Bladder > Bladder Problems > After a Baby

After a Baby

Most Women accept that they might get a vaginal tear during childbirth, but having a bladder or bowel problem after giving birth to their baby is rarely in the minds of expecting mothers.

We cover on this page some possible problems that might occur and the treatments. The main thing to remember is that most of these problems are usually treatable and some, perhaps, can even be avoided by following the health professional's advice.

Urinary Problems

Stress urinary incontinence (SUI) is defined as a sudden loss of urine during normal day to day activities. It is also commonly referred to as bladder weakness and weak bladder. If you have this problem you may notice leakage if you laugh, cough, sneeze, walk, exercise, or lift something.

A weak bladder usually occurs when the muscles in the pelvic floor or sphincter have been damaged or weakened. The pelvic floor is made of layers of muscles which hold the bladder and bowel in place and help to stop leaks. The sphincter is a circular muscle that goes around the urethra (the tube that urine comes out of) and squeezes as the bladder fills up to create a seal so that urine can't leak out.

These muscles can be weakened during pregnancy by the extra weight and natural hormonal changes. Childbirth can cause more problems especially if delivery is prolonged or the baby is large. Forceps and ventouse assisted deliveries may increase the risk of damage, muscle tearing or episiotomies (where the muscle is cut to allow an easier birth) can cause further damage. Pelvic floor exercises can help with these problems. If you'd like to find out more about stress urinary incontinence, treatments and the products available please click here.

Anal Sphincter Tears

Anal Sphincter tears are more extensive than vaginal tears as they involve the two circular muscles that control the anus. A third degree tear may involve damage to one or both of the circular muscles and a fourth degree tear will also include the lining of the anus. When this occurs, it is necessary for the tear to be stitched in theatre and that an epidural or spinal anaesthetic will be required.

At the time of discharge the following advice will be given to help with the healing process and reduce the risk of problems:

• Shower or bath at least once a day to keep the area clean and dry.
• Drink 2-3 litres of fluid every day and eat a healthy well balanced diet, including breakfast, to achieve a normal consistency stool.
• Do pelvic floor muscle exercises as soon as you can after birth. This will increase the circulation of blood to the area, reduce the swelling and ease discomfort. Establishing a routine of practicing pelvic floor muscle exercises whilst sitting feeding the baby and having a glass of fluid at hand to satisfy thirst, makes the most of the time available.
• Follow the programme of pelvic floor muscle exercises given to you by your midwife or physiotherapist to strengthen the muscles which will have been affected during pregnancy and delivery.
• Many women find that they have to rush to the toilet to have their bowels open or have problems controlling wind from the bowel during the first few weeks after delivery, but this control gradually improves. It can be helped by practicing anal sphincter exercises and bowel habit training will help to resist urgency and gradually increase the time between feeling the sensation and the need to empty the bowel.
• Whist the area is healing laxatives should be taken to make it easier to empty the bowel and to prevent constipation.

The next clinic appointment is usually 6-12 weeks after delivery. During this appointment the doctor/ midwife will check on the woman's recovery, but most importantly it allows the woman to discuss any concerns that she has. Most women are able to have a vaginal delivery following a 3rd or 4th degree tear, if the tear has healed and there are no bowel control problems.

Urinary Retention

Difficulty passing urine is a common problem in the first day or two following childbirth, but with careful management this should resolve without long term consequences. The small numbers of women, who are unable to pass urine, experience the discomfort of a very full bladder may need to be catheterised. Recent research indicates that approximately 1 in 500 women may have a problem with bladder emptying which lasts longer than 3 days.

What Causes Urinary Retention?

Hormonal changes in pregnancy cause the bladder muscle to lose tone and so bladder capacity increases from the third month of pregnancy. This increase may not be obvious to the pregnant woman apart from experiencing an increased number of visits to the toilet to empty her bladder. After delivery, the loss of tone of the bladder muscle can cause difficulties in emptying out.

