Pregnancy and IC
How Pregnancy Affects IC
Unfortunately, there is limited scientific data on the subject of interstitial cystitis (IC) and pregnancy.
In 1989, an ICA study surveying 48 IC patients representing 78 pregnancies, yielded valuable data on the effects of pregnancy on IC. Participants rated the severity of their IC pain, frequency, urgency, and pressure symptoms before pregnancy, during each trimester, and after delivery. Findings were divided into groups having mild, moderate, or severe IC symptoms before pregnancy:
- The majority of IC patients experienced moderate symptoms prior to pregnancy. Their symptoms increased only slightly during pregnancy, peaking in the third trimester. Pain did not increase.
- Patients with mild IC symptoms prior to pregnancy reported a slight worsening of symptoms as pregnancy progressed.
- Patients with severe IC symptoms prior to pregnancy noted improvement, except in the third trimester.
Urinary frequency, bacterial bladder infections, and constipation are common complaints for any pregnant woman, and they can be even more difficult for pregnant IC patients. Although your frequency will increase, don’t cut back on fluids because staying hydrated is critical. Bacterial bladder infections can be confused with IC symptoms, so a urinalysis at every prenatal visit is helpful. Avoiding constipation is important because it can contribute to IC flares.
Can You Pass on IC to Your Baby?
The first clue to a genetic link was published in 2001 with a report of a Bulgarian family with many members with IC. A survey of US IC patients indicated that 1.5 percent of family members had confirmed IC and another 12 percent possible IC. Further research in Bulgaria and the United States turned up more families where the genetic predisposition looked strong.
Although there are families where the genetic predisposition seems high, research from the largest twin registry in the world shows that when one identical twin had IC, by far, the other twin did not. The research indicates that environmental influences play a much bigger role than genetic ones in susceptibility to IC.
Learn more about how pregnancy affects IC, genetic risks, and much more in our Winter 2011 issue of the ICA Update.
Concerned about Conceiving?
Based on limited evidence collected to date, infertility does not appear to affect IC patients any more than women in general. Conception may be more difficult to achieve; however. Those who limit their sexual activity because of painful sex may be able to time intercourse to the most fertile days of their menstrual cycle. Books on fertility awareness can be helpful and ovulation prediction kits are widely available at pharmacies.
There are also many ways to decrease pain and increase your enjoyment of sex. Learn more about sex and IC on our intimacy page and from our interview with sexual medicine specialist Susan Kellogg-Spadt, PhD, CRNP, in the Winter 2009 issue of the ICA Update.
Planning Your Pregnancy
Planning ahead for your pregnancy will let you:
- be well nourished for your health and your baby’s
- work with healthcare providers who understand your special needs
- learn how to control your symptoms while keeping your baby safe
- accommodate your IC needs if there is an emergency
- opt for the birth that will be best for your body
- provide for your newborn’s needs
Some IC patients prefer minimal prenatal testing and a low-intervention birth, while others may feel more comfortable with a more highly managed pregnancy and birth. This decision is a matter of personal choice and an important factor to consider when you are making your plan.
Communication among the members of your healthcare team is especially important. Make it a point to ensure that all of your doctors and other healthcare providers are in touch with each other. If your health insurance plan offers limited choice in prenatal care providers, you may need to educate your assigned providers about IC and pelvic pain.
Treating IC During Pregnancy
Today, many doctors advise women to discontinue all but the safest medicines during pregnancy, especially during the first trimester. Some IC patients can control their symptoms with nondrug approaches such as diet, other self-help techniques, and physical therapy. Others may be able to use medicines that have minimal effects throughout the body, such as nonalkalinized anesthetic bladder instillations or topical medications. But some patients need to continue stronger medicines.
If your doctors are not comfortable managing these medicines during your pregnancy, consider working with a perinatologist. Perinatology is a subspecialty of obstetrics focused on high-risk pregnancies. That doesn’t mean your baby is in danger. An important part of this practice is caring for pregnant women who have special medical risks and challenges. Perinatologists are trained in managing riskier medications and treatments during pregnancy. A perinatologist and your OB or primary care doctor may work together, with the perinatologist consulting as needed or regularly, or you and your doctors may decide to have the perinatologist take over your obstetric care.
Learn about the risks of the most commonly used IC and pain medications and much more in our Winter 2011 issue of the ICA Update.
Read more about how opioids and Topamax are linked to some birth defects.
Taking Care of Yourself During Pregnancy
Get the Prenatal Vitamins You Need
Numerous studies indicate that proper nutrition is vital both before and during pregnancy. If you have not already done so, try to identify foods, beverages, and supplements that are irritating to your bladder before you conceive so you can eat a healthy, balanced diet and take the prenatal supplements you and your developing baby need.
You’ll need some supplements because your diet just can’t supply enough of certain nutrients that are essential for your baby, especially folic acid (folate), iron, and calcium.
