CLINICAL PRACTICE GUIDELINE

MANAGEMENT OF POST PARTUM URINARY RETENTION

Publication Date:
Document Classification:
Coordinated by:
Available to:
Review Date:

March 2010
ACT Health Clinical Practice Guideline
endorsed by WHA Physiotherapy Special
Interest Group June 2009
Katie Vine (katie.vine@act.gov.au)
Members of Womens Hospitals Australasia
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
In conjunction with:

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.

2
In conjunction with:

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.

3
In conjunction with:

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 Womens 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
Womens and Babies
The Canberra Hospital

------------------------------Date:

AUTHORISED BY
----------------------------------------Anne Sneddon
Director O&G
Womens and Babies
The Canberra Hospital

---------------------------Date:

4
In conjunction with:

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

5
In conjunction with:

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

MANAGEMENT OF POST PARTUM URINARY RETENTION APPENDIX B

6
In conjunction with:

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