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CLINICAL PRACTICE GUIDELINE

MANAGEMENT OF POST PARTUM URINARY RETENTION

Publication Date:

March 2010

Document Classification:

ACT Health Clinical Practice Guideline endorsed by WHA Physiotherapy Special Interest Group June 2009

Coordinated by:

Katie Vine (katie.vine@act.gov.au)

Available to:

Members of Women’s Hospitals Australasia

Review Date:

February 2012

1. PURPOSE AND SCOPE

The Management of Post-Partum Urinary Retention guideline will be implemented by health

professionals caring for women in the post-partum period to prevent long and short term

sequelae of post-partum urinary retention.

2. POLICY

BACKGROUND

There are two types of urinary retention that can affect women in the post-partum period.

Overt Retention

Clinically overt urinary retention refers to the inability to void spontaneously within 6 hours of

vaginal birth or removal of IDC (Carley et al., 2002; Rizvi et al., 2005; Yip et al., 2004).

Covert Retention

Covert urinary retention refers to elevated post void residual volumes of >150mL and no

symptoms of urinary retention (Carley et al., 2002; Rizvi et al., 2005).

Covert retention seems to be a self limiting condition with residual volumes returning to

normal with 4 days (Yip et al., 1997).

The causes for both types of urinary retention are theorised to be neurological damage

associated with prolonged pressure against the pelvic floor and bladder (Carley et al., 2002; Yip

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the pelvic floor and bladder (Carley et al., 2002; Yip 1 In conjunction with: ACT Health,

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ACT Health, Maternity Practice Guideline, Management of Post-Partum Urinary Retention. March 2009.

MANAGEMENT OF POST PARTUM URINARY RETENTION

et al., 1998), associated pudendal, pelvic or hypogastric nerve injury (Yip, et al, 2004), and pain

inhibited detrusor function (Boston, 2006).

“A single episode of postpartum bladder over distension, if not diagnosed and treated early, may

cause persistent urinary retention and irreversible damage to the detrusor muscle, with recurrent

urinary tract infections and permanent voiding difficulties” (Rizvi et al., 2005).

There are no studies investigating the long term consequence of post-natal urinary retention.

Procedure

All women will be screened within four hours post-partum for risk factors and symptoms of overt

and covert post-partum urinary retention.

Risk factors include:

Epidural analgesia

Prolonged labour

Instrument-assisted delivery

Nulliparity

Perineal oedema

Periurethral trauma (Yip et al., 2005; Boston, 2006; Carley et al., 2002)

Previous history of retention

Symptoms of overt urinary retention include:

Hesitancy

Difficulty passing urine

Slow or intermittent stream

Straining to void

Sense of incomplete emptying (Yip et al., 2005)

Symptoms of covert urinary retention include:

No symptoms of overt urinary retention

No urge to void

Overflow incontinence

In the instance where such symptoms are identified the health professional will then follow the

relevant pathway to ensure optimal management. Overt and Covert pathways are attached as

appendices A and B respectively.

pathways are attached as appendices A and B respectively. In conjunction with: 2 ACT Health, Maternity

In conjunction with:

as appendices A and B respectively. In conjunction with: 2 ACT Health, Maternity Practice Guideline, Management

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ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March 2009.

MANAGEMENT OF POST PARTUM URINARY RETENTION

In the case of overt urinary retention, non-invasive measures should be the first treatment

strategy. In the post-surgical population may result in a successful void in 57% of cases (Stallard

& Prescott, 1998, as cited in Yip, et al., 2004).

These measures include:

Adequate analgesia

Adequate hydration

Ambulation, privacy

Warm bath (Boston, 2006; Yip et al., 2005; Ching-Chung et al., 2002)

Documentation:

A health professional should identify in the progress notes when a woman is following either

pathway.

The outcome of the pathway should also be documented in the progress notes.

3. EXPECTED OUTCOMES

All women identified as having urinary retention receives appropriate management.

All documentation is completed

The woman is aware of follow-up requirements

4. POTENTIAL RISKS

This guideline will reduce the inconsistency of management of urinary retention and reduce the

risk of long and short term sequelae of post-partum urinary retention.

and short term sequelae of post-partum urinary retention. In conjunction with: 3 ACT Health, Maternity Practice

In conjunction with:

of post-partum urinary retention. In conjunction with: 3 ACT Health, Maternity Practice Guideline, Management of

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ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March 2009.

MANAGEMENT OF POST PARTUM URINARY RETENTION

5. REFERENCES

Boston. L. (2006). Postpartum urinary retention. Journal of the Association of Charted Physiotherapists in Women’s Health, 98, 53-60.

Carley, M.E., Carley, J.M., Vasdev, G., Lesnick, T.G., Webb, M.J., Ramin, K.D. & Lee, R.A. (2002). Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery. American Journal of Obstetrics and Gynecology, 187, 430-433.

Ching-Chung, L, Shuenn-Dhy, C, Ling-Hong, T., Ching-Chang, H., Chao-Lun, C. & Po-Jen, C. (2002). Postpartum urinary retention: assessment of contributing factors and long-term clinical impact. Australian and New Zealand Journal and Obstetrics and Gynecology, 42(4), 367-370.

Rizvi, R.M., Khan, Z.S. & Khan, Z. (2005). Diagnosis and management of postpartum urinary retention. International Journal of Gynecology and Obstetrics, 91, 71-72.

Rogers, R.G. & Leeman, L.L. (2007). Postpartum genitourinary changes. Urologic Clinics of North America, 34, 13-21.

Stallard, S. & Prescott, S. (1998). Postoprative urinary retention in general surgical patients. British Journal of Surgery, 75, 114101143.

Yip, S., Sahota, D. & Pang, M. (2005). Postpartum urinary retention. Obstetrics & Gynecology, 106(3), 602-606.

Yip, S., Sahota, D., Pang, M. & Chang, A. (2004). Postpartum urinary retention. Acta Obstetricia et Gynecologica Scandinavica, 83, 881-891.

ENDORSED BY

------------------------------------------- Liz Sharpe Director of Nursing and Midwifery Women’s and Babies The Canberra Hospital

AUTHORISED BY

----------------------------------------- Anne Sneddon Director O&G Women’s and Babies The Canberra Hospital

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Date:

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Date:

Date: ---------------------------- Date: In conjunction with: 4 ACT Health, Maternity Practice

In conjunction with:

---------------------------- Date: In conjunction with: 4 ACT Health, Maternity Practice Guideline, Management of

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ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March 2009.

In conjunction with: 5 ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March
In conjunction with: 5 ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March

In conjunction with:

In conjunction with: 5 ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March 2009.

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ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March 2009.

MANAGEMENT OF POST PARTUM URINARY RETENTION – APPENDIX B

MANAGEMENT OF POST PARTUM URINARY RETENTION – APPENDIX B In conjunction with: 6 ACT Health, Maternity
MANAGEMENT OF POST PARTUM URINARY RETENTION – APPENDIX B In conjunction with: 6 ACT Health, Maternity

In conjunction with:

PARTUM URINARY RETENTION – APPENDIX B In conjunction with: 6 ACT Health, Maternity Practice Guideline, Management

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ACT Health, Maternity Practice Guideline, Management of post-Partum Urinary Retention. March 2009.