Postpartum Bladder Urinary Retention: Pregnancy’s Effects on Bladder
Although pregnancy can be a magical experience, it can also cause stress on your bladder, sometimes leaving long-lasting effects. This article helps you learn more about the causes, symptoms, risk factors, and treatments for postpartum urinary retention.
What happens to your bladder during pregnancy and childbirth?
Starting with early pregnancy, the bladder undergoes a series of changes due to hormonal, neurological, and mechanical stress. The frequency of urination begins to increase in the first trimester and keeps on increasing as the baby grows and presses on the bladder.
The bladder rests on the lower uterine wall and is loosely connected to the uterus via a membrane. As the uterus grows, the bladder is stretched but its capacity is not increased—this makes the bladder more irritable, creating the feeling of urgency.
Urgency and urinary incontinence are common during pregnancy, often causing dribbling and can persist after childbirth depending on the degree of pelvic floor trauma.
If you are experiencing incontinence, try doing pelvic floor exercises to strengthen your muscles that help you hold it in. You can also regularly wear pads to avoid leakage.
Postpartum Urinary Retention
For many women, conditions of incontinence and urgency persist after childbirth, but for others, they develope the opposite condition—postpartum urinary retention (PPUR).
Postpartum urinary retention is defined as the absence of spontaneous micturition (the action of urinating) more than six hours after birth or when residual urine volume after urination is more than 150 cc. If neglected, postpartum urinary retention may result in damage to the nerves and muscle of the bladder, leading to permanent bladder voiding dysfunction.
To treat urinary retention, doctors often prescribe intermittent catheters, which are thin tubes that are inserted into the bladder through the urethra to drain urine out.
How common is postpartum urinary retention (PPUR)?
According to one study, out of the 234 women recruited for the research, 8.1 percent of women developed urinary retention postpartum. Out of the 8.1 percent, 7.7 percent of women exhibited symptoms of PPUR, while 0.4 percent did not.
Risk factors for postpartum urinary retention (PPUR)
- The lack of bladder catheterization during labor
- Prolonged second and third stage of delivery
- Episiotomy (a surgical cut made to the vagina during labor)
- Epidural analgesia (having regional epidural administered during labor)
- Perineal tear and sphincter rupture
Causes of postpartum urinary retention
The causes of postpartum urinary retention are still unclear. Some physiologic, neurologic, and mechanical causes that may be responsible are:
- An increase in progesterone level, which inhibits the bladder muscle and leads to urinary retention.
- Vaginal delivery that is traumatic for the pelvic floor muscles and their nerves, resulting in floppy tone or reduced bladder sensitivity.
- Edema of tissues surrounding the urethra and the vulva as the result of vaginal delivery, which leads to obstruction of the urethra and thus leads to urinary retention.
- Holding back while urinating because it is painful to urinate
Symptoms of postpartum urinary retention
- Pain over the bladder
- Difficulty starting stream and weak stream
- lack of urge to urinate
- frequent urination and nocturia (waking up at night to urinate more than twice)
- involuntary dribbling
Other times, postpartum urinary retention has no symptoms and is considered ‘covert’ and may not be picked up. One episode of retention increases the chance of another one so early diagnosis and intervention are crucial to prevent long term consequences.
Diagnosis of postpartum urinary retention
If the person is unable to void (urinate) within six hours of delivery, she will be diagnosed for PPUR in one of two ways:
- After the patient has voided once, a catheter is used to draw out retained urine in the bladder/ The volume of urine is measured and any amount over 150ml is indicative of postpartum urinary retention.
- The volume of retained urine can also be detected by an ultrasound
Postpartum urinary retention complications
If neglected, urinary retention may result in
- The loss of bladder nerves
- Detrusor muscle (bladder muscle) weakness and failure
- Lack of urination
- Infections—UTI, bladder infection, and kidney infection
- Hydronephrosis (fluid accumulating around the kidney)
- kidney failure caused by renal obstruction.
In some cases, bladder infections can present as urinary retention but that is rare. It is more likely that the retention itself leads to a bladder infection.
Treatments for postpartum urinary retention
- Home remedies: timed voiding—urinating on a set schedule, and double voiding—voiding once, then voiding again in 10-15 to ensure complete drainage.
- Prescribed drugs. If you are breastfeeding, you would need to discuss the effects of the drugs in detail with your doctor.
- Catheter: your doctor may prescribe you with an intermittent catheter to help you drain completely every time you go.
If you have a prescription for an intermittent catheter, here is a comprehensive guide on how to choose the best catheter that is useful for both beginners and seasoned users. The guide helps you make important considerations such as catheter discretion, portability, infection risks, size, and tip.
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