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 expectant mothers. This page aims to cover some possible problems that might occur and some of the treatments available.
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.
Pelvic Floor Damage
The pelvic floor is made of layers of muscles, which act like a hammock, holding the bladder, bowel and uterus in place. 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 or if delivery is quick. 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 to the pelvic floor.
Research has shown that antenatal and postnatal pelvic floor exercises can help to prevent these problems and also improve recovery. You’ll find a guide to the exercises at the end of this page, but if you need assistance do ask your Midwife or Healthcare Visitor.
Urinary Problems and Childbirth
A weak bladder is also referred to as stress urinary incontinence (SUI) which is defined as a sudden loss of urine during normal day to day activities such as;
- Laughing
- Coughing
- Sneezing
- Walking
- Exercising
- Lifting something
A weak bladder usually occurs when the muscles in the pelvic floor or sphincter have been damaged or weakened. 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.
Stress urinary incontinence is common both during the late stages of pregnancy and also postnatally. Pelvic floor exercises usually resolve symptoms but if leakage persists you are encouraged to seek support from your local continence service. Find out more about stress urinary incontinence, please visit our bladder problems section.
Episiotomies and Tears
An episiotomy is where the muscle is cut to allow an easier birth. Tearing of the perineal tissues can be localised to small lacerations around the vagina to more complex tears involving the perineum and anal canal.
Third and Fourth Degree Tears
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 Home
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 sensation and the need to empty the bowel.
- Whilst the area is healing it may be necessary to take laxatives 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 report no problems at this stage, those that do benefit from seeing a specialist physiotherapist who will help the woman to regain pelvic floor strength. Most women are able to have further vaginal delivery following a 3rd or 4th degree tear, if the tear has healed and there are no bowel control problems.
Haemorrhoids
Haemorrhoids, commonly known as piles, are enlarged and swollen blood vessels in or around the lower rectum and the anus.
Piles are common during or after pregnancy due to the pressure from the developing baby, hormonal changes and the delivery of the baby. There are a range of treatments available if they provide discomfort, although be sure to consult your Midwife or GP before seeking any of these.
Urinary Retention after Childbirth
Difficulty passing urine or urinary retention, as it is known, 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 and may need to self catheterise or use a temporary indwelling catheter .
Urinary retention may also present itself as having to pass small amounts of urine frequently – but only in very small amounts.
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 some of its 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 function should be closely monitored if an epidural is used.
Further Information
If you are experiencing any of the problems mentioned in this factsheet, you may wish to seek advice from your GP or local continence clinic. The continence clinics are run by the NHS and you don’t always need to be referred to a clinic by your GP, as some clinics will allow you to book an appointment yourself. You may wish to use our search tool to find your nearest clinic. Pelvic floor muscle exercises are also very useful for strengthening the muscles that support the bladder and bowel. Performing these exercises can help alleviate symptoms and can often prevent the problem from worsening.
For more information about Pelvic floor muscle exercises, please use our guide below:
Pelvic Floor Exercises For Women
[BBC:031] Pelvic Floor Exercises For Women
Training your pelvic floor muscles can help improve your bladder control. This guide explains how to perform pelvic floor exercises, specifically for women.
