Frequent urination after giving birth

What’s ‘normal’ after giving birth?

Pregnancy and childbirth bring about many changes to our bodies. The process of recovery can be confusing and even overwhelming, and there is a great deal of misinformation out there.

Women come to InterMed Pelvic Floor Physical Therapy with many questions about their post-pregnancy bodies and symptoms. Our patients want to know if the changes are permanent. Will their symptoms ever go away, or do they just need to live with them as a new normal? What kind of recovery can be expected after giving birth? How long will that take?

The confusion often comes because some symptoms are considered normal for a period of time, and then become abnormal if they continue beyond that timeframe.

Our goal here is to answer questions and provide information about what is normal and to be expected with the three most common post pregnancy issues that result in a referral to Physical Therapy: bladder health and leakage, pain with sex, and Diastasis Recti Abdominus, a gap between your abdominal muscles.

What is considered normal bladder health after giving birth?
Urinary incontinence, or involuntary leakage of urine, is common for the first few months after giving birth. During the first 3 months, it’s normal to leak when you cough, sneeze, laugh, or lift your baby. It’s also normal to urinate more frequently or to have strong sudden urges. After the initial 3 months, normal urinary control should return. Some women see their symptoms gradually resolve, while others continue to struggle.

The strongest predictors of postpartum incontinence are:

• Low pelvic floor strength
• Incontinence prior to pregnancy
• New onset of incontinence during pregnancy
• Size of your newborn (greater than 6.6 pounds)

Women who do pelvic floor squeezes during their pregnancy and again at 12 weeks postpartum develop less incontinence than women who don’t do squeezes. Guidelines indicate that women who experience incontinence or other symptoms after 3 months would benefit from at least three physical therapy sessions focused on pelvic floor rehabilitation. Strengthening and coordinating these important muscles results in real positive changes for women.

Incontinence is generally treatable with physical therapy because it is a symptom of specific issues in the pelvic floor. As those issues are addressed, the incontinence should stop.

There is good research to support the benefit of seeking help. Studies have shown that women who receive pelvic floor physical therapy for incontinence after delivery continued to show benefits from treatment one year later. One study showed that pelvic floor training with biofeedback (a way for you to see how your muscles are working) resulted in an 88 percent improvement in symptoms.

No one is destined to leak after delivery. We often hear stories from patients who thought that they were supposed to leak because their mother did. If you find that you are still dealing with incontinence — even years later — ask for a referral. We’re here to help you.

Is sex supposed to hurt after having a baby?
During pregnancy, our pelvic floor muscles endure pressure as they support the growing baby. Our muscles also have to work harder to stabilize postural changes as the baby grows larger and heavier. During delivery, our pelvic muscles relax and stretch to allow the baby to be delivered. If the baby is large, or the delivery is difficult, these muscles can be injured. This can cause pain with sex. Returning to sex after having a baby can be a little scary. For the first few times, a little discomfort is normal, especially if there was a tear that required stitches.

Pain during sex is called Dyspareunia. Studies have estimated that 85 percent of women experienced pain on their first attempt at sex postnatally. For most, pain decreases over time. For one in five women, the pain persists beyond a year.

Discomfort with intercourse and penetration should not continue. If dyspareunia isn’t getting better, speak with your provider. We are happy to help you find comfort again.

Is it normal to feel a split in my abdominal muscles above my belly button?
As the baby grows larger, the abdominal wall and abdominal muscles stretch to make room. After delivery, the muscles return to their starting point, but the soft tissue between the muscles can stay stretched out. This soft tissue, the linea alba, connects the left and right rectus abdominus muscles, often called the “six pack.” When this happens, the weak area in the center is called a Diastasis Recti Abdominus, or DRA. It can appear as a raised ridge in the middle of the abdomen above or below the belly button and is more prominent when you strain. A DRA is not a hernia because the abdominal wall is intact, just stretched out and thinned.

Most women experience a DRA after delivery. For most, it will resolve or significantly lessen within 8 weeks. A DRA that is greater than 2cm (approximately the width of 2 finger tips side by side) is not normal and can contribute to a feeling of instability or back pain. Your physician can do a quick test to diagnose this common condition. Physical Therapy can help you to re-stabilize your abdominal muscles. It’s not enough to just strengthen – please don’t do crunches, as this can make the DRA worse. It’s important to learn to use your muscles in the pattern that supports core stability, and also gives your body the best chance of healing.

By Kate Bergeron PT, DPT, WCS; Jessica Clark, MPT; Nadia Sanchez, PT,DPT; Rosemarie Wagner PT,DPT

Is Overactive Bladder Normal After Birth?: BostonUrogyn: Urogynecologists

When you were pregnant, you probably found yourself using the bathroom frequently, especially as your baby grew larger and put more pressure on your bladder. Maybe you’re noticing that this common issue doesn’t necessarily end just because you deliver.

Dr. Neeraj Kohli at Boston Urogyn understands the impact that bladder issues can have on your life. As a national and international leader in urogynecology and reconstructive pelvic surgery, he can identify what’s causing your urinary incontinence and offer innovative treatments to help.

