Urinary retention following childbirth

This leaflet has been written to help you to understand what urinary retention in the postnatal period is, how to prevent it, what causes it and what treatment is offered to recover from this.

Introduction

If you are unable to fully empty your bladder when it is full you are experiencing postnatal urinary retention (also known as voiding dysfunction). This is a common problem in the first day or two following childbirth. About 1 in 500 women may have a problem with bladder emptying which lasts longer than 3 days.

After birth, or after a catheter has been removed, you should feel a normal urge to pass urine within 4 hours. Your midwife will ask you to catch all of your urine the first time that you go to the toilet after birth or after the removal of a catheter. This is so that we can measure how much urine you pass and ask you some questions about how it felt in order to make sure your bladder is working normally again.

If you are unable to pass urine by 4 hours, have no sensation or pass a small amount (less than 250mls), your midwife will check that you are well-hydrated and have good pain relief. If you are still unable to pass a good volume of urine with normal sensation by 6 hours, you may have postnatal urinary retention. This is confirmed by scanning your bladder, or inserting a catheter, to see how much urine remains in your bladder. If there is excess urine in your bladder then you have postnatal urinary retention and if left untreated this can cause pain, long-term bladder damage and urinary incontinence (when you have no control over passing urine). Your midwife or doctor will recommend that a urinary catheter is inserted for 24 hours to “rest” your bladder. We will explain how this is done below.

What can cause urinary retention?

• Pain in the vulva and perineum (the area between your back passage / anus and birth canal / vagina).
• Swelling in and around the vagina / birth canal.
• An epidural or spinal anaesthetic can alter the sensation in your lower body.
• Loss of bladder tone and / or injury to the pelvic nerves during childbirth.

You are more likely to have problems if:

• This is your first baby
• You had an epidural or spinal analgesia
• You had a prolonged labour
• You had an instrumental delivery (forceps or ventouse)
• You had a tear or stitches
• You have a urine infection
• You are constipated
• You have had problems previously

What can I do to help me try to pass urine?

• Take pain relief.
• Get up and walk about – movement really helps to reduce swelling.
• Take measures to feel more relaxed – ask your birth partner, family, friend or a member of staff to watch your baby for you, go to a bathroom in the corridor rather than the bay if that feels more private, when on the toilet make sure you have your feet on the ground and avoid hovering above the seat as this will make it difficult to relax the muscles needed to pass urine.
• Take a warm shower – this will also help you to relax.
• Let your midwife know if you are feeling constipated as this can cause urinary retention too and can be easily treated; please don’t feel embarrassed by telling us this.

What is a catheter?

This is a thin, sterile tube, which is usually made of plastic. The catheter is passed into your waterpipe (urethra) then up into your bladder. This allows the urine to drain out. A small balloon is filled with water at the end of the tube and inside your bladder to make sure it doesn’t slip out.

Your midwife or doctor will ask for your consent (permission) to put a catheter in your bladder. If you decide you do not want this, then you will be encouraged to try to pass urine again yourself. However, you could be in pain and at risk of damaging your bladder permanently if you still cannot pass urine.

Having a catheter inserted can be uncomfortable but it is a quick and safe procedure. A small amount of local anaesthetic antiseptic gel is used to ease insertion. You will hopefully feel much more comfortable once your bladder is emptied. The catheter is usually left in place for at least 24 hours to let the bladder “rest”. A drainage bag will be attached to the catheter to collect the urine, it has a hook so that you can keep it below the bladder and off the floor to help it drain and prevent contamination. Staff will empty this for you.

You can still have showers with a catheter. It is important to keep the perineum (the area between the vagina / birth canal and anus / back passage) clean, especially after going for a poo (opening your bowels). Try to drink plenty of water or diluted juice; about 1 to 2 litres a day or 3 litres if breastfeeding. It is important that you also keep a record of how much you are drinking while the catheter is in place. This is easy to do: you will be given a fluid chart and shown how to write down what you drink and how much urine you pass.

What happens when the catheter is removed?

This procedure is commonly called a “TWOC” – trial without catheter. You will be asked for permission to take your catheter out. A midwife or maternity assistant will remove it. This is a quick procedure and you may experience brief discomfort, but it shouldn’t be painful.

It is important that when the catheter is removed we still monitor what you drink, so keep recording this on your fluid chart. You should drink when thirsty, rather than trying to drink more than usual. It is also important that we measure how much urine you pass the first time that you go to the toilet. You should wait until you have a normal urge to pass urine. Your midwife or maternity assistant will provide you with a bed pan to catch your urine – please let them know as soon as you have done this, as we will then offer a bedside bladder scan to check that your bladder has fully emptied. This scan is done over your lower tummy while you lie on your bed and is quick and painless.

What happens if I cannot pass urine after the catheter is removed or I do not pass enough urine?

