Anatomy of female RENAL system x-ray viewCaring for your bladder after childbirth

Introduction

Following the birth of your baby, you may well feel that the area around your birth canal (vagina) no longer feels as if it ‘belongs to you’. Everything can feel swollen, tender and bruised and sometimes, even a little bit numb. Childbirth places pressure on your bladder and pelvic floor and perineal tear(s), particularly where these are close to the urethra (the opening where the urine comes out), or an episiotomy can leave everything feeling uncomfortable and sore. Newly delivered mothers often feel quite nervous about passing urine for the first time after giving birth. This is because where the urine comes into contact with any grazes or sutures (stitches) it can cause stinging.

 

Bladder care after ‘normal’ (unassisted) vaginal birth

If you had a spontaneous (normal) vaginal birth, the maternity staff will encourage you to pass urine four to six hours following it. They will ask you to let them know when you have passed urine and this will be recorded in your maternity notes. This is because they will want to ensure that you are passing urine without any difficulty and emptying your bladder effectively.

 

Assisted births (forceps and ventouse) and Caesarean birth

If you had an epidural for your labour and/or baby’s birth, you are likely to have a urinary catheter (small tube) inserted into your bladder. This will remain in place for around 12 – 24 hours post birth, unless the doctor advises that it should remain in place for longer (48 hours). The urine drains down the tubing into a collection bag which means you don’t need to worry about having to go to the toilet. Once the catheter is removed, the maternity staff will advise you to try and pass urine (void) within four to six hours. The maternity staff will record the times of the voids and will measure how much urine you pass each time. These measurements are recorded on a fluid balance chart which helps staff to monitor your bladder function and detect any potential concerns. Early intervention where difficulties are found to exist can prevent permanent bladder damage.

 

Bladder problems

After giving birth, some women find that they have problems passing urine, or have no sensation of needing to pass urine. Where you are unable to pass urine or don’t realise that your bladder needs to be emptied, the volume of urine inside the bladder will gradually build up. This is referred to as urinary retention. Urinary retention is not good for your bladder because overstretching of the bladder walls can cause damage in the longer-term leading to stress incontinence (ie where you leak urine if you cough, laugh, sneeze etc.) and/or urgency (where you suddenly need to pass urine).

 

Are there any factors that increase the risk of urine retention?

Research has shown that a number of factors are associated with an increased risk of developing urinary retention:

a). Being in labour for a long time

b). Assisted birth with forceps or ventouse

c). Caesarean section for slow progress in labour

d). Epidural pain relief

e). A larger than average baby

f). Birth trauma eg episiotomy, perineal tears

g). Full bladder during the birth, or immediately afterwards.

What are the signs and symptoms of urinary retention?

There are a range of signs and symptoms which can indicate that you are in urinary retention:

a). No sensation of needing to pass urine or of having a full bladder

b). Bladder discomfort or pain

c). Straining in order to pass urine/difficulty passing urine

d). When passing urine, the flow stops and starts, or comes out slowly

e). Feeling as if you haven’t emptied your bladder properly

f). Urine leaks out because the bladder is over-full.

 

Tips for emptying your bladder effectively

The muscles of the abdomen and pelvic floor become weakened during pregnancy by the weight of your growing uterus (womb); additional strain is then placed on the pelvic floor during birth. It is therefore, important that you do not strain in order to pass urine or open your bowels. The following steps can help you to empty your bladder more effectively:

  • Always sit on the toilet seat; don’t be tempted to try and hover above it
  • With your feet flat on the floor and your legs parted, lean slightly forwards (NB. it may help to rest your arms on the tops of your legs)
  • Allow your abdomen to relax. You may notice that your tummy protrudes a bit but this is fine
  • Stay relaxed – slowly breathing in and out may help you to do this
  • Make sure you are feeling as comfortable as possible; having pain relief 30-40 min before you try to use the toilet can be helpful. This can be especially so, if you had an assisted birth with forceps or the ventouse, and have sore stitches or grazes in the vaginal and urethral area, or had a caesarean section
  • Give yourself plenty of time; the worst thing you can do is to try to rush things
  • Turning a tap on in the bathroom so you hear the sound of running water can help to encourage things along
  • Pouring warm water over your genital area can help as it reduces the stinging sensation when passing urine.
  • Making sure you drink plenty of fluids is important as this prevents your urine from becoming more concentrated and acidic which can cause pain when it passes over raw sore areas.