Understanding incontinence

There are several kinds of urinary incontinence. Two of the most common types associated with pregnancy are stress incontinence and overactive bladder. 

Stress incontinence

Stress incontinence develops when you have increased pressure on your bladder. This can be due to your growing baby or from actions like coughing, laughing, or sneezing.

Overactive bladder

Overactive bladder typically causes an intense and urgent need to go. This issue usually occurs because your bladder muscles begin flexing and contracting involuntarily. 

Approximately 54% of pregnant women have urinary incontinence symptoms that hinder their quality of life, both physically and emotionally. And, at least 7 million new mothers continue to struggle with bladder control issues, even after an uneventful pregnancy and delivery.

Pregnancy, childbirth, and incontinence

When you go through pregnancy and childbirth, several things can lead to incontinence problems, including:

• Weakening of the pelvic floor muscles
• Damage to nerves controlling your bladder
• Movement of your bladder and urethra during pregnancy

You also experience specific hormonal changes that prepare your body for childbirth. These changes, which are important because they increase the elasticity of your joints and tissues, also reduce bladder support. 

For many women, urinary incontinence issues resolve within a year of childbirth. However, 30-50% report still having unwanted urinary leakage five years after delivery. 

Treating overactive bladder and incontinence issues

Just because bladder issues are a normal part of pregnancy, you don’t have to continue to endure it. Dr. Kohli offers numerous solutions based on the severity of your symptoms.

During your appointment, Dr. Kohli performs a full physical exam to identify the specific cause of your incontinence issues. To treat problems like overactive bladder, he often recommends:

• Medications designed to relax your bladder
• Physical therapy techniques to strengthen your pelvic floor muscles
• Botox® injections to temporarily disable your bladder muscles
• The InterStim™ system to restore healthy nerve function in the area

In addition to medical interventions for urinary incontinence, Dr. Kohli often makes lifestyle and behavioral recommendations as well. These approaches often include tracking your diet and fluid intake, addressing weight management issues, and undergoing bladder training. For severe incontinence cases, Dr. Kohli could suggest surgery. 

To find help for your post-pregnancy overactive bladder and incontinence issues, visit one of our convenient locations in Wellesley or South Weymouth, Massachusetts. Give us a call at Boston Urogyn, send us a message here on our website, or request an appointment using our convenient online feature.

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Urinary incontinence and other health issues after childbirth - Useful articles

There are two types of incontinence: in one case it is associated with an irresistible urge (as they say, "did not reach the toilet"), in the other case, involuntary urination occurs when intra-abdominal pressure increases during exercise , laughing, coughing, sneezing, etc. There may be mixed forms. The symptom of this disease is frequent urination more than 8 times during the day and 2 times at night, pain, leakage of urine and "urgency" - a feeling that urination will begin now. The causes of the disease can be different: inflammatory diseases of the pelvic organs, injuries after childbirth, concomitant neurological, endocrine and other somatic diseases.

The problem in most cases is not resolved by itself, causing physical and psychological inconvenience and suffering (the need to walk around with pads and diapers) and reducing the quality of life, including intimate life. They are embarrassed to talk about it, and compared to how many people are prone to this problem, only a few seek help. Often they simply do not know who exactly to turn to - they go to a gynecologist, and to a therapist, and to a neuropathologist, while this should be done comprehensively and always with the participation of a urologist.

Therapeutic exercise for incontinence

In women after childbirth, disorders of vascular circulation and nervous regulation in the pelvic area are not uncommon. If there was a difficult birth, a large fetus, tears, stitches, then the prevention of incontinence should be started immediately, strengthening and restoring the muscles of the pelvic floor, nervous regulation and blood circulation. It is better, of course, to do this before pregnancy. Kegel exercises not only help to cope with involuntary urination, but also increase voluntary control over sexual reactions.

1. Slow contractions: tighten the muscles as if to stop urination, slowly count to three. Relax.
2. Contractions: tense and relax these same muscles as quickly as possible.
3. Push-ups: tense the perineum and abdominal muscles.

Special therapeutic exercises also help to strengthen the muscles of the small pelvis.

1. I.P. lying on your back. We exhale, draw in the stomach, pull the knees to the chest.
2. I.P. Same. Alternately raise straight legs and make circular movements out and in with full amplitude.
3. From the same position, on exhalation, pull up the chest with bent knees and clasp them with your hands.
4. Now raise the upper body and sit down, wrapping your arms around your knees.
5. At the expense of 1-2-3, lift the upper body and one leg, to which we reach with the same hand. We go down to count 4.
6. Knees bent. At the expense of 1-2-3, we raise the pelvis, squeeze the buttocks, retract the anus. On the count of 4, lower the pelvis and relax.
7. From the same position, we lay bent knees to the right and left of the body.
8. I.P. standing, with support. On the inhale we rise on our toes, on the exhale we squat, holding on to the chair.
9. In the same position, holding onto the support, perform a roll from socks to heels and back.
10. I.P. On knees. Sit on your heels, stretch your arms up.
11. From the same position, alternately straighten the legs and pull them back. Shoulders-back-leg at the same time form one straight line.
12. Standing on all fours, alternately pull opposite arm and leg: straighten on the count of times, hold 2-3, return to the starting position on the count of 4. Be careful not to arch your back.
13. From the same starting position on count 1 stretch one leg back, on count 2-3 take it to the side parallel to the floor, bending at the knee, on count 4 return to the starting position.
14. I.P. hands on the belt, one foot is on the chair. We lean forward and reach for the raised leg, bending it at the knee as much as possible.

