Pregnancy

Excessive urination during Pregnancy – Causes and Treatment

During pregnancy, you may feel the need to urinate frequently, sometimes even when the bladder is nearly empty. During later pregnancy, many women find the need to urinate more frequently. Many pregnant women leak some urine when coughing, laughing, sneezing or exercising. During pregnancy it is normal to have to go to the bathroom often.
Frequent urination is one of the most common symptoms of pregnancy that women experience. In fact, some women experience frequent urination and not even know they are pregnant yet. There are a couple of reasons for frequent urination during pregnancy.
Urinating often occurs during early pregnancy as soon as 6-7 weeks due to increased blood flow during pregnancy. Excess blood leads to extra fluid being processed through the kidneys to the bladder.

Causes:
The need to go to the bathroom will change throughout the stages of pregnancy. Sometimes you may feel the need to urinate more frequently. Other times, you feel like you’re back to normal.

- In the first weeks of pregnancy, your body produces a hormone called human chorionic gonadotropin (HCG), which can make you urinate more frequently.
- Your body contains more fluid during pregnancy.
- Your kidneys work harder throughout pregnancy to remove waste products from your body.
- As the uterus grows and rises higher during the second trimester, some women find that they have to urinate as often as before.
- Towards the end of pregnancy, the baby moves down to prepare for childbirth. This increases the pressure on the bladder, causing more frequent urination.
- The added pressure may wake you up several times at night to urinate.
- You can also force some urine to leak out, particularly if the muscles around the urethra are not very strong.

For the first days after birth, you may urinate more often as your body gets rid of excess fluid from the pregnancy. But after a few days, your need to urinate should return to what it was before pregnancy.

Treatment:
Here are some tips for dealing with frequent urination or loss during pregnancy:

Avoid drinks with caffeine.
- Caffeine can make you urinate more frequently.
- Avoid drinks like coffee, tea, colas and other caffeinated beverages that lead to the problem.

Do the Kegel exercises.
- These simple exercises can help stop urine leakage by strengthening the muscles that keep the urethra (the tube through which urine leaves the body) closed. They can even help prepare these muscles for labor and delivery.
- Do these exercises by squeezing the muscles you use to stop urine flow and hold for 10 seconds.
- Do this 10-20 times in a row at least three times a day.

Avoid drinking fluids before bedtime.
- Cut down on night visits to the bathroom, fluid intake should be earlier in the day.
- Reduce the amount you drink in the early evening and night.
- However, be sure to drink adequate amounts of water and juice during the day to ensure that there are robbing your body of vital fluids.

Completely empty the bladder.
- To help prevent leaks, make sure your bladder does not overfill.
- Try not to “hold it” when you feel the need to urinate. This may mean more trips to the bathroom.
- When you urinate, try to lean forward a bit in order to completely empty the bladder. Always empty your bladder before exercising.

Use a sanitary pad or panty shield.
- A pad or panty shield can take unexpected leakage caused by coughing or sneezing.

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Bleeding from the Vagina during Pregnancy – Causes and Treatment

Bleeding during all stages of pregnancy can be dangerous; you should call your healthcare provider if there are any signs of vaginal bleeding during pregnancy. Vaginal bleeding is any blood from the vagina (the canal leading from the uterus to the external genitalia). This usually refers to abnormal bleeding not associated with a regular menstrual period. Some basic things to know about bleeding are:

- If you are bleeding, you should always use a towel or panty liner so you can control how much you are bleeding and the type of bleeding you are experiencing.
- Never use a tampon or introduce anything else in the area of the vagina as a douche or sexual intercourse if you are experiencing bleeding.
- If you are also experiencing any of the other symptoms mentioned below in connection with a possible complication, you should contact your healthcare provider immediately.

The time period of the bleeding can be:
- The first trimester bleeding is vaginal bleeding during the first 3 months of pregnancy. Vaginal bleeding can vary from light spotting to severe bleeding with clots. Vaginal bleeding is a common problem in early pregnancy, complicating 20-30% of all pregnancies.
- Any vaginal bleeding during the second and third trimesters of pregnancy (last 6 months of a 9-month pregnancy) is abnormal.
- Bleeding from the vagina after 28 weeks of pregnancy is a true emergency. Bleeding can range from very mild to very quickly and may or may not be accompanied by abdominal pain. Haemorrhage (another word for bleeding) is the most common cause of maternal death in the United States. It complicates 4% of all pregnancies.

Causes:
Many women have a certain amount of vaginal bleeding during pregnancy. Some studies show that up to 30% of pregnant women experience some degree of vaginal bleeding during pregnancy. Vaginal bleeding during pregnancy is more common in twins and other multiple pregnancies than singleton pregnancies.

Sometimes women experience very little amount of bleeding in the first two weeks of pregnancy, usually around the time of the expected menstrual period. This light bleeding is sometimes referred to as “implantation bleeding.” Doctors do not know for sure what causes this bleeding, but can occur as a result of a fertilized egg from implanting in the uterine wall.