There are procedures that may contribute to the development of difficulties in passing urine, such as: epidural for pain relief, long labour, prolonged second stage of labour, forceps or ventouse delivery and extensive vaginal lacerations. An effect of epidural or spinal anaesthetic is that it blocks normal sensation from the bladder and interferes with the normal bladder filling and emptying function.

Bladder Management

There are certain actions that can be taken to avoid urinary retention - however providing proactive management starts during pregnancy. For a successful bladder management routine to be established it is important for midwives to identify:

• The small number of women who have pre-existing difficulties with bladder emptying and use intermittent catheterisation. An intermittent catheter is a small tube which is inserted into the bladder to drain the urine and then taken out.
• Women with a large capacity bladder who pass urine infrequently, four or less times a day, and pass large volumes of urine, in excess of 600mls.
• Women who have experienced problems with bladder emptying following a previous delivery.

Bladder Management During Labour

In labour women should be encouraged to pass urine at regular intervals, 2 hourly or before top-up of their epidural, if they have one in place. If the woman cannot pass urine after a second attempt, an intermittent catheter should be used to empty the bladder. If labour is long, an indwelling urethral catheter connected to a urine drainage bag on continuous drainage can be used.

Bladder Management Following C-Section or Vaginal Delivery with Epidural

The number of caesarean sections has increased over the years and approximately 1 in 4 women will have a section.

Bladder sensation may take over 10 hours to return after caesarean section under spinal analgesia and over 6 hours following vaginal delivery with or without epidural.

Retention of urine following caesarean section does occur; even though women will have been catheterised for 12-24 hours after delivery. Women most at risk are those who have undergone emergency caesarean section for lack of progress in labour.

Bladder Management Following Vaginal Delivery

It is recommended that women who deliver without epidural pass urine within 6 hours of delivery. Encouragement after 4 hours allows time for simple measures to be tried, such as; pain relief, getting out of bed and walking about or a warm bath. The recommended action after 6 hours, for women, who either cannot pass urine or only pass small amounts of urine, is either an ultrasound bladder scan to estimate the amount of urine within the bladder or catheterisation.

Indwelling urethral catheterisation is the main method of choice in most maternity units. The catheter allows urine to drain in a bag, so preventing the bladder from filling and allowing it to rest, or intermittent drainage via a catheter valve, so as to allow the bladder to fill and empty in a normal cycle. The catheter will be removed after approximately 24 hours to check if normal bladder emptying is achieved. If not women may be sent home with a catheter in place and an appointment given to return to the hospital for removal.

During this period of time women are advised to drink approximately 2 litres in 24 hours. Excessive fluid intake and any intravenous fluids given during labour will increase the production of urine and the speed at which the bladder fills. During the 2nd to 5th day following delivery, the body gets rid of the additional fluids which it retained as part of normal pregnancy, so more urine will be produced.

Alternative Methods of Management

Another option to manage a bladder which does not empty is suprapubic catheterisation, a catheter which enters the bladder through the abdominal wall, which may be left in place for up to 6 weeks. A benefit of suprapubic catheterisation with intermittent drainage is that the woman can try to pass urine in the normal manner. Any urine left in the bladder can be drained via the catheter.

Women can be taught to intermittently self-catheterise to empty the bladder, so as to prevent delayed discharge from hospital. Support and advice at home can be provided by community midwives or local continence nurse specialists. The advantage of this method is that the woman only needs to continue until her bladder resumes a normal pattern of emptying.

Early discharge from hospital may result in women returning to hospital with problems passing urine that were not apparent during the first 48 hours following delivery. It is often found that constipation is the underlying cause and resolving that problem improves bladder emptying.

Further Information

If you are concerned about your problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.

You can also call our specialist helpline on 0845 345 0165 (24 hour answerphone) for medical advice, or visit our Continence Clinic Database facility in the Specialist Services section to find out where your nearest clinic is or call our general enquiries line on 01536 533255 for details.

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