Fourteen million people live with bladder problems, and 6.5 million people suffer some form of bowel issue in the UK (NHS England, 2018). Continence problems can be caused by a number of factors, including childbirth — particularly where the child was born vaginally rather than by caesarean section (Barrie, 2015), but a significant proportion of cases are curable or can be significantly improved (NHS England, 2013). Tucker et al, (2021) highlighted that of women following childbirth and attending gynaecology outpatient settings, 16-28% reported anal incontinence symptoms, compared with around 4% of women in the general population. Early detection of deviations from normal in bladder and bowel function can have a considerable impact on outcomes for women (Lovell and Steen, 2016; Lamb and Sanders, 2016).
This year the Royal College of Nursing (RCN) has published a guidance document Bladder and bowel care in childbirth (RCN, 2021). The aim of the guidance is to provide information about bladder and bowel care throughout pregnancy, labour and into the postnatal period. 

The guidance acknowledges and recognises current national guidance from, for example, Royal College of Obstetrics and Gynaecologist, National Institute of Excellence in Health and Social Care and Scottish Intercollegiate Guidelines Network and can be used as a tool for a wide range of healthcare professionals involved in the care of women.
Several key messages are highlighted, including:
  • Bladder and bowel care is really important to women, and it should be just as important to the healthcare professions that look after them
  • Women should not have to accept continuing problems, they should feel confident to seek help and should be encouraged to talk about bladders and bowels, learning what is normal and what can go wrong – seek help early 
  • Midwives and health visitors can refer directly to a physiotherapist – remember the role of the pelvic floor specialist physiotherapist and pelvic floor exercises and training (a message endorsed by The Pelvic Floor Report [The Pelvic Floor Society, 2021]).    
This is an important document emphasising that care of the bladder and bowel are vital components of care in pregnancy, labour and postnatally and the need to understand why this is important cannot be overstated. The result of complications can have an impact on a woman’s life for a long time afterwards (Whitehouse, 2012). Such potentially life-changing complications may also affect her relationship with her partner and wider family, as well as her ability to look after her child/children (Lamb and Sanders, 2016; RCN, 2021).
The guidance reminds us that pregnancy and childbirth are natural phenomenon, however, complications can arise which can have short and long-term effects. It is important to discuss the changes to physiology during pregnancy, labour and postnatally to ensure the woman understands what is normal, and when she needs to discuss any concerns she has with her midwife or health visitor. It is also important that all health care professionals caring for women reiterate that bladder problems may be common but that does not mean they are normal. Women often tolerate these complications because they assume bladder problems are the norm in the postnatal period, believing nothing can be done to help. Bladder and bowel problems may have a considerable impact on the woman, both her physical and mental wellbeing.

This is an important document emphasising that care of the bladder and bowel are vital components of care in pregnancy, labour and postnatally and the need to understand why this is important cannot be overstated. The result of complications can have an impact on a woman’s life for a long time afterwards (Whitehouse, 2012). Such potentially life-changing complications may also affect her relationship with her partner and wider family, as well as her ability to look after her child/children (Lamb and Sanders, 2016; RCN, 2021).

References

Barrie M (2015) Identifying urinary incontinence in community patients. J Community Nurs 29(6): 45-52

Lamb K, Sanders R (2016) Bladder care in the context of motherhood: Ensuring holistic midwifery practice. Br J Midwifery 24(6): 415-421 

Lovell B, Steen M (2016) A critical literature review of the incidence of postpartum urinary retention. Evid Based Midwifery 14(4): 131-142. Available at: https://www.researchgate.net/publication/312176301_A_Critical_Literature_Review_of_the_Incidence_of_Postpartum_Urinary_Retention    

NHS England (2013) Continence Care Services England 2013: survey report. Available online: http://176.32.230.26/appgcontinence.org.uk/wp-content/uploads/2020/02/Continence-Care-Services-England-Report-2013.pdf 

NHS England (2018) Excellence in continence care. Available online: https://www.england.nhs.uk/wp-content/uploads/2018/07/excellence-in-continence-care.pdf 

Royal College of Nursing (RCN) (2021) Bladder and bowel care in childbirth. Available online: https://www.rcn.org.uk/professional-development/publications/rcn-bladder-and-bowel-care-in-childbirth-uk-pub-009-553   

The Pelvic Floor Society (2021) Seizing the opportunity to improve patient care: Pelvic Floor services in 2021 and beyond. Available online: https://www.pelvicfloorreport.com/wp-content/uploads/2021/05/Pelvic-Floor-Report-V14-WEB.pdf 

Tucker J, Steen M, Briley A (2021) Enhancing the identification of anal incontinence in women of reproductive age. Nurs Standard. Doi: 10.7748/ns.2021.e11735

Whitehouse T (2012) Managing stress incontinence in postnatal women. Nurs Times 108: 16-18  


Back to journal