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Urinary retention

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Urinary retention

  1. 1. Management of Post Partum Urinary Retention<br />
  2. 2. Background<br />2 Types:<br />Overt Retention<br />The inability to void spontaneously within 6 hrs of vaginal birth or removal of an indwelling catheter (Yip et al.,2004)<br />Covert retention<br />Elevated post void residual volumes of >150ml no symptoms of retention<br />
  3. 3. Causes<br />Neurological damage associated with prolonged pressure against the pelvic floor and bladder (Carley et al., 2002)<br />Pudendal, pelvic or hypogastric nerve injury (Yip et al., 2004)<br /> Pain inhibited detrusor function (Boston, 2006)<br />
  4. 4. Risk factors<br />Epidural analgesia<br />Prolonged labour<br />Instrumental birth<br />Nulliparity<br />Perineal oedema<br />Periurethral trauma<br />Previous history of retention<br />(Yip et al.,2005; Boston, 2006; Carley et al.,2002)<br />
  5. 5. Pudendal nerve stretch<br />Pudendal nerve & pelvic floor structure geometry at beginning of 2nd Stage<br />Simulated pudendalnerve & pelvic floor geometry at the end of 2nd stage in oblique view<br />(Lien et al, 2005)<br />
  6. 6. Symptoms of overt urinary retention<br />Hesitancy<br />Difficulty passing urine<br />Slow or intemittent stream<br />Straining to void<br />Sense of incomplete emptying<br />(Yip et al., 2005)<br />
  7. 7. Symptoms of covert urinary retention<br />No symptoms of overt urinary retention<br />No urge to void<br />Overflow incontinence<br />
  8. 8. Management of overt urinary retention 1st treatment strategy<br />Adequate Analgesia<br />Adequate hydration<br />Ambulation<br />Privacy<br />Warm bath<br />(Boston, 2006; Yip et al., 2005; Ching-Chung et al., 2002)<br />
  9. 9. 2nd Treatment Strategy<br />Indwelling catheter<br />Urine catheter sample to be sent to the lab<br />Volume 150-700ml – catheter 24hrs<br />Volume >700ml – catheter 48hrs<br />Removal of catheter wait 4hrs no passing urine go back to 1st treatment strategies<br />After another 2 hrs no passing urine then reinsert the catheter<br />
  10. 10. Management covert urinary retention 1st treatment<br />4hrs post birth has the woman passed urine?<br />No – 2hrly checks<br />Encourage fluids<br />Fluid balance chart<br />Measure 1st passage of urine<br />Send Mid Stream Urine sample<br />
  11. 11. Management of covert urinary retention 2nd treatment strategy<br />Volume between 200-700ml:<br />Continue timing passage of urine<br />No urge to pass urine after 24hrs or at >300ml:<br />Insert indwelling catheter and measure residual volume<br /><150ml continue timing passage of urine<br />>150ml leave catheter in for 24hrs<br />After 24hrs remove catheter repeat process<br />
  12. 12. References<br />Boston. L. (2006). Postpartum urinary retention. Journal of the Association of Charted Physiotherapists in Women’s Health, 98, 53-60.<br />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.<br />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.<br />Lien, K. C., Morgan, D. M., Delancey, J. O., & Ashton-Miller, J. A. (2005). Pudendal nerve stretch during vaginal birth: a 3D computer simulation. Am J ObstetGynecol, 192(5), 1669-1676.<br />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.<br />Yip, S., Sahota, D. & Pang, M. (2005). Postpartum urinary retention. Obstetrics & Gynecology, 106(3), 602-606.<br />Yip, S., Sahota, D., Pang, M. & Chang, A. (2004). Postpartum urinary retention. ActaObstetricia et GynecologicaScandinavica, 83, 881-891.<br />

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