[CG] Postnatal bladder care

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Introduction and background

Postpartum voiding dysfunction is defined as failure to pass urine spontaneously within 6 hours of vaginal delivery or catheter removal after delivery. It occurs in 0.7-4% of deliveries.

The postpartum bladder has a tendency to be underactive and vulnerable to the retention of urine following trauma to the bladder, pelvic floor muscles and nerves during delivery. Operations and regional anaesthesia effect bladder function and sensation.

If postpartum voiding dysfunction is unrecognised, it can lead to bladder underactivity and prolonged voiding dysfunction, with sequelae such as recurrent urinary tract infection and incontinence.

Management

The aim is to prevent urinary retention.  A significant unrecognised retention can permanently damage the bladder.

First void

All women should void within 6 hours of delivery or removal of catheter.

The minimum times that catheters should be left in situ after delivery are as follows:

Spontaneous vaginal delivery with regional anaesthetic

12 hours

Instrumental delivery

12 hours

Caesarean section

12 hours

Obstetric Anal Sphincter Injury (OASIS)

24 hours

 

However - catheters should be removed during the normal working day. Bladder dysfunction is more likely if catheter removed overnight. Remember that the next management step after removal would be 6 hours later.

Postnatal haematuria

If frank haematuria is noted post-operatively, this should be investigated (by CT IVU) as soon as possible and discussed with the urologists. 

If the patient’s urine is blood-stained, and there are no concerns regarding intra-operative bladder injury, it is expected that the urine should clear within a few hours. In this event, it would be reasonable to remove the catheter as planned. If however the urine does not clear within 6 hours or becomes blood-stained again having cleared previously, then this should prompt further investigations (CT IVU) and urology referral.

Postnatal voiding protocol (flowchart)

All women should be asked to void within 6 hours of delivery or removal of the urinary catheter. 

References
  1. Mathew S, Horne AW, Murray LS, Tydeman G, McKinley CA. Are portable bladder scanning and real-time ultrasound accurate measures of bladder volume in postnatal women? J Obstet Gynaecol. 2007 Aug;27(6):564-7.
  2. Lukasse M, Cederkvist HR, Rosseland LA. Reliability of an automatic ultrasound system for detecting postpartum urinary retention after vaginal birth. Acta Obstet Gynecol Scand. 2007 Oct;86(10):1251-5.
  3. Van Os AF, Van der Linden PJ. Reliability of an automatic ultrasound system in the post partum period in measuring urinary retention. Acta Obstet Gynecol Scand. 2006;85(5):604-7.
  4. Yip SK, Sahota D, Chang AM. Determining the reliability of ultrasound measurements and the validity of the formulae for ultrasound estimation of postvoid residual bladder volume in postpartum Neurourol Urodyn. 2003;22(3):255-60.
  5. Barrington JW, Edwards G, Ashcroft M, Adekanmi O. Measurement of bladder volume following cesarean section using bladderscan. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):373-4.

Last reviewed: 04 December 2018

Next review: 01 December 2023

Author(s): Dr S Bollapragada

Approved By: Obstetric Guideline Group