Bladder Letting You Down?

You’re not the only one! Kate Winslet hit the headlines when she announced that she can’t jump on trampolines any more and Chrissy Tiegen tweeted about coming home after the birth of her baby in ‘diapers’, as did Kim Kardashian. Have you found yourself in a similar situation soon after the birth of your baby?

It is relatively common to have some changes in bladder function in the first hours and days after giving birth, but not normal for this to continue much longer than that. During the birth process, lots of structures within the pelvis (including your pelvic floor and neural tissues) stretch to accommodate your baby as she makes her way into the world.

What Causes Bladder Problems After Birth?

There are so many factors that can cause issues with the bladder, but problems very soon after your baby’s birth are often due to stretching of this neural tissue (nerves).

These nerves allow sensation in the pelvis and structures within the pelvis – for example your bladder, pelvic floor muscles and bowel. They also carry motor signals (the commands from your brain that switch on your muscles and allow them to work).

Over-stretching of these nerves can cause decreased sensation around the perineum, in the pelvic floor muscles (so you can’t feel it when you do your kegels), and in the bladder. This can cause symptoms like:

  • urinary urgency (needing to rush to the toilet)
  • overflow leakage (large bladder leaks due to lack of the normal urge to empty the bladder)
  • stress incontinence (leakage with coughs, sneezes or movement)
  • general lack of sensation from the structures in the pelvis.

 

How does this happen?

It’s more likely if your birth is long (particularly the second or ‘pushing’ stage) or if an instrument such as a vacuum or forceps is used to help you birth your baby. The nerves in the pelvis can be stretched or compressed during the birth. This can cause an interruption in the ‘signals’ travelling along them. This is usually temporary. The time it takes for the nerves to repair themselves depends on the extent of stretching or compression the nerve has undergone.

 

What’s the prognosis?

 

We physios classify nerve injuries into different categories but the good news is that most of the time, nerve injuries that occur during birth are minor and quickly resolve.

 

You may find that for the first few days after the birth you get little or no urge from the bladder and end up leaking because you forget to go, or that you get an uncontrollable urge and have to drop everything and run for the bathroom. This should be gradually resolving over the first few days and weeks after the birth. Here are some tips to help you manage in the meantime.

 

Tips For Bladder Issues After Birth

  1. For the first few days, empty your bladder regularly (hourly to two hourly). Set an alarm if you need to – in the business of having a new baby, you can forget until it’s a serious emergency! Once you start to become more aware of your bladder filling, you can begin to space your toilet trips out a little more. Go immediately once you get the slightest urge. When you’re managing this, you can begin to wait a little longer. You can then gradually extend the amount of time you ‘hold on’. Continue this until you’re going to the toilet at your usual frequency.
  2. Don’t change your fluid intake. It generally doesn’t help with bladder symptoms and dehydration can leave you feeling exhausted, cause UTIs (bladder/kidney infections) and affect breastfeeding.
  3. No need to start doing loads of pelvic floor (kegel) exercises right away. If you’ve had an episiotomy or larger tear and you’re sore, you’re probably clenching every time you sit down (and maybe every time you stand up too!). If your sensation ‘down there’ isn’t the best initially, it may be difficult to be sure whether you’re doing your exercises properly. Once it’s a little easier to do those everyday movements without discomfort and your sensation has improved, then you can get started on your kegels if you need to do them.
  4. Ask to be assessed and followed up by your hospital’s women’s health physio. By your 6 week check, any bladder issues should have improved significantly, if not resolved. If you are still having problems, your women’s health physio can give you expert advice and support.

 

To find your closest women’s health physiotherapist in Ireland, visit www.findaphysio.ie

 

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