The bladder can have a bit of a rough time during labour. It can be ignored and not emptied and subsequently overdistended or stretched. It can be pushed and squashed by the descending baby, it can be filled due to IV fluids, affected by hormones and medication and it can be irritated by a catheter or surgery. As a result of all this, some women present with bladder symptoms immediately postnatally and this can cause a lot of distress at a time when emotions are already high and exhaustion is present.
There are three main types of urinary incontinence that may occur immediately postnatally.
Stress urinary incontinence (where urine leaks due to the inability to compress and shut the urethra during an increase in abdominal pressure – such as with a cough), urgency urinary incontinence (where urine leaks in response to an overwhelming urge to reach the toilet) and overflow incontinence.
1. Stress urinary incontinence is very common in the postnatal population – it is thought around one third of postnatal women experience stress urinary incontinence. Often (but not always) it is due to a weakening of the pelvic floor and an inability of the pelvic floor muscles to generate the required, or timely, force closure of the urethra. Urine subsequently leaks during a raise in intra-abdominal pressure, such as with a cough, sneeze or jump.
2. Urgency urinary incontinence is also very common postnatally. This is where the urge to urinate overrides the ability to maintain control and urine escapes. The bladder lining has become more sensitive and overreacts to the filling bladder.
3. Overflow incontinence occurs when the bladder is not emptying properly. Postnatally this is called Postpartum Voiding Dysfunction (PPVD). This may happen due to an obstruction eg postnatally a swollen perineum following a tear or episiotomy or because of overdistension of the bladder which prevents complete emptying and results in regular urine loss.
Overflow Incontinence can occur postnatally and is a warning sign for Postpartum Voiding Dysfunction. This is when a postnatal woman is unable to fully empty her bladder. This may be very apparent – she just can’t wee, or less so – she is managing to pass urine but it is slow, hesitant, small in volume, she keeps having to go back to do more and there may be regular incontinence.
Either way, this is not good news for the bladder. With this condition the bladder is at risk of overdistention (overfilling and stretching) which can lead to a chronically dysfunctional bladder down the line.
PPVD is more likely in those women who have had an instrumental birth, such as forceps, an epidural, a prolonged labour, first-time mums, caesarean section and/or perineal trauma.
After delivery of a baby, the bladder is usually monitored to ensure the woman passes urine within 6 hours of delivery or 6 hours after catheter removal. The volume is measured to make sure it is an appropriate amount (normally over 150ml). If there is no urine or only a very small amount within 6 hours, the woman may require an in/out catheter to drain the urine and is then monitored further. Occasionally an indwelling catheter is required for 24 hours or longer to protect the bladder from overfilling and allow it to recover. The exact protocol is dependent on your local care provider.
The good news is that the bladder, perineum and pelvic floor are normally all great at getting better. For PPVD it is important that you flag up any concerns to your Midwife or Doctor as soon as possible as you will need to be monitored and checked regularly. You may require timed voiding (going to the toilet at a set time) moving forwards and subsequent help and advice.
For stress urinary incontinence and urgency urinary incontinence there is much conservative treatment that can be accessed easily through the NHS or Privately. Ask for a referral to a Women’s Health Physiotherapist. Here you will be assessed and guided through the appropriate muscular rehabilitation, given advice about fluid and bladder control techniques, advised on how to move forwards with general exercise and taught perineal care as appropriate.
Although postnatal incontinence issues are common, they are not normal and as such should not be ignored. Do seek treatment as there is a lot that can be done, with excellent success rates. If you have any questions, please do not hesitate to email me at email@example.com.
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