The amount of bleeding, the stage of pregnancy, and any associated symptoms can help determine the cause of vaginal bleeding during pregnancy. While vaginal bleeding during pregnancy does not mean a problem with the pregnancy, women who experience bleeding during pregnancy should always be evaluated by a physician.

Treatment:
Drugs for treatment of irregular vaginal bleeding depend on the cause. Examples are described below:
- If the cause of bleeding is the lack of ovulation (anovulation), doctors may prescribe either progesterone to be taken at regular intervals, or an oral contraceptive containing progesterone for proper hormone balance. This treatment dramatically decreases the risk of uterine cancer in women who do not ovulate.

- If the cause of irregular vaginal bleeding is a precancerous change in the lining of the uterus, progesterone drugs can be prescribed to reduce the accumulation of pre-cancerous tissue lining the uterus in an attempt to avoid surgery.

- When a woman has not menstruated for less than six months, the cause may be the menopausal transition. During this transition, a woman is sometimes offered an oral contraceptive to establish a more regular bleeding pattern to provide complete contraception until menopause, and to relieve hot flashes.

- If the cause of irregular vaginal bleeding is benign polyps or other tumors, they are sometimes removed surgically to control bleeding, and can not be treated with medication.

- If the cause of bleeding is infection, antibiotics are necessary. Bleeding during pregnancy requires urgent evaluation by an obstetrician. Endometriosis can be treated with medication and / or surgery.

- Sometimes, the cause of excessive bleeding is not evident after the completion of the test (dysfunctional uterine bleeding). In these cases, oral contraceptives may improve cycle control and reduce bleeding.

Deep Vein Thrombosis during Pregnancy – Causes and Treatment

Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein of the leg, calf or pelvis. During pregnancy, swelling and discomfort in both legs is common and does not always mean there is a problem. The blood in the veins is in constant formation of tiny clots that usually breaks down in the body. If the balance of clot formation and resolution changes, significant clotting can occur. A thrombus may form if one or a combination of the following situations exists.

Causes of Deep Vein Thrombosis

Immobility
- Prolonged sitting and travel such as long airplane flights, car or train.
- Hospitalization.
- Surgery.
- Trauma in the leg with or without surgery or casting.
- Pregnancy, including 6-8 weeks after birth.
- Obesity.

Hypercoagulability
- Smoking
- Genetic predisposition
- Polycythemia (increased number of red blood cells)
- Cancer

Trauma to the vein
- Fracture of the leg
- Leg contusion
- Complication of an invasive procedure, the vein

Other causes include:
- The damage occurs to the inner lining of a vein. This damage can result from injuries caused by physical, chemical or biological factors. Such factors include surgery, serious injury, inflammation and immune response.
- Blood flow is sluggish or slow. Lack of movement can cause slow or sluggish blood flow. This can occur after surgery, if you are sick and in bed for a long time, or if you are travelling for a long time.
- Your blood is thicker or more likely to clot than normal. Certain hereditary conditions (such as factor V Leiden) increase the tendency for blood to clot. This is also true for treatment with hormone therapy or birth control pills.

Treatment for Deep Vein Thrombosis

As soon as the doctor suspects a venous thrombosis, you are advised to start treatment with an injection of heparin (an anticoagulant) to “thin the blood.” There are different types of heparin. The most commonly used in pregnancy is “low molecular weight heparin (LMWH).

Superficial Thrombophlebitis:
The treatment of superficial blood clot is symptomatic:
- Hot towels
- Leg compression and
- An anti-inflammatory drug like ibuprofen.

Deep venous Thromboses
Treatment of DVT above the knee is anticoagulation, unless there is a contraindication.Contraindications include recent major surgery (from anticoagulation would be thin all the blood in the body, not just in the leg, leading to serious bleeding problems), or abnormal reactions when previously exposed to anticoagulant medications.

Anticoagulation prevents further growth of blood clotting and prevents the formation of a clot that can travel to the lungs. Anticoagulation is a two-step process. Warfarin is the drug of choice for anticoagulation. It should be started immediately, but unfortunately it may take a week or more for blood to get properly diluted. Therefore, the molecular weight heparin is administered at the same time. It thins the blood through a different mechanism and is used as bridge therapy until the warfarin has reached the therapeutic level. Enoxaparin injections can be given on an outpatient basis.

Surgery
Surgery is a rare option in the treatment of deep vein thrombosis large leg in patients who can not take blood thinners or who have recurrent clots while on anticoagulant medications. Surgery is often accompanied by placement of a vena cava (IVC) filter to prevent future clots embolization to the lung.

Cerulea dolens Phlegmasia describes a situation in which a blood clot in the iliac vein of the pelvis and the femoral vein in the leg, blocking almost all of the blood return and jeopardizing the blood supply to the leg. In this case surgery may be considered to remove the clot, but the patient also required anticoagulant medications.