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Postural Changes in Pregnancy

Postural Changes in Pregnancy


Overactive Bladder Syndrome (Urge Incontinence)

What is the Pelvic Floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. The pelvic floor has three openings that run through it, the urethra, the vagina, and the rectum.

The functions of the pelvic floor include:

  • To support the pelvic organs, specifically the uterus, the bladder, and the rectum
  • To help provide sphincter control for the bladder and bowel
  • To withstand increases in pressure that occur in the abdomen such as coughing, sneezing, laughing, straining, and lifting
  • To enhance the sexual response

What is Urge Urinary Incontinence?

Urge urinary incontinence is the involuntary release of urine following a sudden strong urge to urinate. This urgent need to urinate may occur during the day and often at night as well. Urgency, frequency and nocturia (going too frequently in the night) are symptoms of an ‘overactive or irritable’ bladder. The smooth muscle pump of the bladder is spasming or contracting giving rise to this urgency. Urine is composed of water, electrolytes, and other waste material that has been filtered out of the blood in your kidneys. Urine is then transported via the ureters to your bladder, where it is stored. Once full, the muscles in the wall of your bladder contract forcing urine through the urethra and out of your body. Sphincter muscles and pelvic floor muscles keep the urethra closed to avoid leakage of urine. These muscles relax at the same time the bladder contracts in order to allow urine to exit your body.

Signs and symptoms of urge urinary incontinence include:

  • The strong urge to urinate followed by the leakage of urine
Many women also experience triggers, or anything that increases the urge to urinate including running water, cold, or the thought of urinating.


What Causes Urge Urinary Incontinence?

The dysfunction is a combination of problems with the bladder, urethra, vagina, pelvic floor and nervous system. The first step is to understand that the urgency that you feel is generated centrally through the nerve connections from the bladder to the brain. The nerves to the brain get confused. They cannot tell whether the bladder is actually full or whether they are receiving a false and urgent message, these stimulus trigger the brain to mistakenly tell us to go to the toilet. We need to deny the urge to fix the circuitry problem.

There are several causes for urge urinary incontinence, these include:

Alcohol and Caffeine Alcoholic drinks and caffeine cause your bladder to fill more quickly and can trigger a strong uncontrollable urge to urinate. Bladder irritants Carbonated drinks, citrus juices, artificial sweeteners, tea, and coffee can irritate your bladder and worsen urge incontinence. Even teas and coffees without caffeine are irritants. Nicotine is also a bladder irritant. Dehydration When dehydrated, your urine becomes very concentrated. This highly concentrated urine can irritate your bladder and worsen urge incontinence. Urinary tract infection During a urinary tract infection, bacteria can irritate your bladder. This can result in strong urges to urinate, increased frequency, and incontinence. Constipation The bladder and rectum have a common nerve supply. Constipation causes compacted stool in the rectum which over-activates these nerves, increasing urinary urgency and frequency. Overactive bladder Overactive bladder is when nerves send signals to the bladder at the wrong time, causing it to contract at an inappropriate time leading to incontinence. Aging As you age, the capacity of your bladder to store urine decreases and the frequency of overactive bladder symptoms increases. The risk of overactive bladder also increases with various blood vessel disorders, seen more commonly in the elderly. Interstitial cystitis This is a painful condition that involves inflammation and scarring of the bladder wall. Symptoms include painful, frequent urination as well as urinary incontinence. Hysterectomy and other surgery The bladder and uterus are very close together and have common supporting ligaments and muscles. Removal of the uterus as in hysterectomy, risks damage to structures supporting the bladder. If these supporting structures are damaged, a prolapse or cystocele is likely to occur. Symptoms of a cystocele include urinary incontinence. Additionally, surgery may damage the nerves that supply the bladder, also leading to urinary incontinence. Bladder cancer or bladder stones Symptoms of bladder cancer or bladder stones include urinary incontinence, urgency, frequency, and painful urination. Other symptoms include blood in the urine and pelvic pain. Neurological damage Any neurological disorder such as multiple sclerosis, Parkinson's disease or stroke can cause urinary incontinence by interfering with the nerve signals that control the bladder. Additionally, if the nerves supplying the bladder or pelvic floor muscles are damaged, urinary incontinence may result.  

How is Urge Urinary Incontinence treated?

Treatments of urge urinary incontinence are tailored to suit your individual problem. The following should be considered: Pelvic floor muscle strengthening Strengthening the supporting muscles of your bladder is very effective in helping stress urinary incontinence. Biofeedback, or the use of special computer equipment to measure muscle activity, can help improve muscle control. Electrical stimulation can also assist in strengthening the pelvic floor muscles. Bladder training Bladder retraining is the technique used to try to increase the capacity of the bladder and decrease the sensitivity of the bladder. By teaching your bladder how to store more urine without leaking or giving uncomfortable spasms, you will have more time between voids, less discomfort and more freedom to go out. This is a disciplined program to suppress an overactive bladder. Expect the program to take at least 3 months to have a positive effect Defecation training Medication to calm the bladder, this is normally initiated after 3 months, talk to your doctor Vaginal oestrogen, if you are post menopausal Surgery – very rarely  

Normal bladder function

  • fluid intake of 1.5- 2 litres
  • normal frequency of voiding (passing urine) 4 – 6 times a day (every 2-3 hours) and perhaps once at night
  • each time you void, you should pass 250 – 500ml (1-2 cups) of urine
  • if you get the urge to void, you should be able to comfortably defer until it is convenient for you to go to the toilet
  • when you pass urine, it should flow in a steady continuous stream, without hesitation, until your bladder is empty
  • you should not need to push or strain to pass urine
  • you should be able to pull up on your pelvic floor when the flow of urine is finished, before you stand up
  • urine should be pale yellow coloured, it may be darker in the morning as it is more concentrated.
If your urine is always dark it is a sign that you are not drinking enough.

Pelvic Pain in Pregnancy

Pelvic and Pubic Pain in Pregnancy

What cause it?

The ligaments holding the pelvic bones together become soft and stretch due to hormones (relaxin). This leads to an unstable pelvis. Pain or instability can occur at any of the pelvic joints
  • The pubic bone at the front can separate from 2 – 3 mm, this starts from as early as 8 weeks, it can separate as far as 10 mm and this is when symphysis pubis dysfunction is diagnosed.
  • The joints at the back (sacroiliac joints) also stretch making this joint unstable which causes pain and dysfunction
Changes in weight and posture also affect the position of the pelvis, which in turn makes it more difficult for the muscles to stabilise the pelvis as they are stretched and weakened. 1 in 5 women will suffer with pelvic instability with about 5% having serious problems

Symptoms Include:

  • Pain in the front or back of the pelvis, groin, buttock, thigh, hip and lower back
  • Difficulty walking or a waddling walking pattern
  •  Pain when standing on 1 leg
  •  Pain when turning or twisting
  • Rolling in bed
  •  Clicking/clunking sounds from the pelvis
  •  Pain when opening your legs