During pregnancy, you'll spend a lot of time in the bathroom.

By Richard H. Schwarz, MD

Pregnancy's Calling Card


What do pregnancy and going to the bathroom every other minute have to do with each other? A lot more than you think. During these nine months, your urinary system will be going through some major changes. For example, pregnancy hormones stimulate your kidneys to expand and produce more urine, which helps your body get rid of extra waste more quickly. And as your baby gets bigger and bigger, his weight may press on your bladder, so you'll need to go more frequently.

First trimester: For many women, frequent urination is one of the first signs of pregnancy. In addition to the hormonal changes that increase urine production, your uterus expands and presses on your bladder -- even when your baby is tiny -- so you'll need to go more often. This isn't surprising if you consider that over the course of your pregnancy, an organ that was originally the size of a fist grows to accommodate a 7- to 10-pound baby.

Second trimester: Happily, you'll get some temporary relief in the second trimester. As your uterus continues to expand, it will rise higher in the abdomen, away from your bladder, so you'll have to urinate less frequently.

Third trimester: In the last months of pregnancy, the urge to go frequently will come calling again. The baby will drop lower in your pelvis in preparation for delivery, which puts pressure on your bladder. You may even find yourself getting up to go several times during the night. If this disturbs your sleep too much, try cutting back on fluids after 4 p.m. (make sure you drink the necessary six to eight glasses of water a day before then). Also avoid coffee, tea, cola, and any other caffeinated beverages. Caffeine can increase urination.

Bladder Control

During pregnancy, especially in the last trimester, you may find that when you laugh, cough, sneeze, lift something, or exercise, you leak a little urine. This is called stress incontinence. It's caused, at least in part, by the pressure of your uterus on your bladder.

You may be able to prevent leakage by doing Kegel exercises. These exercises strengthen the muscles surrounding the urethra (the tube that carries urine from your bladder out of your body), which you use to hold in urine. To do a Kegel, tighten and then relax those muscles -- as if you're trying to stop your urine stream -- as well as the muscles surrounding your vagina and anus. You can do Kegels anywhere, anytime, while you're sitting or standing. Try keeping the muscles contracted for about 10 seconds, 10 to 20 times in a row, at least three times a day.

Kegels may also help to prevent the incontinence that affects some women after childbirth. Urinary incontinence that first appears during or soon after delivery usually goes away without treatment. However, if you have incontinence that lasts longer than a few weeks after delivery, check with your healthcare provider. He may prescribe one of several medications that can help.

While stress incontinence during pregnancy almost always results from normal changes in your urinary tract, it is occasionally triggered by a urinary tract infection, which needs medical attention. Tell your doctor about any leakage so she can rule out an infection.

The Infection Connection

Pregnant women may be especially prone to lower urinary tract infections -- about 1 to 3 percent of women come down with them during pregnancy. The culprit? Your expanding uterus, which crowds your bladder and prevents you from emptying it completely, exposing it to bacteria for longer periods of time. Sometimes you'll feel as if you need to go even when your bladder is nearly empty, which is more than just uncomfortable; small pools of urine in the bladder are breeding grounds for such bacteria. Try leaning forward when you urinate to help empty your bladder completely.

Most lower urinary tract infections are caused by bacteria that normally inhabit the intestines, such as E. coli. Less commonly, a urinary tract infection may be caused by a bacterium called Group B strep (GBS), which is a more serious condition that can make your baby very sick. It requires oral antibiotics during pregnancy and intravenous antibiotics during labor and delivery to keep your baby safe.

Your healthcare provider will probably recommend a urine culture early in pregnancy, and again during the third trimester. That's because about 5 to 10 percent of pregnant women have symptomless urinary tract infections, which, without treatment, can result in health problems for you and your baby, such as a kidney infection or a premature or low birth weight baby. Your doctor may also check your urine for bacteria at each prenatal visit using a dipstick, which works the same way as a home pregnancy test. However, this test is not as accurate as a culture, which is why doctors often do urine cultures as well.

Typical symptoms of a urinary tract infection include:

  • Frequent urination
  • Burning and pain during urination
  • Bloody urine
  • A tender lower abdomen

Contact your healthcare provider if you develop any of these symptoms. She'll send a sample of your urine to the laboratory for a culture to check for bacteria. If it turns out that you have an infection, your doctor will provide a safe antibiotic for you. Once treated, the infection should clear up quickly. (Call your doctor if you still feel burning after three days of treatment -- you may need a different medication.) It's important to take all your medication as directed.

Your healthcare provider may check your urine after you finish your medication to make sure the infection is gone. Because these infections sometimes recur, she may also do a monthly urine culture. If the infection returns, you may need to take antibiotics for the rest of your pregnancy.

Untreated, a lower urinary tract infection often spreads upward to the kidneys, where it may pose a serious risk to you and your baby. About 2 percent of pregnant women develop these kidney infections, called pyelonephritis, most commonly in the late second or early third trimester. Symptoms can include:

  • Chills
  • Fever
  • Painful urination
  • Blood in the urine
  • Back pain
  • Nausea
  • Vomiting

Pyelonephritis is dangerous because it greatly increases a pregnant woman's risk of preterm labor and delivering a low birth weight baby; it can also cause a risky blood infection in the mother. If you develop pyelonephritis, you may need to be hospitalized and treated with intravenous antibiotics, which usually reduce fever and ease other symptoms within a day or two. Then you'll probably need to continue treatment at home with oral antibiotics.

While you may have some urinary complaints during pregnancy, they're likely to be minor annoyances. By keeping all your prenatal appointments, you can help ensure that any urinary tract infections can be treated quickly so they won't harm you or your baby.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your won health or the health of others.

American Baby


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