Problems With Urethra After Childbirth?

TEAM KNIX / FERTILITY PREGNANCY

Giving birth is a major physical trauma and it has impacts on your body beyond your reproductive system. 

It is very common for women to experience “urine retention” or difficulty passing urine following childbirth. But it is important to pee within 6 to 8 hours of delivery to prevent urinary tract infections (UTIs) and keep the bladder healthy.

The good news is that this difficulty is usually temporary and passes once you recover.

How Childbirth Affects the Bladder

Your bladder can be a little traumatized by you giving birth. The pressure exerted by an exiting baby might force it to shut down temporarily. Or any anaesthesia you were administered may have decreased its sensitivity, effectively “numbing” it.

As with any abdominal surgery, swelling and pain can also impact your body’s basic functions. Basically, it can take awhile for your body to ‘reboot’ after any kind of trauma.

There’s also a psychological effect; you yourself may be nervous to pee. Peeing after childbirth can sting (in part due to tears and incisions) and this may also fill you with dread that inhibits your ability to urinate.

What to Expect After Childbirth

Expect your nurses to be very interested in when you’re ready to pee and how much urine you pass when you do use the bathroom. They want to feel like your body’s basic functions are returning to normal before they release you.

Again this is similar to any surgery; they want you to pee, or they want to hear you’ve got gas or you tummy’s rumbling, that your appetite is returning etc. 

Your nurses or doctors will want you to pee within 6 to 8 hours of delivery and after you’ll go, they’ll want to see how much urine you’ve passed. They may also measure the bladder for distension (aka fullness).

If you do not manage to urinate within the designated timeframe, your healthcare providers may use a catheter to drain your bladder. They’ll be on the lookout for signs of a urinary tract infection (UTI) as this is sometimes the reason new mothers cannot pee postpartum.

Even if you manage to pee and are cleared for release, continue to pay attention to urination and any unusual sensations as your body heals. You should feel that you are making a sure return to normally. If you’re only able to pee small amounts, if there’s pain or a burning sensation or if you experience a fever, make sure to book an appointment to see your doctor.

Similarly, if you feel you can’t control leakages and are experiencing incontinence, chat with your doctor.

Urethral Prolapse

While the urethra itself can be bruised during childbirth, this usually heals as swelling is reduced. Other than bruising, no significant sources speak to postpartum urethral damage.

Urethral prolapse (urethrocele) is when the urethra pushes into the vaginal canal, or protrudes out of the urethral opening.

Urethral prolapse in female patients is a rare event. It usually occurs in much older women. While pregnancy and childbirth may be precursors to urethral prolapse in later life, there have only been two documented cases of postpartum urethral prolapse (source).

How Common is Postpartum Urinary Retention?

Postpartum urinary retention (PPUR) affects roughly 8% of women who give birth (source). Risk factors for experiencing PPUR include:

  • Being catherized during labor
  • Prolonged labor
  • An episiotomy, which is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth.
  • Epidural analgesia (having regional epidural administered during labor)
  • Perineal tear and sphincter rupture 

How to Help Your Bladder Recover Immediately Postpartum

There are some steps you can take to help your bladder recover after childbirth. 

Sip, Don’t Gulp

Drinking fluids helps kick your systems back into action. Rather than gulping vast quantities of water, sip water continually.

Get Moving (Gently Does it)

Moving around similarly helps your body wake back up. While you may be weak still, begin as soon as you can, even if it’s with short, accompanied walks up and down the ward. Take it easy and listen to your body (don’t push through unusual pain). But as you gain strength, your body will respond and your systems will find their rhythm again.

If You’re Shy, Ask for a Little Space

It can be difficult to pee with an audience, so if your nurses are hovering and you’re finding it gives you performance anxiety, don’t feel shy to politely ask for a little space. 

Try Sitz Baths or Ice Packs

If swelling and bruising has caused pain that is making it psychologically difficult for you to urinate, try ice packs or ask your nurse if a sitz bath would help relieve that pain.

Picture a Waterfall…

It may be a little silly (and it’s more a way of overcoming a psychological hurdle) but picturing running water can sometimes help if you’re trying to stimulate your urge to urinate. You can also run a tap. 

Timed Voiding

Urinating on a schedule or double-voiding (where you urinate and then go again 10-15 minutes later) can help make sure your bladder empties.

What About Postpartum Urinary Incontinence?

It is common to experience a little incontinence during pregnancy, due to:

  • Increased pressure on the bladder: Your growing baby puts pressure on the bladder and surrounding organs, which can lead to loss of urine or an increased need to urinate in women.
  • Extra fluids in your body: When you are pregnant, you should drink between 2 and 3 litres of water per day. More fluids make it easier to leak urine.
  • Hormonal changes: Hormonal changes during pregnancy cause your pelvic floor muscles to relax, which can lead to incontinence.

This experience can continue after childbirth and depending on your delivery, may become worse or begin to dissipate. If incontinence worsens after childbirth, talk to your doctor as there may have been damage to your pelvic floor muscles. It’s also recommended to do (or continue) doing Kegels after childbirth to help your pelvic floor muscles regain their strength after a vaginal delivery.

Do Kegel Exercises to Strengthen Your Pelvic Floor Muscles

These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum and will help you manage bladder control problems.

Good news: Kegel exercises or pelvic floor muscle exercises can be done any time, either sitting or lying down. You can even do Kegel exercises when you are eating, sitting at your desk, or when you are resting.

If you’re unsure how to do pelvic floor or Kegel exercises, your doctor or physiotherapist can help you. But basically it’s like pretending you have to urinate and then holding it. You relax and tighten the muscles that control urine flow.

One way to learn the pelvic floor muscles you should activate is to pay attention when you pee: Start to pee and then stop. You should feel the muscles in your vagina, bladder, and anus get tight and move up. These are the pelvic floor muscles. 

Wear Leakproof Underwear While You’re Recovering from Giving Birth

Pregnancy and childbirth are not a casual undertakings and it’s only natural that your body would feel a little worse for wear afterwards. While media has normalized an expectation that you can bounce back to normal in no time and be “red carpet ready”, it’s not really the case for most of us.

Instead, allow yourself time to recover and provide yourself tools to ease that recovery time. Soreness, tenderness and a light bladder leaks will likely be part of that recovery. Leakproof underwear will offer you protection from any involuntary urine leakage and help minimize the embarrassment and inconvenience of urinary incontinence. 

Do keep your doctor abreast of what’s happening and always be alert to signs of more serious medical concerns. In particular, don’t ignore unusual or persistent pain or bleeding. Other than that, be kind to yourself—you just gave birth!