This is an automatically translated article.
The article was professionally consulted with Specialist Doctor Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.
Postpartum urinary retention is defined as the inability of a woman to empty her bladder while it is full of urine, seen in the case of vaginal delivery, assisted delivery, or cesarean section, also known as urinary retention. urinary tract after cesarean section. This is a dangerous medical condition, so it should be treated and treated immediately, to avoid causing unwanted complications.
1. Postpartum urinary retention
Postpartum urinary retention is a condition in which urinary tract disorders occur, causing the patient to feel the urge to urinate but cannot do so. Postpartum urinary retention usually occurs at about 6 hours postpartum, the patient presents with lower abdominal pain and may have bladder bridge sign on clinical examination.
In clinical practice, postpartum urinary retention is divided into 3 main types as follows:
Postpartum symptomatic urinary retention: The patient is unable to urinate after birth for about 6 hours, or after it is removed. If the catheter leaves the body, the patient is still unable to urinate. Postpartum urinary retention without symptoms: The symptoms of urinary retention in the patient were not obvious and when ultrasound showed a residual urine volume greater than 150ml. This is the most common case of postpartum urinary retention in clinical practice, accounting for 70% of cases. Prolonged postpartum urinary retention: The patient is unable to urinate for a long time, requiring urinary catheters for many days, but this condition is rare, accounting for the lowest rate among postpartum urinary retention types. . According to some studies, there are many causes of urinary retention after birth, the most common of which are the following problems:
During labor, the fetal position is downward, causing the first part of the fetus to fall. Pressure on the mother's bladder neck or urethra leads to urine stagnation at these sites, resulting in bladder distension and loss of tone, and finally bladder neck muscle spasm causing the patient to urinary retention. The perineum of a pregnant woman after giving birth is torn and needs to be stitched, then the suture site may be swollen and cause pain for women, making them feel like they don't dare to push when urinating. postpartum urinary retention.
In addition, after giving birth, the bladder loses its sensitivity to stimulation caused by full urine, so postpartum urinary retention will also occur in this case. Some postpartum patients need to insert urinary catheter many times, causing bladder infection which is also one of the causes of postpartum urinary retention. Injury to the pelvic nerve during childbirth. The risk factors that are favorable conditions leading to urinary retention after birth are:
First child birth, also known as having a second child The patient is given an epidural or spinal anaesthesia Labor process and pregnancy in women lasts longer than the physiology of normal labor. The patient gives birth in a state that requires the support of a number of devices such as suction cups and Forceps. When giving birth, the patient's perineum is torn or the patient's vulva is swollen and edematous. The patient has a history of urinary tract infection or some previous urinary tract disease. During labor, the bladder is overstretched. Patients with cesarean section also lead to urinary retention after cesarean section. Babies born weighing more than 4000g
2. Urinary retention after cesarean section
In addition to normal postpartum urinary retention, urinary retention after cesarean section can also occur due to a number of factors as follows:
The patient undergoes anesthesia and anesthesia: Bupivacaine and Fentanyl spinal anesthesia techniques Opioid is a drug of the Opioid group that is thought to have the ability to cause urinary retention after childbirth with a rate of about 10% - 15%. Therefore, it is necessary to monitor the patient's urinary retention until the drug wears off and is no longer in the patient's body.
Anxiety after cesarean section also leads to urinary retention. Some procedures performed during cesarean section are too violent to injure the bladder, which can cause bladder contusion and paralysis, causing the patient to lose the ability to urinate normally. In particular, it can be mentioned that the failure to fix the Foley urinary catheter to the patient's thigh during caesarean section causes the urine bag to be full, which will stretch the tube and cause the bladder neck to be compressed leading to edema. bladder neck causing urinary retention after cesarean section. Or it may be that the catheter is not properly removed, not performed deflation in the balloon and pulled the balloon without deflation, which also leads to urinary retention for patients performing cesarean section.
3. Is urinary retention after birth dangerous?
Postpartum urinary retention, if not detected, handled properly and quickly, will greatly affect the mental health of the postpartum mother. In addition, postpartum urinary retention also interferes with some daily activities of the patient, affects the recovery of health after birth as well as problems related to the newborn such as lactation for the baby, taking care of the baby. Taking care of a newborn baby will also face many limitations. Therefore, it is necessary to treat postpartum urinary retention as soon as possible to avoid unwanted complications as follows:
Bladder paralysis Bladder rupture Urinary tract infection Ureteral reflux Renal hydronephrosis Acute renal failure or failure Chronic kidney failure Urinary incontinence
4. Diagnosis of urinary retention after birth
To diagnose postpartum urinary retention, the pregnant woman needs to have some clinical and subclinical symptoms as follows:
Clinical:
Lower abdominal pain Urgency, small amount of urine, and infrequent urination Unable to urinate after at birth for at least 6 hours Unable to urinate after removing the urinary catheter for urinary retention after cesarean section The patient feels that after urinating, there is still urine in the bladder that has not been completely empty. A bladder bridge sign may be present on physical examination. Uterine fundus is high and deviated from normal position Subclinical:
Ultrasound shows bladder with residual urine volume greater than 150ml
5. How to cure urinary retention after cesarean section
Principles of treatment of urinary retention after cesarean section include 4 main principles as follows:
Practice urinating to help increase the reflex to urinate Using antibiotics to prevent infection due to urine retention in the bladder Use anti-inflammatory drugs to prevent swelling in the bladder neck being compressed Use measures to increase bladder tone so that the bladder can contract back to normal. How to cure urinary retention after cesarean section includes several main methods as follows:
Support to practice non-invasive urination habits:
Exercise the patient to move, squat Drink lots of water, the amount is about 2.5L - 3L in 1 day. Flush the vulva area with warm water and practice urinating while the faucet is running Warm the lower abdomen When urinating, you can press on the bottom of the bladder Apply cold compresses to the perineal area if the perineum is swollen masonry.
Invasive method:
Insert a urinary catheter for the patient after 6 hours of birth and do not let the bladder bridge be overstretched, it is necessary to pay attention to aseptic procedures when inserting a urinary catheter for the patient, the urinary catheter must have suitable size so as not to cause any damage to the urethra and bladder neck. Insert a urinary catheter and remove the clamp every 3 hours to restore bladder reflexes. Some supportive drugs:
Oral pain relievers or pain relievers put into the patient's anus. Anti-inflammatory drugs to combat swelling such as Alphachymotrypsin Antibiotics to prevent infection. Drugs to help increase bladder tone such as Prostigmin or Xatral Some other methods:
Acupuncture Tests, urine cultures, perform antibiotics if the patient has prolonged urinary catheterization to promptly handle if an infection occurs. out.
6. Conclusion
Postpartum urinary retention, especially urinary retention after cesarean section, is a very common condition for women about 6 hours after giving birth, affecting the ability to urinate as well as mental and postpartum recovery. of pregnant women. Therefore, it is necessary to detect and treat urinary retention early for women after giving birth, to avoid unwanted complications and to help patients recover their health after giving birth as soon as possible.
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