If multivitamins bother your IC, consider taking these essential nutrients as individual supplements. Folate is critical, and diet cannot supply enough, so if folate is bothersome, try taking no more than the recommended amount, testing different brands, and splitting up the dose over the day. Iron may be constipating, but some forms may be less so. If you can’t find one that isn’t, consider having your iron levels tested regularly and take iron when your levels are getting low. Vegetarians also need to take B12 because only animal products contain it.
Researchers are finding that some other supplements may also be critical in pregnancy. You can learn about these and much more about nutrition and self care in pregnancy in our Winter 2011 issue of the ICA Update.
Hydration is also essential during pregnancy. Don’t cut your water intake to lessen your frequency. In pregnancy, your blood volume increases two to three times what it is normally, so you need fluids for that. Being dehydrated can cause premature contractions. It can also lead to levels of amniotic fluid that are too low, called oligohydramnios, which can be dangerous for you and your baby, increasing the risk of deformities and premature labor.
Fitness and Physical Therapy to Keep You Comfortable
Along with diet, a variety of nondrug options may help you remain medication free, including meditation and relaxation, IC and pregnancy-friendly exercise, and physical therapy.
During pregnancy, there’s a lot of weight on your bladder and pelvis. In addition, pregnancy hormones actually loosen ligaments, so joint and bone problems, especially with the pubic bone, can become a source of pain.
These are reasons why it’s wise to move away from weight-bearing exercise, such as high-impact aerobics, and use exercise that doesn’t put stress your pelvic area and your joints, such as yoga. In yoga, positions that spread your feet far apart may be too stressful, whereas those that take pressure off your pelvis can be helpful.
Physical therapy for the pelvic floor and your physical therapist’s advice on exercise, pregnancy belts, alternative birth positions, and postpartum pelvic health can be very helpful. Although some OBs may be concerned about pelvic floor therapy during pregnancy, if you have been getting physical therapy with a knowledgeable PT and it has been successful, it can be safe and helpful during pregnancy.
Learn more about physical therapy and fitness during pregnancy in our Winter 2011 issue of the ICA Update.
Prepare Birth and Emergency Plans
A birth plan is a document that you and your partner can write during your pregnancy that lists your preferences for the childbirth process.
Birth plan worksheets are widely available on the internet. With these, you typically specify your wishes, such as:
- Whether and what type of anesthesia and pain medicine you want to use during labor
- Whether you will permit the use of labor-inducing drugs
- Whether you will permit non-essential hospital personnel (such as medical students or student nurses) to observe your birth process
- Whether you will permit an episiotomy
Because you have special needs as an IC patient, you may also want to have your treatment preferences—and your providers’ contact information and supporting letters—available to take with you in case of emergency. For example, you may want to be sure ultrasounds are done with a transvaginal transducer, which doesn’t require your bladder to be full, or in an emergency, to be filled through a catheter. You may also want to specify that you need a child-size catheter if one becomes necessary for any reason.
These plans and documents are helpful because, during labor or an emergency, you may not always have time or the ability to discuss your wishes, and your usual provider might not be available.
Plan Your Delivery
IC patients reported that their pregnancies with IC were as successful as the pregnancies they had gone through before IC. Approximately one-third of the survey respondents delivered vaginally without anesthesia, while fewer than one-third delivered vaginally with anesthesia. Another one-third delivered by C-section. The type of delivery did not affect IC symptoms for these patients.
Each type of delivery has its pros and cons for IC patients:
- Vaginal delivery may be chosen to avoid anesthesia, catheterization, and incisions. However, be aware that catheterization, anesthesia, and C-section may become necessary because of complications during labor.
- Scheduled C-section delivery can avoid prolonged labor and trauma that can affect bladder, bowel, and sexual function. However, it limits your interaction with your newborn, recovery is much longer, and adhesions, which can cause pain, are a risk.
These are issues of special importance to IC patients—discuss them thoroughly with your healthcare providers. And get them talking to each other! Be prepared for a last-minute change in delivery plans and discuss any concerns with your doctor ahead of time.
Your Newborn and Your Medications
If you use opioids during pregnancy, your newborn may need to be carefully weaned from them. That may mean an extended stay for him or her in the hospital while specialists look for signs of withdrawal and then monitor the baby as they administer tiny and gradually decreasing doses to help keep him or her comfortable.
Plan ahead for this possibility by talking to your OB, perinatologist, the hospital’s neonatologist, and lactation consultant (if you breastfeed) well in advance of birth. Even before you get pregnant isn’t too early to talk to these specialists.
Learn more about opioids during pregnancy and opioid weaning for your newborn in our Winter 2011 issue of the ICA Update.
Breastfeeding Your Baby
Breastfeeding has significant nutritional, psychological, and immunological advantages for you and your baby.
When you have IC, there are added considerations.
- The medications you take can affect your baby, so be sure to discuss them with your healthcare providers. Lactation consultants are trained to be knowledgeable about maternal medications and breastfeeding safety.
- Breastfeeding can also cause uterine contractions, which may have an effect on your bladder.
- Breastfeeding may deprive you of sleep. Pumping breast milk for bottle feedings by a family member or helper can let you sleep more.
Revised Monday, March 25th, 2019