Rebuilding Bladder Resilience After Pregnancy

Apr 16

Are you pregnant and wondering when you won’t need to go to the bathroom all the time? Are you postpartum, wondering when your bladder will get back to baseline?

Let’s start by looking at the anatomy of the bladder.

The bladder is a pelvic floor organ that is underneath the uterus and drains through the urethra right up against the front of the vaginal canal. The bladder typically signals the brain when it is 33% full and then again when it is 75% full. The bladder then waits for the brain to signal to release its opening so we can urinate. This feedback loop typically works to have enough time to get to the bathroom without needing to rush or have leaks before we get to the bathroom. This skill is called urinary continence.

As you know the bladder is under a lot of pressure from the growing uterus and needs to move up to accommodate the growth during pregnancy. The closer you get to 40 weeks, the greater change of the baby’s head lowering into your pelvis and increasing the pressure on bladder. The bladder is less able to expand and therefore gets fuller faster, signaling more often. The nerves that send signals back/forth are also under more pressure so they don’t send signals as well. Relaxin, a hormone that promotes losing of connective tissue in the body, also loosens the tissue of the bladder and urethra which makes it hard to control urination. There may be urinary incontinence. There are three types of urinary incontinence:

Stress incontinence: leaking with jumping, coughing or sneezing, or running due to these actions causing sudden pressure change in the abdomen and squishing the bladder and urethra
Urge incontinence: leaking of urine when you feel an urgent need to pee.
Mixed incontinence: a mix of stress and urge incontinence. It can look like needing to go with a lot of urgency and then leaking with movement to get to the bathroom

So why does the needing to go more frequently not stop after delivery?

Early postpartum, especially the first two weeks, your body still has excess fluid stored up in spaces between organs and tissues that it needs to get rid of. Your kidneys work hard to eliminate that extra fluid. That means so you may find yourself:

Still having higher blood pressure (trending down towards normal for you)
Going more often
Going for longer
Sweating more, especially at night

It is not unusual to be getting rid of ~3 liters of fluid per day via sweat/urine! In fact, it’s more worrying if a birthing person isn’t going 3-4 hours every day. It can take up to 8 weeks after birth to get back to baseline urination frequency. And if you’re wondering what baseline is, research shows it is typical to urinate 2-10 times during the day and 0-4 times at night. (Quite the range!)

Let’s talk about what could be going on if you’re 8 weeks postpartum and still dealing with incontinence.

Relaxin can still be present in the body and still loosening bladder/urethra tissue. Pelvic floor muscles, which support the bladder staying in place and contracting properly, get over-stretched in pregnancy.

We also pick up some bladder habits during pregnancy or right after a baby is born that don’t serve our bladder. These habits include:

Urinating just in case
Urinating throughout the night
Not drinking water throughout the day
Trying to hold in urine often

Forcing urine out due to rushing
Tensing up our bodies during urination due to pain or fear of pain after delivery

Instead, here are some habits to cultivate to help recover bladder function:

Stay hydration

Breastfeeding mothers experience an increased water loss via milk secretion, representing ~700mL per day (measured at 8 weeks postpartum). This fluid loss can put breastfeeding people at increased risk of dehydration. This also increases risk of constipation, which can lead to issues with urination as well.

Avoid bladder irritants

Current medical advice for urgency or urge incontinence: limit caffeine, alcohol, and acidic beverages including carbonated beverages. Recent research has conflicting results with respect to caffeine on urinary incontinence symptoms. If you are having urgency or urge incontinence, you can try a week trial without caffeine to see if it’s contributing to your symptoms. If there is no change after a week, you can always re-introduce it.

Limit “just-in-case” trips to the bathroom

A long-term habit of peeing when you don’t need to can lead to more urgency and frequency, leaking right before you go, and puts you at risk for developing an overactive bladder. Try to go only when you need to. If you are peeing for less than 10 seconds, your bladder likely wasn’t full.

Avoid improper pelvic floor strain

Relaxing your pelvic floor while you urinate is important to keep normal amounts of tension in those muscles. Cutting off your urine stream may over-train pelvic floor muscles, causing more tension and less function in those muscles. Forcing urine out can increase risk of pelvic organ prolapse.

Pelvic Floor Muscle Training

Pelvic floor muscles are key to supporting pelvic organs, including the bladder. Recent review found that exercise and pelvic floor muscle training (PFMT) have been shown to reduce the symptoms and severity of urinary incontinence. They also can reduce the symptoms of pelvic organ prolapse. A pelvic floor PT or OT will be able to assess your current ability to do pelvic floor contraction and relaxation, as well as give exercises that help train pelvic floor muscles to contract in a coordinated manner. You can start internal work with a pelvic floor PT or OT once cleared with your OB/midwife at your 6-week postpartum visit.

If you experienced urinary incontinence before and during pregnancy, you’re more at risk for having it after birth. Urinary continence and associated pelvic floor disorders are linked to poor quality of life and impact to simple daily activities like standing, walking, or lifting to more complex activities like exercise, sex, toileting, or caring for your children.

Reach out to me or another pelvic floor professional with questions!

Caring for your bladder and pelvic floor will help it support you for the rest of your life!

References

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