 

What should I do if I still can’t pass urine?

  • If you feel that you haven’t emptied your bladder properly, try rocking gently back and forth. Pelvic rocking can help to empty the bladder. You could also try standing up, rocking your pelvis back and forth; then sitting down and trying to pass urine once more
  • Consider applying gently pressure just above the top of your pubic bone where your bladder is
  • If you are struggling to relax, try passing urine in a warm bath or while in the shower
  • If despite trying all of the above you are still unable to pass urine; tell your midwife immediately. They will feel your abdomen to see whether they can feel a full bladder. If you are at home you may be advised to return to hospital where a midwife or doctor may suggest performing a scan of your bladder (bladder scan) to see how much urine is present. If there is any concern that your bladder is full, the midwife will advise that a catheter is inserted to see how much residual urine is present. If a significant amount of urine is drained, they will recommend that the catheter remains in place
  • Women with urine retention will have a catheter in place for 24-48 hours. This time frame is usually sufficient to allow any oedema (swelling) or bruising from the birth to subside. Once the catheter has been removed the vast majority of women go on to pass urine without any further problems
  • Occasionally, women with retention of urine will be discharged home from hospital with a catheter still in place. Most are asked to return to the maternity unit a week later to have their bladder function reviewed and the catheter removed. Once normal bladder functioning has been confirmed, they can return home and there is no need for any further follow-up.

 

Keeping your bladder healthy

Damage to the bladder can occur where there is urine retention and the bladder walls become overstretched. To prevent this from happening; it is important that you empty your bladder regularly. Maternity staff will suggest that you try passing urine every two to three hours during the first 24 hours post birth to prevent the bladder becoming over-distended.

Ensure you drink plenty of water – you should aim to drink around two litres of fluid every day. See also our article on ‘Hydration – are you drinking enough?’ It is best to avoid tea, coffee and coca cola, as these drinks contain high levels of caffeine which can irritate the bladder. Drinking water regularly throughout the day flushes waste products and toxins from the body and helps prevent urinary tract infections (urine infections) developing. Adequate hydration also dilutes your urine making it less acidic; if you had grazes or stitches drinking plenty of fluids will help to make passing urine more comfortable. Drinking adequately is also important if you are breastfeeding your baby.

 

Keeping a healthy bladder for the future

Pelvic floor exercises are very important for healthy bladder functioning. You should start doing these exercises as soon as you can post birth and continue to do them every day. They will help to strengthen your muscles and improve tone. This is important for controlling your bladder function and preventing stress incontinence. See also our article on ‘Postnatal exercises’. NB. You should not perform pelvic floor exercises if you have a urinary catheter in place.

Should you have any concerns about your bladder functioning, whether this relates to problems with stress incontinence or difficulties emptying your bladder; tell your midwife, health visitor or GP. They will be discrete and sensitive to your feelings, and can ensure that you are referred for specialist treatment and support as necessary. The sooner any potential difficulties are detected, the less likely it is that they will lead to permanent damage in the longer-term.

Birch L, Doyle PM, Ellis R et al (2009). Failure to void in labour: postnatal urinary and anal incontinence. British Journal of Midwifery 17(9):562-566.

Champion P (2013). The childbearing bladder: an amazingly adaptable organ. Essentially MIDIRS 4(6):17-23.

Davies L (2012). Sitting next to Nellie: Bladder care. Essentially MIDIRS 3(3):38-42.

Foon R, Toozs-Hobson P, Millns P et al (2010). The impact of anesthesia and mode of delivery on the urinary bladder in the postdelivery period. International Journal of Gynecology and Obstetrics 110(2):114-117.

Mackenzie MJ, Woolnough MJ, Barrett N et al (2010). Normal urine output after elective caesarean section: an observational study. International Journal of Obstetric Anesthesia 19(4):379-383.

2017-05-26T16:29:20+00:00