Psychological changes in
pregnancy, labour and puerperium
of the proximity of the uterus, cervix and vagina to the bladder and urethra
their functions are correlated during child bearing and childbirth.
Increased Frequency: In the first 12 weeks of
pregnancy, while the enlarging uterus is still a pelvic organ, the bladder can
not fill up to its full capacity so the woman urinates frequently. This is
described as physiological. Also during the last 4 weeks of pregnancy when the
fetal head lies in the pelvis there is recurrence of increased frequency. In
the middle weeks of pregnancy frequency in association with dysuria is due to
Acute Retention: Is a rare condition but sometimes
occurs in about the twelfth week of gestation if the uterus is extroverted.
Incontinence: This sometimes occurs in late
pregnancy when the head is deeply engaged in the pelvis.
Increased Frequency: More
common with OccipitoPosterior Position (OPP). Pressure on the sacral plexus of
nerve causes excess stimulation of the nerve to the bladder. There is increased
desire but can not actually do it.
Acute Retention: The pressure on the nerve plexus
mayconversely cause lack of sensation stimulus to the bladder. In labor the
urethral stretches from 4cm to about 15cm or more thus almost occluding the
lumen completely. This makes micturation and even catheterization difficult.
Incontinence: If the bladder is not emptied at
the end of firststage of labor there is dribbling of urine with each expulsive
contraction during the second stage.
bladder causes delay in the first and second stages of labor. Bruising of the
bladder may occur and on the urethral in addition to overstretching. Full
bladder can lead to non-
of the placenta and PPH (Post Partum Haemorrhage).
The Frequency: There is increased secretion of
urine in thefirst 48 hours of puerperium. Frequency at this time is
physiological. Some times it may be due to infection or lax muscle tone.
Acute Retention in puerperium may be due to:
Posture: Complete bed rest with use of bed pan.
Privacy: May be embarrassed by people around.
Pain: fear of pain following perineal tear or
difficult labor on the nerve of the bladder during labor.
Lax muscle tone: as a result of over distention of
the bladder. Abdomen should be palpated daily to rule out sub involution of the
uterus and signs of infection.
may result from trauma like Vesico-Vaginal Fistual (VVF). But stress
incontinence is more common as in the multigravida, it results form lax pelvic
floor muscles and weak sphincters.