Written by Jessica McKinney, PT, MS and Samantha Pulliam, MD and sponsored by
Pregnant and seeing more of the ladies’ room these days? Or are you wondering if that’s a pregnancy symptom you’ll develop soon? There are several things that determine how often you pee – some have to do with pregnancy and some that just have to do with being a human being!
Let’s level-set, first. You may be wondering what normal is in the first place.
For adult females who are not pregnant, going to the bathroom every three to four hours in a 16-hour day is typical – that’s an average of five to seven trips to the toilet during the day. If you’re someone who makes a few more bathroom pit stops – say, every two to three hours – you may simply be on the upper end of normal. Urinating more frequently than every two hours during the day and more than once per night seems to be the cut-off for ‘bothersome frequency.’ At the most basic level, the range of urinary frequency can fluctuate based upon input compared to output. The more fluid you take in, the more fluid you’ll need to get out, so keep that in mind! Especially if you start drinking more water during pregnancy.
Urinary frequency, particularly when accompanied by other symptoms, such as pain with urination, a strong sense of urgency, abnormal urine color, difficulty emptying or loss of bladder control, may be an important sign of an underlying medical condition, such as a urinary tract infection. Speak with your health care provider right away if you have any of these symptoms.
How does pregnancy affect urinary frequency?
During pregnancy, your blood volume – the total amount of blood in your body – increases by 30-50%. The heart accommodates by increasing how much blood it is pumping out, and the kidneys begin to filter the blood at a higher rate. All of these changes lead to a greater amount of urine that is produced, and this makes for more trips to the bathroom.
An increase in urinary frequency may also be due to changes happening in the pelvic floor, as a result of pregnancy. With each day, the uterus grows larger. There is greater movement of the pelvic organs, and the bladder and the uterus drop lower in the pelvis. This change puts extra pressure on the bladder and keeps the bladders from totally expanding – both of these contribute to the increased need to urinate.
For many women, increased frequency begins during the first trimester and continues to increase throughout pregnancy. Waking at night to go to the bathroom – once, twice, even three or more times – is also very common. By the third trimester, up to 78% of pregnant women report symptoms of urinary frequency. Rest assured that this is not the ‘new normal,’ and these symptoms typically return to pre-pregnancy rates after delivery. While these may be common, they typically begin to resolve within six to eight weeks after childbirth.
Also, certain pelvic floor disorders, such as urinary incontinence, anal incontinence, and pelvic organ prolapse, may occur for the first time during pregnancy, or worsen during pregnancy or early postpartum if they were already present. These conditions may increase the likelihood of also having symptoms of urinary frequency.
If any of these symptoms exist and are bothersome, current guidelines recommend referral to a urogynecology specialist or physical therapist for further care. The good news is that effective treatment options are available. Depending on the cause, this may include pelvic floor muscle exercise, bladder training or physical therapy.
About the authors:
Ms. McKinney is a physical therapist and has specialized in pelvic and women’s health throughout her career. Her background includes women’s health education, advocacy, and business and program development in the US as well as in low-resource global health settings. She currently serves as Vice President of Medical Affairs and Clinical Advocacy at Renovia Inc.
Dr. Pulliam a fellowship-trained and board certified urogynecologist, a subspecialty of medicine focused exclusively on female pelvic health. She has been in clinical and leadership positions at Massachusetts General Hospital and the University of North Carolina (Chapel Hill), as well as within the American Urogynecologic Society, and she currently serves as the Chief Medical Officer at Renovia Inc.
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