Good care can reduce the risk of long-term problems and help recovery. Here we look at what to look out for and how to support women during this time.

• Problems with bladder and bowel function are common but not normal.
• Women may feel embarrassed or unsure about seeking help—clear, kind communication is key.
• Early support can prevent long-term complications.

• Bladder and bowel problems are common, but not normal—early support matters.
• Women may feel embarrassed or unsure about seeking help—clear, kind communication is key.
• Care must be individualised, taking into account culture, beliefs, and expectations.
• Health professionals must explain terms clearly—for example, ‘frequency’ of urination.
• Women with 2nd-degree tears may need referral; this must be explained early.
• Midwives and health visitors can refer directly to pelvic health physiotherapists.
• Offer chaperones for all intimate examinations or procedures.
• People from transgender, non-binary or intersex communities may have additional or different needs.

Hormones and the growing baby affect how the bladder and bowel work.

What is normal?

Bladder function: Frequency could be 4-8 times a day, every 3-4 hours. Nocturia (getting up at night) is usually once a night in someone of childbearing age.

Bowel activity: Considered to be between three movements a day and three movements a week. View the Bristol Stool Form Scale (PDF).

Bladder changes:

• 1st trimester: Increased progesterone relaxes the bladder muscle. Can increase the risk of infection or reflux.
• 2nd trimester: Less pressure from the uterus. Symptoms may ease.
• 3rd trimester: Pressure increases again, causing more frequent urination.

Bowel changes:

• Constipation is common due to hormonal changes and reduced movement in the gut.

Advice to offer women

• Drink 1.5–2 litres of fluid daily (does not have to be just water).
• Avoid irritants, such as caffeine, fizzy drinks, citrus and alcohol.
• Promote front-to-back hygiene and washing after sex to avoid infections.
• Encourage pelvic floor exercises early.

Bladder care during labour

• Women should be encouraged to urinate regularly.
• A full bladder can slow the baby’s descent and make labour more painful.
• Record urine volume on the partogram and assess the bladder every 4 hours.

Risk of infection

• Catheters increase the risk of UTIs.
• Good catheter care is essential.

Bowel activity during labour

• It’s normal to pass stools—privacy and dignity must be protected.

Bladder

• Urinating within six hours of birth is vital.
• Large volumes may be normal due to body changes.
• If unable to pass urine or bladder is still full—refer for catheterisation.

Bowel:

• Haemorrhoids and constipation are common postnatally.
• Encourage hydration, fibre, correct toilet posture and avoid straining.

See more: Correct toilet position for opening your bowels (PDF).

Watch for:

• Faecal urgency or incontinence—may improve as pelvic floor heals but refer if it doesn’t.

The pelvic floor:

• supports pelvic organs
• helps control the bladder and bowel
• plays a role in birth and sexual function.

During pregnancy

The pelvic floor may be weakened by weight and pressure of the growing uterus. Symptoms may include stress incontinence or organ descent.

After birth:

• the risk of injury increases with vaginal or instrumental birth
• hormones like relaxin can delay recovery.

Pelvic floor exercises (PFEs) are recommended antenatally and postnatally. Use apps like NHS-endorsed Squeezy can help with getting women into a routine.

Additionally:

• they include long holds and short contractions
• should not involve breath-holding or squeezing other muscles
• are recommended to be done three times a day, ideally during feeding times.

Urinary tract infections (UTIs)

• Caused by pregnancy-related changes.
• May be symptomless but still harmful.
• Treated with antibiotics—early diagnosis is key.
• Prevention: good hygiene, hydration and avoiding bladder irritants.

Urinary incontinence

• Stress incontinence: Leaks with coughing/sneezing.
• Urgency incontinence: Strong need to go, can’t hold it.
• Treated with: Pelvic floor exercises and support.

Constipation

• Affects up to 38% of pregnancies.
• Caused by increased progesterone and reduced gut movement.
• Treat with fluid, fibre, timing toilet visits, and possibly laxatives.

Types of tears:

• 1st/2nd degree: May require stitches and self-care.
• 3rd/4th degree (OASI): Affect the anal sphincter and may cause long-term issues like incontinence or PTSD.

OASI prevention:

• Warm compresses in the second stage of labour.
• Selective episiotomy at a 60-degree angle.
• Manual perineal protection techniques.
• Good communication during birth.

Postnatal care:

• Women should be followed up 6–12 weeks later.
• Provide antibiotics, stool softeners and clear aftercare.
• Refer to pelvic health physio when needed.

Urinary retention:

Can occur after birth due to swelling, trauma, pain, or nerve issues.

Signs:

• Can’t pass urine or only pass small amounts.
• Pain or bladder fullness.
• Urge to go but no relief.

Management:

• Use bladder scans.
• Catheterisation may be needed.
• Flip-flo valves are not always recommended—free drainage preferred.

Home advice:

• teach how to care for catheters
• monitor fluid and bowel health.

Bladder and bowel problems can impact:

• relationships
• mental health
• confidence and sex life.

Health care professionals must:

• ask how the woman is feeling
• offer referral to mental health or specialist services
• create space for honest discussion.

Some women may feel too embarrassed to raise concerns. Professionals should:

• use simple, respectful language
• check understanding—never assume knowledge
• always explain pelvic floor care and bladder/bowel changes early in pregnancy
• encourage women to seek help and offer clear signposting.

If something goes wrong, women should know:

• how to raise concerns safely
• that they will be heard and supported
• where to go for advice (PALS, Birthrights, Ombudsman).

Perinatal Pelvic Health Services (PPHS):

• national initiative launched in 2021 across the UK
• helps prevent and treat mild-to-moderate pelvic floor issues
• asks four simple questions to help identify those needing support.

Read more about the Perinatal Pelvic Health Services (PPHS).

Bladder and bowel care is a vital part of maternity support. Early conversations, sensitive assessment and timely referrals can prevent long-term complications and support recovery.

Download the full PDF to explore this topic in more detail. This may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.