩而已。

在很多情況下,陰道分娩會很順利,對父母來說是一次美妙的體驗。因此情況允許的話,這種分娩方式是最好的。不過陰道分娩仍然可能出現問題。探討我們可以如何更好地瞭解及防止生產時對骨盆底的傷害的研究現正在進行。

What can i do about weak pelvic floor muscles?

The birth of a 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.
  • Do pelvic floor muscle training to strengthen your pelvic floor muscles (See the leaflet “Pelvic Floor Muscle Training for Women”).
  • Keep good bladder and bowel habits:
    1. eat fruit and vegetables;
    2. drink 1.5 - 2 litres of fluid per day;
    3. do not go to the toilet ‘just in case’ as this might cut down how much your bladder can hold; and
  • Try not to get constipated.
  • Don’t strain when opening your bowels. A good way to sit on the toilet is to put your forearms onto your thighs and, with your feet close to the toilet, raise your heels. Relax your pelvic floor muscles and gently push.
  • Keep your weight within the right range for your height and age, and try not to gain too much during pregnancy.
  • Continue to exercise.
  • Ask for advice about bladder infections.

For more information, see the leaflet “Good Bladder Habits for Everyone.”

對於衰弱的骨盆底肌肉我可以做些甚麼?

分娩可能扯傷了你的骨盆底肌肉。嬰兒出生後最初幾周,任何“向下推”的動作或會再次拉扯骨盆底肌肉。你可以透過不向下推骨盆底來保護你的骨盆底肌肉。這裡有一些建議會對你有幫助。

  • 在打噴嚏,咳嗽,擤鼻涕或提舉物件之前儘量收緊,提起骨盆底肌肉並保持下去。
  • 每次咳嗽或打噴嚏之前交叉雙腿,並用力將其收緊在一起。
  • 與別人一起提舉重物。
  • 不要做跳躍運動。
  • 做骨盆底肌肉鍛練,增強你的骨盆底肌力(參閱資料單張“女性骨盆底肌肉鍛練”)。
  • 保持良好的大小便習慣:
    1. 吃水果蔬菜;
    2. 每天飲用1.5—2升液體
    3. 不要為了“以防萬一”而去廁所,因為這樣做可能會減少膀胱的儲尿量;以及
  • 儘量防止便秘。
  • 排大便時不要太用力。坐馬桶的一種好方法是將前臂放在大腿上,雙腳靠近馬桶,提起後腳跟。放鬆骨盆底肌肉然後輕輕向下用力。
  • 保持你的體重處於符合你的身高及年齡的範圍內。懷孕期間儘量不要增重太多。
  • 繼續做運動。
  • 尋求關於膀胱感染的建議。

欲瞭解更多資訊,請參閱資料單張“每個人都要有的良好排尿習慣”。

Will things get better?

Do not lose heart. Even very poor bladder or bowel control just after giving birth can get better without help 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.

情況會得到改善嗎?

不要灰心。當骨盆底組織,肌肉及神經修復時,即使是生產後非常差的大小便控制於頭6個月內不用帮助也能得到改善。

長期進行定期的骨盆底肌肉鍛練,並採取正確建議對你會有幫助。

當媽媽以後很容易忽略自己的需要,在這個時候不要忘記照顧好自己。

如果6個月之後情況沒有改善,就要告訴你的醫生,理療師,或排便科護士顧問。

Seek help

Qualified nurses are available if you call the National Continence Helpline on 1800 33 00 66* (Monday to Friday, between 8.00am to 8.00pm Australian Eastern Standard Time) for free:

  • Information;
  • Advice; and
  • Leaflets.

If you have difficulty speaking or understanding English you can access the Helpline through the free Telephone Interpreter Service on 13 14 50. The phone will be answered in English, so please name the language you speak and wait on the phone. You will be connected to an interpreter who speaks your language. Tell the interpreter you wish to call the National Continence Helpline on 1800 33 00 66. Wait on the phone to be connected and the interpreter will assist you to speak with a continence nurse advisor. All calls are confidential.

* Calls from mobile telephones are charged at applicable rates.

尋求幫助

如果你致電國家排便節制熱線,有資質的護士會接聽你的電話1800 33 00 66* (週一至週五,澳大利亞東部標準時間8:00am—8:00pm)。

  • 信息;
  • 建議;及
  • 資料單張。

如果你在講英語或者理解上有困難,你可以透過撥打13 14 50獲取免費電話傳譯服務以接通國家排便節制熱線。電話會用英語接通,因此請說明你要講的語言並且不要掛機。你會被連接到一個講你母語的傳譯員。告知傳譯員你想要致電國家排便節制熱線,電話是1800 33 00 66。待電話接通後傳譯員會幫助你與排便節制護理顧問對話,所有的來電均保密。

* 用手機打出會收取相應費用。