How soon can one get pregnant after a miscarriage?

Dr Flo,

I had a miscarriage about nine months ago and I have been trying to get pregnant again for the past three months without success. Is it possible that what caused the miscarriage is making it hard for me to conceive?

Dear reader,

It is possible to conceive from six weeks after losing a pregnancy, and losing one pregnancy should not prevent you from getting pregnant again. However, just like in other circumstances, getting pregnant may not happen immediately you start trying. It only becomes a medical concern if there is no conception after one year of trying to conceive.

If there were no complications after the miscarriage like prolonged bleeding, pain or abnormal discharge, and if your periods resumed normally, then it is likely that you recovered well. However, it is advisable for you to be reviewed by a gynaecologist, both to check your current health state and also to screen for any identifiable causes of the miscarriage that can be addressed such as some infections. It is important to note that sometimes there is no identifiable cause of the miscarriage, and as such, there may be no way to prevent a future miscarriage.

In addition to the physical evaluation, it is also important to address any psychological issues that you may be dealing with like fear, guilt, internal or social pressure, or trying to replace the baby you have lost. It may be helpful to speak with a mental health professional or with a support group of others who have gone through a similar experience.

Dear Doc,

What is a urinary tract infection? What causes it? Would you recommend taking a lot of fluids or water so that the kidneys do not get unduly infected? Also, if one urinates copiously and often, is it cause for concern?

Alnashir D Walji

Dear Alnashir,

Thank you for the two issues raised.

On the first concern, urinary tract infection is an infection affecting any part of the urinary tract, either the kidneys, the urethras, the bladder or the ureters. The infection may be from micro-organisms spreading up the urinary tract from the external perineal area. This happens more frequently in females because the urethra is shorter than their male counterparts. The infection may also spread through the blood stream from an infection in another part of the body. The infection may also spread into the urinary tract from other organs around it, especially the reproductive organs.

There’s a higher risk of getting a urinary tract infection if you are female; or if you have low immunity; older age; if you have had procedures or instrumentation into the urinary tract, including use of catheters; if there’s a structural abnormality or blockage such as due to an enlarged prostrate or a kidney stone; if you have some chronic illnesses like diabetes, stroke, multiple sclerosis or spinal cord injuries; hormonal changes; or due to some genetic factors. Other factors that increase the risk of developing a urinary tract infection are infrequent and incomplete bladder emptying; hygiene concerns and sexual intercourse.

Symptoms of a urinary tract infection may include pain when passing urine, blood in urine, increased urgency and frequency of passing urine, incontinence, lower abdominal and/or flank pain, fever and chills, nausea and vomiting.

Urinary tract infections are diagnosed from the symptoms, physical examination findings and tests, which may include urine analysis and culture, blood tests, and scans, as necessary. Treatment is with antibiotics. If not treated in time or incompletely, urinary tract infections can spread to other parts of the urinary system and body, and can lead to structural damage within the urinary system. Urinary tract infections may also be recurrent, especially for those at high risk.

Regarding taking a lot of fluids to avoid infection, urinating frequently and completely is actually protective against urinary infections, and therefore adequate hydration is beneficial.

In regards to the second concern on frequent urination, this may be a concern. Normally, an adult will make between 800ml and two litres of urine a day, and urinate about seven to eight times a day, assuming fluid intake of between 1.5 litres and two litres. Frequent urination is having to urinate more than eight times a day or waking up two or more times a night to pass urine. Frequent urination may occur normally because of increased fluid intake, or taking a lot of fluid close to bedtime, due to pregnancy, or as a result of taking alcohol or caffeine. Constipation may also trigger or worsen the symptoms.

Frequent urination may also be due to a health concern such as due to a urinary tract infection, diabetes (either diabetes mellitus or insipidus), prostate enlargement, inflammation of the prostate, problems within the bladder (such as infection, inflammation, bladder stones, bladder cancer or overactive bladder), urinary incontinence (loss of bladder control), nerve problems, high calcium levels in blood, vaginal inflammation or infection, pelvic organ prolapse or ovarian cancer. Frequent urination may also be the intended or side effect of some medications and it may also develop following radiation treatment of the pelvis.

The underlying cause of the frequent and copious urination should be identified so that it can be managed appropriately. In addition to the symptoms and the findings on physical examinations, a number of tests may be carried out to determine the exact diagnosis, and the treatment will depend on this.

In addition, some lifestyle measures to manage this would include fluid management, especially to avoid drinking a lot of fluids before bedtime; avoiding alcohol and caffeine intake, which increase the frequency of passing urine; diet management to avoid constipation; and Kegel’s exercises and bladder retraining for better bladder muscle control, to assist the bladder to hold urine for longer. There are also medications and other treatment procedures to improve bladder control.

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