1+1=3! Part 6 – Woes During Second Trimester Part 1

All my mummy friends, as well as those online articles, all state that the second trimester is the “honeymoon period” during the whole of pregnancy. They alleged this is because mummies-to-be have passed the first trimester of worrying about miscarriage, being extremely tired and having bouts of morning sickness, and they have yet to experience third trimester’s symptoms: backaches, leg swelling and having to carry a huge ball in front of them 24/7. However, for myself, as I have had a relatively easy first trimester, second trimester was and still is a torture for me.

Acute Retention of Urine (ARU) secondary to Retroverted Uterus

Immediately at the start of my second trimester, I realised that I needed more time to try and pee whenever I wake up in the middle of the night. Sometimes, I would sit on the toilet bowl for minutes just trying to pee. I also had to resort to walking about for a few minutes first before I could pee. I googled and learnt that this might be due to my retroverted uterus; this means that instead of tilting forward towards the bladder (anteverted uterus, which majority of the women have), my uterus is tilted towards the back of my body. I first learnt that I had a retroverted uterus when I thought I had a miscarriage in Mar 2018. It was during my follow-up checks that the polyclinic doctor told me that I had a retroverted uterus. However, he assured me that there was nothing to be worried about as this does not cause any issues generally, not even problems with fertility.

When I saw my gynae at my next check-up, I told her about my issue of having difficulty in peeing at night. She explained that it was indeed likely due to my retroverted uterus. When my baby was small in my first trimester, there was no issue because baby was still light. As I progressed to second trimester, baby’s weight was more significant now that he/she was pressing downwards, causing my bladder neck opening to close. The fact that I was lying down to sleep at night (obviously) further aided baby in pressing down and closing my bladder neck. She further told me that this problem would likely continue during my pregnancy until my baby had no more space to grow backwards towards my spine and my body naturally tilt my uterus forward (in the “normal” position) for my baby to continue his/her growth. I read online that this also meant that ladies with a retroverted uterus would usually have a smaller belly in the initial period as their baby would be growing inwards towards their back. There was nothing I could do to resolve my urinary issue but to patiently wait for my baby to become bigger. She then advised me to visit the Emergency Department (ED) if I ever cannot pee on my own as Acute Retention of Urine (ARU) is a medical emergency. When that happened, they would have to put in a urinary catheter to drain my urine out for me. Here is an article which talks about this issue: Recurrence of urinary retention secondary to retroverted gravid uterus. I read that once this occurred for the first pregnancy, there was a higher chance that the same thing would occur again during subsequent pregnancies. Sigh.

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Upon hearing this, I had contemplated buying the requisites for doing clean intermittent catheterisation (CIC) myself in case the day where I cannot pee arrive. On the other hand, I did not really want to believe that this could happen to me. After all, though I developed difficulty in peeing at night, I always manage to pee eventually. I just took longer than usual and had to try various ways like restricting my fluid intake after 9pm each night as advised by the gynae, sleep sitting up, standing and pacing up and down for a few minutes before peeing or squatting to pee. Hence, I procrastinated buying the necessary requisites needed to perform a self-CIC. I thought that that day where I could not pee would not come if I continued with my various ways of trying to cope with the problem. However, sleeping in a sitting position was very uncomfortable and I always did not feel well-rested despite sleeping at 10pm. So sometimes, I would take a chance and just “heck care” by lying down to sleep. I would always regret this eventually though, because I would have great difficulty trying to pee when I wake up in the middle of the night. One day, my luck totally ran out. I had done whatever I usually did (as above) to try to pee. However, no amount of pacing, squatting, whistling etc could make me pee. After trying to pee for an hour (and desperately googling for solutions at 3+am in the middle of the night and even calling the KKH 24hr emergency hotline), I gave up. I woke Sunshine and told him I needed to go to the ED nearest my home (though I contemplated going to KKH, I really could not wait and I also knew that the draining of urine could be done in any ED).

Part 6a Retroverted Uterus
Disclaimer: This is my own interpretation of my situation. The pink represents the uterus while the blue is the bladder. My uterus is tilted backwards as per arrow 1. This causes the base of the uterus to press on the bladder (see arrow 2), which in turn causes the bladder neck to shift and close the opening as per arrow 3, preventing urine from flowing out as per arrow 4.