If you are unable to pass urine by 4 hours, are leaking urine uncontrollably or only pass a small amount, the midwife will make an individualised plan with you. This might include waiting a further 2 hours and ensuring you have adequate pain relief in the meantime. The midwife may also do a bedside bladder scan or pass an “in and out” catheter to see how much urine is still in the bladder. If you still have urinary retention, it will be advised that a new catheter is inserted for a period of at least 7 days. This does not prevent you from going home. You will be provided with equipment for managing your catheter at home and shown how to drain it.

A weekday outpatient appointment will be arranged for you in Clinic 22 for a repeat “TWOC”. You can bring your baby to this appointment as it can sometimes mean you need to wait at least 4-8 hours, so please make sure you bring a pram / pushchair and provisions for you and your baby. We can provide a private space so that you can feed your baby. If you need hot water or any assistance, please ask a member of staff. Please discuss any additional needs or concerns with the midwives on the postnatal ward and clinic 22 before or during your appointment. You are free to leave the clinic during your appointment if you wish to.

In most cases urinary retention is a temporary problem but sometimes requires a few weeks to resolve. If you have any ongoing issues passing urine we may teach you how to perform self catheterisation (Clean Intermittent Self Catheterisation) as an interim measure until the issues resolve. The midwives and maternity assistants in Clinic 22 and the specialist urogynae nurses, will provide support and advice during this time and will arrange any follow-up you may need.

Going home with a catheter

Personal hygiene

Wash the area where your catheter enters your body as part of your daily hygiene regime. Avoid applying creams, antiseptics or talcum powder around this area. Bathing or showering with a catheter in place will not cause any harm. If you get any discharge from the catheter entry point to your body, clean this area more often and contact maternity assessment (Clinic 23) on 01223 217217 if the discharge persists or smells. If you feel unwell (flu-like symptoms, fever or shivers) or if you notice fresh red blood in your urine, then you also need to contact us on 01223 217217.

What should I drink and how much?

You should drink at least 1 - 2 litres per day (approximately 8-9 cups or 2-3 pints) and up to 3 litres if breastfeeding. Ideally drink when thirsty, rather than trying to drink more than usual, and restrict your caffeine intake as this can irritate your bladder. If the colour of your urine is a light yellow colour, then you are drinking enough. You should avoid constipation by eating fresh fruit and a diet rich in fibre.

What is a Flip-Flow catheter valve?

You may be provided with a Flip-Flow valve on your catheter bag which is a tap-like device that fits into the end of your catheter to help retrain your bladder. The Flip-Flow offers you an alternative to using urinary drainage bags during the day.

Instructions for using the Flip-Flow valve:

Days 1 and 2 – empty catheter every 3 hours to ensure your bladder does not become too full. If you get a feeling to pass urine before 3 hours you may empty the catheter earlier.

Day 3 – aim to empty the catheter every 3-4 hours or earlier if the feeling to pass urine is felt before this.

Days 4 to 7 – empty the catheter only when you have the feeling to pass urine. However, if you don’t have this feeling by 6 hours, you must empty the catheter.

Night-time

During the day, to help you move more easily, you can use a leg-bag under your clothes. Make sure it is well-supported with the straps provided. At night-time you will need to attach a night bag to the Flip-Flow valve, to prevent having to empty the bag overnight. Remember to open the valve. You will be given 7 night bags to take home.

What should I do if my catheter is not draining or it is leaking?

Urine leakage can be normal. This is caused by bladder spasm due to irritation of the bladder by the catheter. If your catheter appears to not be draining:

• Check the drainage bag is below the level of the bladder, particularly when sitting in a low chair
• Make sure that the tubing is not twisted or restricted by tight clothing
• Make sure that the tubing is not pulled tight or stretched as this may restrict urine flow
• Check that the drainage bag is connected correctly
• Make sure that the straps, which secure the leg bag to your leg, are positioned behind the leg bag tube
• Urine will not drain if the bag is full. Empty the bag when it is two thirds full.
• Constipation can prevent your catheter from draining
• Change your position and walk around if possible
• Urine will not be produced if you are not drinking enough, so make sure you are following the advice above

For support with your catheter while at home, you can also contact the district nurses or urinary continence team via your GP practice.

Will bladder problems happen again in another pregnancy?

This is hard to say – you may have a recurrence of problems or none at all. However, it is very important to tell the midwife at your pregnancy booking appointment and when you attend in labour that you have had bladder problems after or during your last pregnancy, so that the staff caring for you are aware of this.

It can be very common to have temporary bladder problems in pregnancy and after childbirth. We are here to help you when these occur.

Please do not feel embarrassed to discuss any problems with your midwife or doctor who can offer advice and support.

Contacts / further information

If you have any questions, please contact the midwives on the maternity assessment line: 01223 217217.

For more information and support visit the Bladder and Bowel Community website (opens in a new tab).

References / sources of evidence

Bladder and bowel Community, 2021. After a Baby. (opens in a new tab)

NHS, 2020. Urinary catheter. (opens in a new tab)