Urinary tract problems are common in pregnancy. One of the earliest signs of pregnancy—and one of the more annoying symptoms women have while pregnant—is the increased need to urinate during the day and in the middle of the night. There are many changes in your body during pregnancy that cause this.
One reason is that you are drinking and eating more, which will naturally lead to more frequent trips to the bathroom. As your baby develops, the pressure of your growing uterus on your bladder will increase, and the urge to urinate will be felt more strongly. In some women, this pressure can also cause urinary incontinence or leakage of urine.
During pregnancy, your body requires more energy and expends more energy, and is functioning at an elevated basal metabolic rate (BMR). This increase in BMR (one of the functions of the hormone progesterone) is due to your body’s increased tissue mass and the extra work your major organs are doing to maintain the level of blood circulation, respiration, and renal function needed for your baby to develop. Thus your body processes your fluids more quickly, leading to increased urine output.
Progesterone has other effects as well. This hormone relaxes your body’s smooth muscles, including those in the urinary tract. This can contribute to stress incontinence and can also increase the risk of urinary tract infection (UTI) by dilating the ureters (the tubes that connect the kidneys to the bladder).
Stress Incontinence and Frequent Urination
Stress incontinence is the most common urinary tract problem during pregnancy. Most pregnant women will experience some degree of stress incontinence, or the involuntary passing of small amounts of urine. This commonly occurs when coughing, sneezing, or laughing. The word stress refers to a sudden pressure or stress on the bladder caused by a contraction of the abdominal muscles.
Exercising and lifting heavy objects can also cause unintentional urination. Stress incontinence can be mild or severe, and can happen at any time during pregnancy, but is most common in the third trimester. The muscles in the bladder sphincter (the upper urethra) and in the pelvic floor are under additional strain during pregnancy and are more relaxed than usual due to hormonal changes, so extra pressure on the abdomen or bladder (for example, from sneezing) may result in leakage of a small amount of urine.
While stress incontinence can be embarrassing and distressing, there are ways to manage and prevent it. Getting into the habit of emptying your bladder more often will help reduce the frequency of accidents. You may opt to wear a sanitary pad on days when you feel the need for reassurance. Your doctor may also advise you to perform Kegel exercises.
To perform Kegel exercises, you need to tighten the pelvic floor muscles while keeping your abdominal, thigh, and buttocks muscles relaxed. Hold the pelvic floor muscles while you count to 10 and then relax the muscles for the same count. These exercises can be done throughout the day, whenever it is convenient for you. However, having a schedule may lead to better and faster results. We like the 5-5-5 schedule. Do them five times a day, five in a row and hold the Kegel muscle for five seconds.
Frequent urination can be dealt with in a few ways. One trick is to cut back on fluid intake after dinner. Another is to empty the bladder before any expected physical activity such as a walk or exercise. Keep your intake of caffeine and salty foods low. The former increases urine output and the latter causes water retention, which will then increase urine output later!
Urinary Tract Infections (UTIs) in Pregnancy
In pregnant women, the incidence of UTI can be as high as 8 percent. UTI is a bacterial infection (medically this is called a lower UTI), usually of the bladder. Rarely, there can be a kidney infection, which is also known as an upper UTI. Escherichia coli, or E. Coli, is a strain of bacteria that accounts for 80 to 90 percent of these infections. An antibiotic taken for seven to ten days is usually sufficient to eradicate the infecting organism(s) of non-serious UTIs. (American Family Physician, 2000).
Pregnant women are not predisposed to developing UTIs, but once they have a urinary tract infection, they are at greater risk for an acute upper UTI or pyelonephritis (kidney infection), which can be a severe illness requiring hospitalization, and in rare cases can even be fatal to both the mother and the fetus.
During pregnancy, there are normal changes in the function and anatomy of the urinary tract. These include kidney enlargement (ureteral dilatation), and compression of the lower ureters and bladder by the growing uterus. Progesterone relaxes the muscles of the ureter, causing some dilation, and also allowing for reflux—the backwards flow of urine from the bladder back up into the ureter, which can potentially introduce bacteria further up. The bladder also does not empty (a condition known as urinary stasis). The urine is not as acidic and it contains more sugars. The presence of glucose in the urine (glycosuria) can encourage bacterial growth. Higher levels of protein and hormones in the urine as a result of pregnancy may lead to a decreased ability of the urinary tract to resist invading bacteria. All of these factors can contribute to an increased susceptibility to UTI.
Common bacterial UTIs in pregnancy include:
- Asymptomatic bacteriuria. This infection is often caused by bacteria that are present before pregnancy. Although this infection does not cause symptoms, treatment may be required to prevent progression of the infection. Your doctor will screen for bacteriuria with a urine culture done at your first prenatal visits.
- Acute urethritis or cystitis. This is an infection of the urethra or bladder that causes pain or burning with urination, frequent urination, urge to urinate, and occasionally but not typically, a fever. It can result from untreated asymptomatic bacteriuria or can develop as a normal UTI that women are prone to.
- This affects the upper urinary tract or kidney and may cause symptoms similar to acute cystitis plus back pain and fever. Pyelonephritis may lead to preterm labor, severe infection, and adult respiratory distress syndrome. This infection is treated aggressively, often with multiple antibiotics. If your symptoms are severe, you may be hospitalized and given intravenous antibiotics.
- Group B Streptococcal infection. Group B Streptococcus (GBS) is a common condition when tested for in the vagina, but is a less common cause of urinary infection in pregnant women. However, a baby that comes into contact with GBS while passing through the mother’s vaginal canal during delivery can become infected. It is routine for vaginal GBS testing to be done close to the due date and for IV antibiotics to be used during labor if GBS is positive. This is because GBS infection in newborns can be severe and potentially life-threatening.
How to Prevent Urinary Tract Problems During Pregnancy
There are many things you can do to prevent urinary tract problems. Number one on the list is drinking lots of fluids. Try for six to eight glasses a day (less in the evening if there is frequent voiding at night). Not only is this important for a healthy pregnancy, it also helps flush out bacteria that might cause an infection.
- Avoid overly processed foods (sugar can inhibit white blood cells from fighting infection)
- Go to the bathroom regularly and before and after sex
- When urinating, try to empty the bladder completely every time
- Always wipe from front to back so as not to deposit bacteria near the urethra
- Don’t use douches or feminine hygiene sprays
- Keep the genital area clean with water or mild soap
- Add lemon to your water to increase the urine acidity
- Avoid sitting with your legs crossed and wearing tight, restrictive clothing, which may encourage a back-up in your urinary tract, causing an infection
- Wear cotton panties, which are breathable, rather than synthetic panties, which can trap moisture next to the skin
- Contact your doctor or health care professional if you think you have any type of urinary or vaginal infection