How long does postpartum urinary retention last?

Micturition (passing urine) can be distressing and difficult for many new mothers after giving birth. This issue can often develop into postpartum urinary retention, a relatively common condition where women are unable to empty their bladders fully following childbirth. Understanding this condition is important for expectant mothers and mothers recently giving birth. Here, we will look at the meaning of postpartum and postpartum urinary retention, its causes, risk factors, and how long it lasts.

The meaning of postpartum

The time following the birth of a baby is known as postpartum and can last 6-8 weeks. During this time the well-being and care of the mother and baby is essential.

What is postpartum urinary retention?

Postpartum urinary retention, also known as voiding dysfunction, occurs when a woman is unable to empty her bladder after giving birth. This is seen as a sudden inability to urinate or the need to urinate in small amounts more often. Postpartum urinary retention is defined as the presence of a postvoid residual bladder volume of 150 milliliters or more, or the inability to void within six hours after vaginal delivery.

Causes of postpartum urinary retention

The causes of postpartum urinary retention vary and include a combination of physiological, neurological, and mechanical processes. Some of the main factors that contribute to this condition include:

Pain and swelling

Discomfort and swelling in the vulva, perineum, and birth canal can interfere with the normal functioning of the bladder and make it difficult to empty.

Nerve damage

The pelvic nerves, which control bladder function, can be temporarily or permanently damaged during childbirth, particularly in cases of prolonged labor, instrumental deliveries (such as forceps or vacuum-assisted births), or extensive perineal tears.

Muscle weakness

Pelvic floor muscles, which support the bladder, can weaken during pregnancy and even further by the physical stress of childbirth. This can lead to a loss of bladder tone and damage the ability to empty the bladder.

Anesthesia effects

Pain relief such as epidural or spinal anesthesia used during labor and delivery can temporarily numb the sensation in the lower body, making it difficult for a woman to recognize the need to urinate.

Constipation

Straining during bowel movements can make pelvic floor muscle weakness worse and contribute to urinary retention.

Risk factors for postpartum urinary retention

Certain factors can increase the likelihood of developing postpartum urinary retention, including:

• First-time mothers
• Prolonged second stage of labor
• Instrumental deliveries
• Presence of episiotomy (muscle tearing) or perineal lacerations
• Large newborn
• Use of spinal or epidural analgesia
• History of previous urinary retention or bladder dysfunction

Understanding these risk factors can help healthcare providers closely monitor women who are more likely to develop postpartum urinary retention.

Symptoms of postpartum urinary retention

The primary symptom of postpartum urinary retention is the inability to empty the bladder fully. This can appear in various ways, including:

• Sudden inability to urinate
• Frequent urination in small amounts
• The feeling of a full bladder
• Discomfort in the lower abdomen
• Leakage of urine

Some women may experience no symptoms at all, a condition known as “covert retention” or asymptomatic urinary retention. This underscores the importance of healthcare providers monitoring bladder function postpartum.

Diagnosis and assessment

Postpartum urinary retention is diagnosed through patient history, physical examination, and bladder assessment, using the following methods:

Residual urine volume measurement

Immediately after the first time a new mother urinates (postpartum urination) a healthcare provider will measure the volume of urine remaining in the bladder. A residual volume of 150 milliliters or more indicates urinary retention.

Catheterization

A healthcare provider may insert a small, sterile tube (catheter) into the urethra of a woman who is unable to urinate or is experiencing significant discomfort to drain the bladder.

Bladder scanning

A bladder scan, performed by placing a handheld ultrasound device on the lower abdomen, can also be used to estimate the volume of urine in the bladder.

Treatment

The primary goal of treating postpartum urinary retention is to restore normal bladder function and prevent long-term complications. Treatment will depend on the severity of the condition and the individual’s response to treatment.

Watchful waiting

Healthcare providers may recommend a “wait-and-see” approach, particularly if the woman can urinate within six hours of delivery and the post void residual volume is less than 150 milliliters. This allows the bladder to “rest” and regain its normal function with the support of pain management and hydration.

