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Expecting A Baby?

要生宝宝了吗?

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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.

当你怀孕时,会有许多人为你提供各种建议。但却极少有人会提醒您在怀孕期间和生孩子之后要注意大小便控制方面的任何异常症状。

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.

我的骨盆底肌肉有什么作用?

参阅骨盆底图片。骨盆底肌肉有多种作用。它们:

  • 帮助关闭膀胱,阴道(阴道口)和直肠(肛门);及
  • 帮助将膀胱,子宫及直肠维持在正常位置。

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问题?

如果你的骨盆底肌肉衰弱,可能会出现一些症状。你可能:

  • 在咳嗽,打喷嚏,提举物品,大笑或做运动时漏尿;
  • 无法控制排气;
  • 感到急需排尿或排便;
  • 去厕所后仍有大便漏出;
  • 不容易擦干净;
  • 排便有困难,除非改变姿势或用手指帮忙;或者
  • 觉得阴道内有一块东西,或有经期那种下坠感,多数于晚上发生,可能表示。

有一个或多个盆腔器官下垂到了阴道内。这叫作盆腔器官下垂。这种下垂非常普遍,大约有十分之一的澳洲妇女会出现这种情况。

你可能还会有性方面的问题。婴儿出生之后,你会很疲累并且要忙于照顾婴儿。阴道分娩会令阴道周围组织变弱或缺乏感觉。阴道撕裂或损伤后的疼痛会持续好几个月。母乳喂养可能导致雌激素水平下降,因此阴道会很干,从而引起更多问题。你及你的伴侣跟专业医护人员谈谈这些问题会有所帮助。

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失常?

有些女性似乎更加可能出现大小便失常,即使她们分娩时相当顺利。我们还不知道哪些女性会出现这些问题。

已经出现大小便失常症状的女性,如肠道刺激综合症或急需排尿(也叫作尿急),更有可能令这些问题恶化或出现新问题。便秘、咳嗽及肥胖也会令问题更严重。

有些分娩情况会令女性更易出现大小便失常:

  • 生第一个孩子;
  • 胎儿过大;
  • 产程长,主要是第二产程长;或
  • 阴道难产,即用吸引器或医生用产钳将胎儿娩出时要切开外阴,或者外阴或阴道被严重撕裂, 需要缝针的情况。

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.

如果我剖腹产又会怎样?

选择剖腹产似乎是避免这些麻烦的一种方法,但情况并非如此简单。生第一个孩子时剖腹产可以将严重排尿控制失常的风险从10%降低至5%,但第三次剖腹产之后就可能毫无益处。剖腹产本身也有风险。以这种方式出生的孩子更有可能在出生时出现呼吸困难。产妇可能会面临更高风险,而且剖腹产留下的伤疤会令将来的骨盆手术更加困难。因此你可能只是换了一种麻烦而已。

在很多情况下,阴道分娩会很顺利,对父母来说是一次美妙的体验。因此情况允许的话,这种分娩方式是最好的。不过阴道分娩仍然可能出现问题。目前正在研究如何更好地了解和防止分娩时对骨盆底的损伤。现在,妊娠和分娩涉及到在各种不同类型的风险之间作出选择。你及你的伴侣需要考虑这些风险,并要和你的孕期专业护理人员讨论这些风险。没有人能担保你和你的宝宝在分娩中一帆风顺。

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.”

对于衰弱的骨盆底肌肉我可以做些什么?

分娩可能扯伤了你的骨盆底肌肉。婴儿出生后最初几周,任何“向下推”的动作或会再次拉扯骨盆底肌肉。你可以通过不向下推骨盆底来保护你的骨盆底肌肉。这里有一些建议会对你有帮助。

  • 在打喷嚏,咳嗽,擤鼻涕或提举物品之前尽量收紧,提起骨盆底肌肉并保持下去。
  • 每次咳嗽或打喷嚏之前交叉双腿,并用力将其收紧在一起。
  • 不要自己一人提举重物。
  • 不要做跳跃运动。
  • 做骨盆底肌肉锻炼,增强你的骨盆底肌力(参阅资料册“女性骨盆底肌肉锻炼”)。
  • 保持良好的大小便习惯:
    1. 吃水果蔬菜;
    2. 每天饮用1.5—2升液体。
    3. 不要为了“以防万一”而去厕所,因为这样做可能会减少膀胱的储尿量;以及
  • 尽量防止便秘。
  • 排大便时不要太用力。坐马桶的一种好方法是将前臂放在大腿上,双脚靠近马桶,提起后脚跟。放松骨盆底肌肉然后轻轻向下用力。
  • 保持你的体重处于符合你的身高及年龄的范围内。怀孕期间尽量不要增重太多。
  • 继续做运动。
  • 寻求关于膀胱感染的建议。

欲了解更多信息,请参阅资料册“每个人都应有的良好排尿习惯”。

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.

情况会得到改善吗?

由于骨盆底组织、肌肉和神经逐渐修复,即使产后大小便控制严重失常,在最初的6个月不用帮助也能得到改善。

长期进行定期的骨盆底肌肉锻炼,并采取正确建议对你会有帮助。

当妈妈以后很容易忽略自己的需要,在这个时候不要忘记照顾好自己。

如果6个月之后情况没有改善,就要告诉你的医生、理疗师或排便科护士。

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.

寻求帮助

如果你致电国家排便节制热线,有资质的护士会接听你的电话1800 33 00 66*(周一至周五,澳大利亚东部标准时间8:00am—8:00pm)。

  • 信息;
  • 建议;及
  • 资料册。

如果你在讲英语或者理解上有困难,你可以通过拨打13 14 50获取免费电话传译服务以接通国家排便节制热线。电话会用英语接通,因此请说明你要讲的语言并且不要挂机。你会被连接到一个讲你母语的传译员。告知传译员你想要致电国家排便节制热线,电话是1800 33 00 66。待电话接通后传译员会帮助你与排便节制护理顾问对话,所有的来电均保密。

* 用手机打出会收取相应费用。