Post Partum Voiding Dysfunction

Post Partum Voiding Dysfunction

Postpartum voiding dysfunction—if defined as failure to pass urine spontaneously within 6 hours of vaginal delivery or catheter removal after delivery—occurs in 0.7–4% of deliveries.The postpartum bladder has a tendency to be underactive and is, therefore, vulnerable to the retention of urine following trauma to the bladder, pelvic floor muscles and nerves during delivery. If postpartum voiding dysfunction is unrecognised, it can lead to bladder underactivity and prolonged voiding dysfunction, with sequelae such as recurrent urinary tract infection and incontinence. In the immediate postpartum period, abnormal voiding parameters were identified in 43% of women in a prospective study of 184 women using uroflowmetry and measuring postvoid residual urine volume on ultrasound. All women had daily measurements taken, from the first day following vaginal delivery until discharge. The authors defined abnormal voiding parameters as a mean flow rate 10 ml/second when a volume 150 ml was voided and a residual urine volume was 100 ml. Women with abnormal voiding parameters upon discharge were asked to return weekly until normal voiding parameters were recorded. High residual urine volume was recorded in 37 women, 9 had a low flow rate and in 33 both parameters were abnormal. Only 21 of the 79 women with abnormal voiding parameters were symptomatic. Four required catheterisation for urinary retention. At discharge, normal voiding parameters were recorded in 68% and, of the 25 women discharged with abnormal voiding parameters, returned for testing and all voided normally. The majority of women classified as having abnormal voiding parameters had a high residual urine volume and the addition of uroflowmetry did not provide any beneficial information compared to ultrasound