In the ED, I explained my situation and a random ultrasonic bladder scan shown that I had about 800mls of urine in my bladder. The doctor offered an indwelling catheterisation (IDC, where the catheter would be kept inside me until my problem was resolved by who knows when) but was happy to order an in-out (i.e. a catheter would be inserted to drain the urine and then promptly removed after all urine had been drained) when I counter-offered. After all my urine had been drained, I was kept for observation while they ran tests to determine if I had a urinary tract infection (UTI, which may also cause acute retention of urine). Coincidentally, the patient who came in after me also had an ARU. He also knew his problem and explained that it was caused by his enlarged prostate so they promptly inserted an IDC to relieve him of his discomfort. During the waiting period, I was able to pee again as I had not been lying down. I thought the insertion of a tube into my urethra was painful enough. Little did I know that I would experience pain especially upon initiation of urine for the rest of the day after the catheter had been removed. The pain caused by the pressure to push the urine out every single time I peed for the rest of the day was so painful! Sunshine and I left the ED at almost 6am and we were both zombie-like at work that same morning. After this incident, I told myself I really should buy the necessary requisites to perform CIC on my own and save all the time, trouble and money going to an ED when the same thing happened again. However, I procrastinated again and two days later, I ended up in the ED again after failing to pee for 45min. This time round, I had about 700mls of urine in my bladder and another on-call Dr offered IDC for me again. As I was perfectly able to pee in the day or even at night when I sleep sitting up, I refused to have an IDC as this not only caused discomfort, it would also increase the risk of a UTI, which would supposedly increase risk of miscarriage. The doctor wrote a memo to refer me to a Urogynaecologist at KKH and told me that I could learn self-CIC in the meantime.

Having been bitten twice and wasting hundreds of dollars, I bought the necessary requisites for CIC on the very same day after work. The first time I did CIC on myself, I had lots of difficulty trying to balance a small mirror on my ankles and I could not find my urethra. I tried not to disturb Sunshine as I did not want both of us to be tired out when I myself could resolve my own issue but he would always be woken up. Being very frustrated about the whole situation and feeling uncomfortable and sorry for myself, I became very impatient that I poked the catheter everywhere including at my clitoris and even wrongly into my vagina very roughly. I finally found my urethra after struggling for a period of time. This time round, having only trying to pee for about 30min, I drained about 600mls of urine from myself. In the end, I suffered again due to my own roughness – I had bleeding “down there” for the whole day whenever I wiped after peeing. The first time I saw the blood, I panicked as I thought my baby was in danger. Thankfully, I was not bleeding from my vagina, but from my clitoris and was in pain the whole day. Sigh. Hence, the second time I had to do CIC for myself, I was much gentler. I could also find my urethra at my first attempt and relieved myself faster: 500mls after failing to pee for 30min. However, what first drained out shocked me: milky white discharge, which made me doubt for a second whether I had wrongly inserted the catheter into my vaginal again. As clear urine soon followed, I had no doubt that I had inserted correctly into my urethra but I became worried that I might have an UTI as milky, cloudy urine is one of the signs and symptoms of UTI. Thankfully, the urine test I did at my next check-up showed that I had no UTI.

Part 6a Requisites for CIC
Requisites for CIC

I am not one to keep things from my parents since I was young and I kept them updated about my urinary problem right from the start. When they randomly checked in on me one day, I felt so overwhelmed that I just broke down and cried. Initially, I was frustrated at having this issue and my papa told me not to be as my baby would then inherit my “pek chek-ness” but on that day, I was beyond feeling frustrated already. I felt that it was unfair that I had to choose between lying down to sleep and then resulting in myself having to do a CIC or sleep sitting up and not feel well-rested. I was very emotional that I had to undergo this when everyone else did not, but kept telling me second trimester would be the best and just commenting that my belly was smaller than usual etc. In addition to feeling guilty for disrupting Sunshine’s sleep, I would also feel guilty for being sad as I was afraid that this would negatively affect my baby, and then I would feel sad and cry more. It was a vicious cycle and I cried multiple times about this issue especially to Sunshine. The entire ordeal from when I first told my gynae about my difficulty in peeing to when I could finally sleep lying down and still being able to pee when I wake up, lasted about a month till I reached week 16. I was elated when I “cheated” by lying down to sleep and realised that I had no problems with peeing when I woke up in the middle of the night! Yay! Xiao Bu Dian had finally grown bigger/heavier enough to tilt my uterus forward and not press on my bladder neck opening! 😀

Click here for Part 5.
Click here for Part 7.

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