There is no need to despair: although treatment is not a simple process due to the large number of components involved in the formation of this syndrome, it is very effective. In all cases, it begins with conservative methods: medicines, physiotherapy and, of course, the therapeutic exercises we have already mentioned. Refrain from activities that increase intra-abdominal pressure. If conservative treatment does not help, low-traumatic surgical methods come to the rescue in the form of imposing various types of loops.

Problems in the perineum

During childbirth, injuries to the soft tissues of the perineum are possible. Doctors pay special attention to this, but the woman herself should be engaged in prevention throughout the pregnancy. First of all, this is gymnastics, which prepares the muscles of this area for the birth load. Cure inflammatory processes that reduce the elasticity of the perineum (they include thrush), be careful with nutrition: an excess of sweet and starchy foods, especially in recent months, lead to an increase in the size of the fetus, increasing the risk of trauma, which then backfires problems in sexual life.

Sometimes an episiotomy is done for the benefit of the baby and mother. Healing is very fast due to tissue matching and a powerful hormonal explosion. The main task of the mother, if she has stitches, is to keep them clean. This, of course, is hygiene (washing twice a day, from front to back, you can use a decoction of chamomile or a weak solution of potassium permanganate) and ensuring oxygen access. Associated with the latter is the ban on underwear and pads, which causes violent protest among women in maternity hospitals.

One should not underestimate such an important moment as the normalization of the stool on the third day after childbirth. Defecation does not provoke the divergence of the sutures, on the contrary, this stool retention can lead to trouble, so try to achieve a soft and spontaneous stool by the third day, and upon returning from the hospital, consult a doctor to make sure that the sutures are healing correctly, without divergence and suppuration.

Uterus and vagina

Some women who have recently given birth complain of vaginal gaping, even asking to "sew it up so that it was like before." Bringing the vaginal ring back to normal is really very important, but this process takes some time. During childbirth, the vagina stretches to let the baby through. Closing occurs within six months, which can be accelerated, for example, by the already mentioned Kegel exercise or the mixing-breeding of the legs.

Immediately after delivery, the uterus should empty well, so turn over, give a vertical load. This will improve blood flow, help her take a central position. Any exercises on the press are possible only after the complete cessation of secretions, otherwise an increase in intra-abdominal pressure increases the risk of resumption of bleeding. You can do it 6-8 weeks after giving birth in a prone position so as not to strain the muscles of the pelvic floor. But sitting in the hospital, especially if you have stitches, is not necessary - it is better to eat while standing, and to feed the baby - lying down.

The return of the tone of the soft tissues of the perineum will also be helped by sexual intercourse, which improves tissue nutrition. Please note: they are allowed when the placental site has been restored in the uterine cavity and there is no longer a risk of inflammation. If you feel pain during intercourse, do not hesitate to tell the doctor about it - he will find out the reason and advise the appropriate position.

Hemorrhoids

Another problem after the birth of a baby is hemorrhoids - a frequent manifestation of varicose veins. If hemorrhoids appear after childbirth, carefully observe them during the first days. Applying cold and topical application of anti-hemorrhoidal agents will help. Remember that the use of drugs after childbirth is limited, so it is necessary to deal with hemorrhoids that have appeared, if necessary, contacting a proctologist.

We hope that you will not be at a loss, even if you encounter any of the above troubles and will definitely deal with them as soon as possible. Happy and trouble-free motherhood to you!

Urination disorders after childbirth

24.04.2020

Urination problems after childbirth not uncommon About 80% of new mothers suffer from this problem.

Types of urinary disorders after childbirth

The bladder sometimes suffers from the following disorders:

• urinary incontinence . Characteristic mainly for natural births . The cause may be a large fruit;
• no signal to urinate . After the birth of a child, the tone of the bladder decreases, the uterus does not press on it, swelling of the walls appears, it becomes larger due to the fullness of urine . In most cases, after a couple of days, the urinary organ returns to normal, and the excretion process urine does not cause inconvenience;
• pain during urination. Perineal lacerations, sutures and minor injuries cause discomfort to the woman during urination . Urine irritates mucous membranes, so pain occurs. After the stitches are removed and the perineum is completely healed, the painful condition goes away;
• urination more often than usual. After births fluid is excreted from the body, which leads to frequent trips to the toilet. Note: the bladder is inflamed if there is a small amount of urine .

Elimination of the causes of urination disorders

Having noticed problems with urination after childbirth , it is important to contact doctor in time for the appointment of complex treatment. Gynecologist will examine the patient, prescribe a urine test , in some cases Ultrasound of the small pelvis, computed tomography, refer to consultation to urologist . Prescribed drugs that are allowed when breastfeeding .