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

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.

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.

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%).

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.