Unit-10
Subunit-10.1
RETENTION OF URINE
INTRODUCTION
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
Voiding difficulty and urinary retention is a common phenomenon in the immediate
postpartum period.
The importance of prompt diagnosis and appropriate management of this condition is the
key to ensuring a rapid return to normal bladder function.
Postpartum voiding dysfunction occurs in a significant number of women, which can
potentially cause permanent damage to the detrusor muscle and long-term complications
when left undetected or untreated.
DEFINITION
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Retention of urine is a condition in which the urine is retained in the bladder and the patient
(woman) is unable to expel the urine. Urine production from the kidney continues but the
accumulated urine is not released from the bladder.
Acute urinary retention is defined by the International Continence Society as a painful,
palpable, perusable bladder, with the patient unable to pass any urine when the bladder is
full, although it should be recognized that pain may not be present in the postpartum woman
especially following epidural analgesia.
Post-partum urinary retention (PUR) also known as insidious urinary retention after vaginal
delivery or puerperal urinary retention is a relatively common condition.
Traditionally post-partum urinary retention is described as the absence of spontaneous
micturition within six hours of vaginal delivery.
TYPES OF RETENTION
1. Overt Retention
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
Women who are unable to micturition spontaneously within 6 hour after vaginal
delivery and categorized as having overt (symptomatic) urinary retention.
4ff ftAlso known as active retention presents with the sudden onset of the inability
to void leaving a significant amount of residual urine in the bladder.
2. Covert Retention

Covert (asymptomatic) urinary retention is defined as having a postvoid residual
bladder volume (PVRBV) of more than 150 ml, detected by ultrasound or by
catheterization, with symptoms of urinary retention.
INCIDENCE
Estimated incidences range from 0.05% to 37.0%.
RISK FACTORS
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Nulliparous women
Prolonged labor, especially a prolonged second stage
Assisted/instrumental delivery.
Perineal injury.
Caesarean section
Regional analgesia
CAUSES
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Lying recumbent in bed continuously.
Lax abdominal and bladder wall.
Privacy not maintained.
Secondary to pain (reflex) from an episiotomy wound or laceration. Reflex inhibition due
to stitched perineum or bruised urethra.
Fear of pain.
Difficult instrumental birth and/or shoulder dystocia.
Prolonged second stage labor.
PATHOPHYSIOLOGY
 The precise pathophysiology of postpartum urinary retention is still unknown; however, it
is likely to be multifactorial, including physiological, neurological, and mechanical
processes in the postpartum period.
1.One of the most common cause is the use of regional anaesthesia .
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Due to afferent neural blockade which supresses the sensory stimuli from the bladder to
the pontine micturition center.
As a result, the reflex mechanism that induces micturition is blocked which may result in
reduced contractility of bladder and urinary retention.
2.Result of nerve injury during delivery:

The pudendal nerve, with afferent nerve branches supplying the bladder, is damaged during
pelvic surgery and vaginal delivery.
 There is a significant increase in pudendal nerve terminal motor latencies, which may take
a few months to recover post delivery.
3.Pelvic floor tissue stretching during delivery resulting in pudendal nerve damage:

Both instrumental delivery and prolonged labour can be predisposing factors to this
damage.
4.Tissue oedema around the urogenital area, resulting in a transient mechanical obstruction to
urine outflow.
5. Physiological changes contributing to Postpartum Urinary Retention:
Elevated levels in pregnancy and in the immediate postpartum period
Reduced smooth muscle tone
Dilated bladder, ureters during pregnancy and the first few weeks of postpartum
Coupled with changes in vesical pressures (an initial rise in pregnancy followed by a rapid drop
to normal values within a few days after delivery)
Results in a hypotonic bladder in the early puerperium
Urinary Retention
S.N
1
.
SPECIFIC
OBJECTIVES
CONTENT
TIME
Self
4min
introduction
Topic
introduction
Objectives
What do you
mean by
postpartum
urinary
retention?
At the end of the Introduction of 4min
session, students will postpartum
be able to:
urinary retention.
define postpartum
urinary retention.
define postpartum Definition
of 4min
urinary retention.
postpartum
urinary retention.
Brainstorming
4.
2.
At the beginning
of the session,
TEACHING
METHOD
TEACHING
EVALUATION
MEDIA
Discussion
PowerPoint
What
postpartum
urinary
retention?
Discussion
PowerPoint
state the incidence of Incidence
of 1min
postpartum urinary postpartum
retention.
urinary retention.
Interactive
Lecture
PowerPoint
5.
describe the risk Risk factors of 5min
factors of postpartum postpartum
urinary retention.
urinary retention.
Interactive
Lecture
PowerPoint
6.
clarify the causes of Causes
of 5min
postpartum urinary postpartum
retention.
urinary retention.
Interactive
Lecture
PowerPoint
7.
elaborate
the Pathophysiology 10min
pathophysiology of of
postpartum
postpartum urinary urinary retention.
retention.
Interactive
Lecture
PowerPoint/
Chart paper
8.
illustrate
symptoms
postpartum
retention.
Discussion
PowerPoint
What
is
postpartum
urinary
retention?
What is the
incidence
of
postpartum
urinary retention.
What are the risk
factors
of
postpartum
urinary
retention?
What are the
causes
of
postpartum
urinary
retention?
What is the
pathophysiology
of
postpartum
urinary
retention?
What are the
symptoms
of
postpartum
urinary
retention?
3.
the Symptoms
of 5min
of postpartum
urinary urinary retention.
is
9.
explain the diagnosis Diagnosis
of 3min
of
postpartum postpartum
urinary retention.
urinary retention.
Interactive
Lecture
PowerPoint
10.
describe
the Management of 8min
management
of postpartum
postpartum urinary urinary retention.
retention.
Interactive
Lecture
PowerPoint/
chart paper
11.
discuss the nursing Nursing
5min
management
of management of
postpartum urinary postpartum
retention.
urinary retention.
Discussion
PowerPoint
12.
list the complications Complications of 3min
of
postpartum postpartum
urinary retention.
urinary retention.
Discussion
Metacard
13.
summarize the topic.
Questioning
and Answering
Summary
3min
What are the
diagnosis
of
postpartum
urinary
retention?
What are the
management of
postpartum
urinary
retention?
What are the
nursing
management of
postpartum
urinary
retention?
What are the
complications of
postpartum
urinary
retention?