Bladder Health During Pregnancy and Post-partum
By Laura E. Stachel
Pregnancy affects most parts of our body, and our bladder is no exception. Early pregnancy hormones increase the urge to urinate. The weight of our growing uterus on our bladder reduces our bladder capacity, making frequent urination one of the tell-tale signs of pregnancy. Urinary tract infections can be more problematic in pregnancy; even asymptomatic infections are treated during pregnancy to lower the chances of developing kidney infections. And losing bladder control becomes increasingly common in late pregnancy and post-partum.

The bladder muscle is shaped like a balloon. The main part of the balloon is made of smooth muscle cells that stretch and relax as the bladder fills. We urinate through a small tube called the urethra. Two sphincter muscles constrict the urethra until you’re ready to urinate. Your pelvic floor muscles support the urethra and help to keep it closed. When your bladder is full, nerve fibers from the bladder transmit this information to your brain, resulting in the “urge” to urinate. When you go to the toilet, you must relax the muscles of your urethral sphincter and pelvic floor, and contract the bladder muscles. Therefore, healthy bladder function relies on normal bladder anatomy, strong pelvic floor muscles, and healthy brain and nerve function.

Your growing pregnant uterus shifts the position of your bladder, making it more vulnerable to urine leakage. Your pelvic floor muscles can weaken and stretch with pregnancy and childbirth, and difficult deliveries can harm the nerves to the bladder. For many women, these changes translate into difficulty controlling the flow of urine. Activities that increase stress on the bladder, such as jogging, coughing, sneezing, or heavy lifting may result in urine leakage. Most women with this type of urine loss, called stress incontinence, will eventually have better bladder control in the months that follow delivery.

Luckily, there are exercises that can improve your bladder control during and after your pregnancy. They are called Kegel exercises, and are designed to help strengthen your pelvic floor muscles. To do Kegel exercises, you need to squeeze and contract the muscles of your pelvic floor. You can identify these muscles by trying to stop the flow of urine while you are urinating. Concentrate on tightening the muscles in this area while relaxing your thigh, back and abdominal muscles. Try to hold this muscle for four seconds, then release the muscle for the same amount of time. Repeat this process 10 times. As your muscle becomes stronger, increase the length of time you contract this muscle and rest. Try holding the muscle for up to eight seconds at a time. You should do a series of Kegel’s each morning and evening as a minimum.

The person who invented these exercises, Dr. Kegel, advised doing 100 Kegel’s a day! You can practice tightening your pelvic floor muscles throughout your day: while driving in a car, while watching TV, while washing dishes. Be sure to do them regularly in order to get the maximum effect. Many childbirth educators recommend Kegel’s for all women to improve pelvic floor functioning during and after childbirth. As each subsequent pregnancy has the tendency to further weaken our pelvic floor muscles, doing Kegel’s could be an important exercise for anyone interested in preventing future bladder and pelvic problems.

If you continue to have loss of bladder control many weeks after your delivery, you should discuss this with your doctor. Sometimes a difficult delivery can damage bladder nerve function or weaken the pelvic floor profoundly. There are biofeedback techniques and physical therapy exercises that can further strengthen your pelvic floor. In other cases, surgical repair may be the only way to regain control of your bladder. One thing is for sure: you do not need to live forever with bladder problems. If your doctor cannot help you, ask to be referred you to a specialist in this area, called a gynecologic urologist.