Protracted postpartum urinary retention: risk factors, treatment, and effect on pelvic floor dysfunction.

Abstract

Aim: Postpartum urinary retention occurs in the first twenty-four hours following delivery, though protracted cases-where retention does not resolve following an initial 24 hour in-dwelling catheter-are less well defined, and their incidence is unclear. This study aimed to examine the risk factors, treatment, and effect on pelvic floor dysfunction of protracted postnatal urinary retention.

Methods: This was a case control study. Cases of protracted postpartum retention where women required intermittent self-catheterisation from 2015 - 2023 were identified from a hospital database and a matching number of non-protracted cases were randomly selected from the same database as controls. Symptoms were assessed using the ICIQ-FLUTs questionnaire. Variables were analysed using the Chi-squared test, Fisher's Exact Test, Student's t-test, or Mann-Whitney U Test, as appropriate.

Results: There were 71482 deliveries during the study period, thus incidence of postpartum urinary retention was 6.9/1000 (491/71,482) and the incidence of protracted retention was 0.6/1000 (40/71,482). One woman was included twice, while a further five cases of protracted retention were identified from written records from 2014 giving a total of 44 cases for analysis. The hospital database did not exist prior to 2015. A total of 20 (22.7%) responses were received. The median follow-up was six years. Operative delivery appears to be a risk factor. Questionnaire responders reported urgency in 13 (65%) of women but bother scores were low. Stress urinary incontinence was denied by 7 (35%) of women while urge incontinence was described by 4 (20%).

Discussion: Women can be counselled that protracted postpartum urinary retention is rare and in the medium-term this retention appears to have a minimal effect on bladder function.