BLADDER CONTROL DURING PREGNANCY AND AFTER THE BIRTH OF YOUR BABY

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1 BLADDER CONTROL DURING PREGNANCY AND AFTER THE BIRTH OF YOUR BABY Information Leaflet Your Health. Our Priority.

2 Page 2 of 8 Contents Stress incontinence... 3 Pelvic floor exercises... 3 Urgency and frequency... 4 Basic tips for bladder training... 5 Healthy bowel habits... 6 Useful resources... 6 Supervisors of Midwives... 7 The exercise and advice given in this booklet are designed to help you recover your bladder control.

3 Page 3 of 8 Stress incontinence What is stress incontinence? If you have stress incontinence, it means that you cannot stop your urine leaking from you. This can happen when you exercise, strain yourself, run, jump, cough, sneeze or even laugh. It is not related to emotional stress in any way. Physical exercise or strain causes extra pressure in the abdomen and this puts extra pressure on the bladder. The muscles which support and close off the bladder s opening don t work properly and so urine leaks out. The problem is more common in women, but some men suffer from it too. Why don t the muscles work properly? The muscles that support and close off the bladder are called the pelvic floor muscles, and sometimes they can become weak. The most common cause of weak pelvic floor muscles is pregnancy and childbirth, although being overweight having a very bad cough or constipation can also weaken the muscles. Pelvic floor exercises What is the pelvic floor? The pelvic floor is the layer of muscles at the base of your pelvis that support your pelvic organs, bladder and womb, and control the passage of urine. It is in a sling shape from the pubic bone at the front to the bone at the bottom of your spine. The pelvic floor muscles usually work without us having to think about it, for example, to stop us passing urine. Why should I exercise my pelvic floor muscles? You should exercise your pelvic floor muscles because they can become weak or damaged like any other muscle. If this happens, the muscle will not work properly and you may leak urine. How do I know which muscle to exercise? If you don t know where your pelvic floor is, you can find it by imagining you are going to the toilet and are trying to stop yourself; or you can put two fingers into your vagina and try to squeeze around them. The muscles you use to do this are your pelvic floor muscles.

4 Page 4 of 8 How do I exercise the muscles? You must do fast and slow exercises to make your pelvic floor muscles stronger. Slow exercises You should sit or stand comfortably with your knees slightly apart. Try to squeeze as if you are trying not to pass wind and also squeeze the muscle around your urethra, as if you are trying not to pass urine. When you can do this, squeeze them both together, as tight as you can, and hold for as long as you can, up to ten seconds. You may not be able to hold it for more than two or three seconds at first. Repeat this as often as you can, up to ten times, but have a rest in between each one for four to five seconds. Fast exercises Fast exercises are done in the same way as slow exercises but, when you squeeze the muscles, let go immediately so that you only feel a very quick lift in your pelvic floor. You should repeat these exercises as many times as possible, up to ten times. You should do both the fast and slow exercises at least four times a day if you can. Do not do so many exercises that the muscles ache! Urgency and frequency Urgency is when you suddenly need to go to the toilet immediately if you do not, your urine may leak. Frequency is when you go to the toilet a lot, i.e. eight times or more in the day, but only pass small amounts of urine. When your bladder is filling up, the bladder muscle is relaxed. When the bladder is becoming full it sends a signal to the brain. Then, when it is convenient and we decide to go to the toilet, the bladder muscles begin to contract. Adults usually go to the toilet between four and seven times a day and no more than once during the night. When we first feel the need to go to the toilet, we can usually hold on until it is convenient for us to go. Why do urgency and frequency happen? Urgency and frequency happen when the bladder muscle starts to contract before going to the toilet. This can happen if you get into the habit of going to the toilet just in case, which means that the bladder only has to hold a small amount of urine, instead of waiting until the bladder is full.

5 Page 5 of 8 Urgency and frequency can be affected by: Anxiety Constipation Infection Certain medicines Drinks containing caffeine (tea, coffee, fizzy drinks and so on) Alcohol Diseases of the nervous system, such as Multiple Sclerosis or Parkinson s disease What can I do about it? You can improve your condition in the following ways: Do not have too many drinks that contain alcohol or caffeine. If you drink more than 2 litres of fluid each day cut it down. Also, don t drink too little as this can irritate the bladder. Only go to the toilet when you need to never go just in case. Try not to become constipated. Train your bladder to hold more urine so you need to go to the toilet less often. Ask your doctor or midwife whether physiotherapy could help you. Ask your local continence specialist nurse for help. Talk to your midwife or Health Visitor. Basic tips for bladder training Why do bladder training? Bladder training helps to cut down the number of times you have to go to the toilet (to pass urine) every day. It helps to stop urine leaking from your bladder when you really need to go to the toilet. You should try to increase the time between your visits to the toilet. If you go every two hours, try to hold on for an extra half hour. If this is too difficult, try to hold on for an extra quarter of an hour and when you can do this easily, increase it again so that eventually you go to the toilet every 2 ½ hours. You can lengthen the times between going to the toilet by ignoring the first desire to urinate (if it is soon after you have emptied). Sometimes it is difficult to ignore you could try: Lifting the pelvic floor muscles up HARD. The urge should subside after 30 seconds or so. Sit on a hard surface such as the arm of a chair. This applies pressure to the pelvic floor, which helps the bladder to relax and the urge to subside.

6 Page 6 of 8 If you are unable to sit down (e.g. whilst queuing for a public toilet!), try rubbing hard on the inside back surface of the legs, which has a similar effect. Take your mind off it be counting backwards from 100 in 3s, or reciting the times tables! Keep a record of how often you are emptying your bladder (the physiotherapist can give you a chart if you wish). It is encouraging to see how well you are doing, and helps to build up confidence. Aim to empty no more than 7 times a day. You should gradually increase the time between your visits to the toilet until you are only going six or seven times a day, and no more than once during the night. Healthy bowel habits Some people are surprised to find that their bowel habits can have an effect on their bladder. You should try to keep your bowels under control by following these guidelines: Eating regularly can help your bowel get into a predictable pattern. Bowels like routine! Don t skip breakfast! Only take as long as you need. Don t sit for ages on the loo. You should be able to empty the bowel with minimum effort. Try not to strain. Allow yourself time and privacy to be able to relax. When you feel the need to empty your bowel respond! If you keep ignoring your bowel (because you are busy) you can make yourself constipated. Eat properly. Fibre can improve your bowel habit. Best advice is to make sure you have 5 portions of fruit and vegetables a day. (Sometimes suddenly eating a lot of fibre when you are not used to it, can make things worse by producing gripes and wind. Take it slowly!) Exercise can stimulate the bowel to work regularly. Make sure at least that you have a good 20 minute walk a day. Some medicines can upset bowel habit. Check with your doctor or midwife if you think this may be the case. If you drink more than 2 litres of fluid each day, cut it down. Your kidneys will produce more urine if you have caffeine, fizzy drinks, have squash or juice instead. You should also reduce the amount of alcohol you drink. Useful resources

7 Page 7 of 8 Supervisors of Midwives Need extra information, support or advice? Contact a Supervisor of Midwives by ringing the main switchboard at Stepping Hill Hospital: A Supervisor of Midwives is available 24 hours a day. Supervisors are concerned with ensuring the safety and well-being of mother and baby and with the provision of high quality midwifery care. Contact us Antenatal Clinic Lead Gynaecology Nurse, Jasmine Suite

8 Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT144 Publication date May 2013 Review date May 2016 Department Women s Unit Location Stepping Hill Hospital