Intermittent catheterization

If a woman is unable to urinate or has a significant residual volume, healthcare providers may recommend intermittent catheterization (the insertion of a catheter into the bladder to drain urine at regular intervals), typically every four to six hours. This approach helps to “rest” the bladder, allowing it to regain its normal function over time.

Indwelling catheterization

In more severe or persistent cases of postpartum urinary retention, healthcare providers may use an indwelling catheter, which remains in the bladder for an extended period, typically 24 to 48 hours, to allow the bladder to recover.

Pelvic floor rehabilitation

Postpartum pelvic floor exercises can help strengthen muscles that support the bladder and improve bladder function. Healthcare providers may recommend a structured pelvic floor rehabilitation program to aid recovery.

How long does it last?

The duration of postpartum urinary retention can vary from woman to woman, depending on the underlying causes and the effectiveness of the chosen treatment approach.  However, research has shown that women diagnosed with postpartum urinary retention usually resolve symptoms in 2 to 6 days .

Typical timeline

In most cases, postpartum urinary retention resolves within the first few days or weeks after childbirth. Research suggests that around 1 in 500 women may experience a problem with bladder emptying that lasts longer than three days.

Factors affecting duration

Certain factors can influence the duration of postpartum urinary retention, including the severity of the condition, risk factors, and the response to initial treatment. Women who undergo more complex deliveries, may require a longer recovery period.

Recurrence in subsequent pregnancies

Postpartum urinary retention in one pregnancy does not necessarily indicate a higher risk in further pregnancies. However, women must inform their healthcare providers about any previous episodes of postpartum urinary retention, as this can guide the monitoring and management of their bladder function during future pregnancies.

Prevention

The risk and severity of postpartum urinary retention can be reduced by:

Antenatal bladder care exercises

Pelvic floor exercises can help strengthen the muscles that support the bladder and improve overall pelvic floor function.

Intrapartum strategies

Healthcare providers may limit the duration of the second stage of labor, avoid unnecessary instrumentation, and carefully manage pain relief, to minimize the risk of pelvic floor and nerve damage.

Postpartum monitoring

Monitoring of bladder function in the immediate postpartum period and prompt intervention, if urinary retention is suspected, can help prevent the development of more severe or prolonged cases.

Long-term consequences

Postpartum urinary retention is mostly a temporary condition that improves with treatment and management. However, in some instances, the condition may have long-term implications on a postpartum bladder if not treated or if the underlying causes are not effectively addressed.

Potential complications

Untreated or persistent postpartum urinary retention can lead to complications such as urinary tract infections, bladder damage of the detrusor muscle, and the development of chronic urinary incontinence. These issues can have a significant impact on a woman’s quality of life and overall well-being.

Follow-up and ongoing care

Women who have experienced postpartum urinary retention should be closely followed by their healthcare providers, with regular monitoring of bladder function and pelvic floor rehabilitation. Referral to the Department of Obstetrics and Gynecology or continence specialist may be recommended for specialized care and management.

Support

Dealing with postpartum urinary retention can be a challenging and emotional experience for new mothers. Women need to understand that they are not alone and that there are resources and support available to help them navigate this condition.

Emotional support

Reaching out to support groups, or online communities can provide valuable emotional support and help women feel less isolated during the recovery process.

Practical strategies

Relaxation techniques, staying hydrated, and practicing pelvic floor exercises can all help with the management of postpartum urinary retention and the overall postpartum recovery experience.

Conclusion

Postpartum urinary retention is a relatively common, yet underdiagnosed condition that can impact a woman’s postpartum recovery. Understanding the causes, risk factors, and typical duration of this condition, can help healthcare providers and women work together to ensure a smoother transition into the postpartum period.

Sources

• Bladder Problems After Giving Birth – Bladder & Bowel Community
• Postpartum urinary retention after vaginal delivery: Assessment of risk factors in a case-control study – PMC
• Urinary retention following childbirth – CUH