Common Pregnancy Problems

Incontinence
Incontinence is a common problem, and it can affect you during and after pregnancy. Sometimes pregnant women are unable to prevent a sudden spurt of urine or a small leak when they cough, laugh or sneeze, or when they move suddenly, or just get up from a sitting position. This may be temporary, because the pelvic floor muscles (the muscles around the bladder) relax slightly to prepare for the baby’s delivery. Some women have more severe incontinence and find that they cannot help wetting themselves.
Doing your pelvic floor exercises can help.

What is the pelvic floor?
The pelvic floor is like a hammock of muscles and ligaments between your legs which support the bladder, uterus (womb) and bowel. The openings from these organs, the urethra from the bladder, the vagina from the uterus and the anus from the bowel pass through the pelvic floor. The pelvic floor muscles attach to your pubic bone at the front and the tail bone at the back.
What do the pelvic floor muscles do?
When the pelvic floor is strong, it supports the pelvic organs to prevent problems such as:
• Incontinence (the involuntary loss of urine or faeces)
• Prolapse (lack of support) of the bladder, uterus and bowel
The pelvic floor muscles also help you to control bladder and bowel function, such as allowing you to ‘hold on’ until you reach the toilet.
What causes pelvic floor muscle weakness?
Some of the common causes of pelvic floor muscle weakness are:
• childbirth – particularly following delivery of a large baby or prolonged pushing during delivery
• being overweight
• constipation
• persistent heavy lifting
• excessive coughing
• changes in hormonal levels at menopause
or just growing older.
How do I strengthen my pelvic floor muscles?
It is recommended that all women exercise their pelvic floor muscles everyday throughout life, to prevent weakness or improve strength.
Exercising weak muscles regularly, over a period of time can strengthen them and make them work better. Regular gentle exercise, such as walking can also help to strengthen your pelvic floor muscles.
Exercise 1 (long hold for strength)
Step 1: Sit, stand tall, lie on your back with your knees bent and legs comfortably apart or kneel on your hands and knees.
Step 2: Close your eyes, imagine what muscles you would tighten to stop yourself from passing wind or to ‘hold on’ from passing urine. If you can’t feel a distinct tightening of these muscles, ask for some help from a physiotherapist. She will help you to get started.
Step 3: Now that you can feel your pelvic floor muscles working, tighten them around your front passage, vagina and back passage as strongly as possible and hold for three to five seconds.
Remember, the squeeze must stay strong and you should feel a definite ‘let go’. Repeat up to ten times. Rest for a few seconds in between each squeeze.
Steps one to three count as one exercise set. If you can, do three sets per day in different positions. Do your pelvic floor exercises everyday for the rest of your life.
Exercise 2 (quick squeeze for power)
Squeeze and lift your pelvic floor muscles as strongly and as quickly as possible. Do not try to hold on to the contraction, just squeeze and let go. Rest for a few seconds in between each squeeze. Repeat this 10 to 20 times.
If you can, do this exercise set one to three times per day.
What can I do to prevent damage?
To prevent damage to your pelvic floor muscles, avoid:
• constipation
• persistent heavy lifting
• repetitive coughing
• putting on too much weight
Make training part of your life by:
• tightening your pelvic floor muscles every time you cough, sneeze or lift
• doing some regular exercise, such as walking
• progressing your exercises by doing them during the day in different positions e.g. standing, sitting or on your hands and knees
A weak pelvic floor or incontinence is curable.
If you are unsure of whether you are exercising your pelvic floor muscles correctly or you have urinary problems, you should make an appointment with a physiotherapist or your doctor.
When to get help
In many cases incontinence is curable. If you have got a problem, talk to your midwife or doctor.

Urinating a lot in pregnancy
Needing to urinate or pass urine often may start in early pregnancy.
Sometimes it continues throughout pregnancy. In later pregnancy it is the result of pressure from the baby’s head on your bladder.
How to reduce the need to pass urine
If you find that you need to get up in the night to pass urine, try cutting out drinks in the late evening. But make sure you drink plenty of nonalcoholic, caffeine-free drinks during the day. Later in pregnancy, some women find it helps to rock backwards and forwards while they are on the toilet. This lessens the pressure of the womb on the bladder so that you can empty it properly.
When to get help
If you have any pain while passing water or you pass any blood in your urine, you may have a urine infection, which will need treatment. Drink plenty of water to dilute your urine and reduce pain. You should contact your GP within 24 hours of first noticing these symptoms.
Don’t take any medicines without asking your midwife or doctor.