URINARY COMPLAINTS IN PREGNANCY

Urinary tract infection: It is one of the common causes of puerperal pyrexia, the incidence being 1–5% of all deliveries. The infection may be the consequence of any of the following:

1) Recurrence of previous cystitis or pyelitis

2) Asymptomatic bacteriuria becomes overt

3) Infection contracted for the first time during puerperium is due to-

• Effect of frequent catheterization, either during labor or in early puerperium to relieve retention of urine
• Stasis of urine during early puerperium due to lack of bladder tone and less desire to pass urine.

The organisms responsible are—E. coli, Klebsiella, Proteus and S. aureus. Necroti zing fasciiti s involving the skin, subcutaneous tissues, rectus sheath and the muscles (myofasciitis) in a cesarean section wound.

RETENTION OF URINE: This is a common complication in early puerperium. The causes are-

1) Bruising and edema of the bladder neck,

2) Reflex from the perineal injury,

3) Unaccustomed position.

TREATMENT: If simple measure fails to initiate micturition, an indwelling catheter is to be kept in situ for about 48 hours. This not only empties the bladder but helps in regaining the normal bladder tone and sensation of fullness. Following removal of catheter, the amount of residual urine is to be measured.

If it is found to be more than 100 mL, continuous drainage is resumed. Appropriate urinary antiseptics should be administered for about 5–7 days.

INCONTINENCE OF URINE: This is not a common symptom following birth. The incontinence may

be:

1) overflow incontinence,

2) stress incontinence,

3) true incontinence.

Overflow incontinence following retention of urine should first be excluded before proceeding to differentiate between the other two. Stress incontinence usually manifests in late puerperium whereas, true incontinence in the form of genitourinary fistula usually appears soon following delivery or within first week of puerperium.

Diagnosis of stress incontinence is established by noting the escape of urine through the urethral opening during stress. The exact nature of urinary fistula is established by noting the fistula site by examining the patient in Sims’ position, using Sims’ speculum or by three swab test, if the fistula is tiny.

SUPPRESSION OF URINE: One should differentiate suppression from retention of urine. If the 24 hours urine excretion is less than 400 mL or less, suppression of urine is diagnosed; the cause is to be sought for and appropriate management is instituted.

HOMOEOPATHIC MEDICINES FOR URINARY COMPLAINTS DURING PREGNANCY: -

1) Cantharis:- Strong urging to urinate with cutting pains that are felt before the urine passes, as well as during or after may indicate a need. The person may feel as if the bladder is not emptied, still feeling a constant urge to urinate.

2) Nux vomica:- Irritable bladder with a constant need to urinate, passing only small amounts, suggests a need for this remedy. Burning or cramping pain may be felt in the bladder area, with an Itching sensation in the urethra while urine passes.

3) Sarsaparilla:- this remedy is often useful in Cystitis and often helps when symptoms are unclear. Frequent urging is felt, with burning pain at the end of urination.

4) Apis Mel:- Indicated when the person frequently needs to urinate,but only small quantities are passed. Stinging and burning sensations are felt and the person may also experience soreness in the abdomen. A lack of thirst is another indication that Apis may be needed.

5) Belladonna:- beneficial if urging to urinate is frequent and intense and the bladder feels very sensitive. Small amounts of highly coloured urine passes.

6) Chimaphila umbellata:- If a person has a troublesome urge to urinate but has to strain to make it pass, this remedy is useful. A scalding sensation may be felt while the urine flows, with a feeling of straining afterward.