One of the most frequent complaints pregnant women have is the seemingly never-ending need to urinate. Numerous trips to the restroom day and night are a hallmark of most pregnancies, especially in the first and last trimesters. Let’s review why this happens, how to reduce the number of trips, and when to be concerned.
Why do I have to urinate so often?
Some women notice a more frequent need to pee even before they realize they are pregnant. In fact, as I explained here, a need to urinate more frequently is one of the most common early signs of pregnancy, starting about six weeks into your first trimester.
In early pregnancy, your womb is low down in your pelvis. As your baby grows, your growing uterus pushes down on your bladder, urethra, and pelvic floor muscles. When your baby grows too big to fit in your pelvis, your womb moves up into your abdomen and then you will probably find you make fewer trips to the restroom. In addition to the “pressure effect”, after the embryo has implanted in your uterus, your body produces a pregnancy hormone known as hCG (human chorionic gonadotropin). This hormone increases the blood flow towards the pelvic region and kidneys and triggers an increase in urination.
As your pregnancy progresses, your body will also produce more urine. This is because your kidneys have to deal with the extra waste from both your increased circulation and your baby (over the course of your pregnancy the amount of blood circulating in your body rises until you have almost 50 percent more than before you got pregnant!) Fortunately, your bladder increases in capacity over the course of your pregnancy to deal with this. Therefore, you may find that in your second trimester the restroom breaks are more sporadic (however, many women report no relief in the second trimester…)
Hormones and lack of space both put pressure on your urinary system in later pregnancy. The pregnancy hormone progesterone can relax the tubes of your urinary system, making it harder for urine to pass from your kidneys into your bladder and then from your bladder. This may mean lots of trips to the loo to pass small amounts of urine.
In later pregnancy, even when your bladder is empty, the pressure of your growing baby can make it feel full. You’ll particularly feel this at the end of pregnancy when your baby’s head has engaged ready for birth.
Having trouble emptying your bladder completely because of changes in the shape and position of your bladder is another reason for the extra pit stops.
Immediately after your baby is born, you will produce even greater quantities of urine because your body has to get rid of the extra fluid you retained during pregnancy. Between the second and fifth day after birth, you may notice an increase in the volume of urine. This is completely normal. Then, your need to urinate will return to what it was before you were pregnant.
Should I cut back on fluids? What can I do?
No! Cutting down on fluids can leave you dehydrated. You need to drink a lot to help carry nutrients to your baby. You should be drinking at least eight medium-sized glasses of fluid a day. It’s best to stick to non-caffeinated (and, of course, non-alcoholic) drinks, so water is the best option. If you are well hydrated, your urine will look clear. If you are dehydrated, it will look yellowish or cloudy.
You may notice that you need to get up to pee more often during the night in particular. That’s in part because when you lie down, some of the fluid that you retained in your legs and feet during the day makes its way back into your bloodstream and eventually into your bladder. Therefore, a couple of hours before you go to sleep, avoid beverages that have a mild diuretic effect, such as coffee, tea, and alcohol (I suggest you cut back on alcohol completely during pregnancy. Read the recommendations of the Centers for Disease Control and Prevention –CDC– about alcohol consumption in pregnancy).
Some women report less trips to the bathroom after they urinate leaning forward. This helps completely empty your bladder.
The weakening of the pelvic floor muscles during pregnancy and childbirth can lead to urinary incontinence. To minimize the risk and prevent other pelvic floor problems, do your Kegel exercises and read here how to prevent pelvic floor damage. Kegel exercises help you gain control over the urethra. The best part is that the exercise can be performed discreetly just about anywhere. You can do the exercise about three times a day with 10-20 contractions a time for 10 seconds.
When should I be concerned?
You should consult with your health care provider if
- You feel pain or burning when you urinate.
- Your urine smells particularly unpleasant, is cloudy, or contains blood.
- You have constant lower abdominal pain.
- You feel generally unwell.
The diagnostic tests your health care provider may suggest include:
- Ultrasound – identifies any abnormalities in the kidneys, bladder and urethra
- Urinalysis – checks the urine for infectious bacteria
- Bladder stress test – measures the urine that may leak when you a cough or sneeze
- Cystoscopy – examines bladder and urethra for checking abnormalities.
The most common reason for concern is urinary tract infection (UTI). If left untreated, a UTI can lead to a kidney infection (pyelonephritis) or preterm labor, or both. Drink plenty of water to dilute your urine and see your health care provider as soon as possible. You’ll need antibiotics to treat the UTI. Your health care provider should know what antibiotics are safe to use during pregnancy. Do not use any medication without first consulting your health care provider!