Postpartum Bladder Dysfunction

Bladder control issues that occur following pregnancy and childbirth. Some women have issues with bladder emptying as a result of an overdistension injury of the bladder.

• First pregnancy

• Prolonged 2nd stage of labour

• Instrumental delivery – forceps/ventouse

• Caesarean birth

• Epidural anaesthesia

• Perineal trauma

• Large for gestational age baby

• Lack of or no sensation to void

• Inability to void 6 hours after birth or catheter removal

• Abdominal pain or discomfort

• Urinary urgency or frequency

• Passing small amount of urine

• Hesitancy or urinary dribbling 

• Sensation of incomplete bladder emptying 

• Urinary incontinence

All women who had given birth should be on high alert for potential bladder dysfunction due to the presence of risk factors as stated above.

 Simple measures that can be implemented to prevent bladder dysfunction:

• Aim to void every 2-3 hours during labour or the use of indwelling catheter if regional anaesthesia is offered

• Adequate analgesia use after delivery

• Use of cold packs on the perineum to reduce perineal swelling

• Laxatives use to prevent constipation

• Scheduled or timed voiding every 3 to 4 hours after birth to promote bladder emptying or over distension of the bladder

• Strict fluid balance monitoring to avoid fluid overload

• Bladder scan to be performed by nursing or midwifery staff to check for residual volume in the bladder after passing urine

Immediately after delivery:

• Insertion of indwelling catheter to allow bladder rest if unable to pass urine or with high residual volume in the bladder after void

• A trial of void (assessing your ability to empty your bladder sufficiently by measuring the urine you pass and left over urine in the bladder after each void) will take place after 24 hours.

• Indwelling catheter will be reinserted if bladder emptying remains inadequate, followed by a repeat trial of void after 1 week.

• Women with persistent bladder dysfunction will be taught to perform self-catheterisation using a short plastic catheter 

• Pelvic floor physiotherapist will be involved to provide education and advice on voiding techniques to assist with bladder emptying.

Long term management: 

Further assessment and review by urogynaecologist/pelvic floor surgeon may be warranted if bladder issues persist after 3 months of conservative management. Bladder testing (urodynamics study) may be considered if ongoing issues persist with bladder emptying or urinary incontinence

Management options:

• Conservative management with physiotherapist, double/triple voiding technique

• Intermittent self-catheterisation

• Medications – limited evidence of use in postpartum women

• Sacroneuromodulation (SNM) – insertion of a pacemaker like device in lower back to regulate your bladder function

• Percutaneous tibial nerve stimulation (PTNS) – stimulation of nerve controlling bladder function using a small acupuncture needle close to the ankle. Effective treatment for an overactive bladder or urge incontinence but limited evidence of use in voiding difficulty