Postpartum urinary retention Risk factors, clinical impact and management

Pregnancy as well as delivery are both associated with pelvic floor disorders such as pelvic organ prolapse, overactive bladder syndrome and urinary incontinence. However, little is known about the relationship between voiding dysfunction and postpartum urinary retention (PUR). It is feasible that the onset of voiding problems later in life is related to the period immediately after delivery when inadequate voiding is a frequently encountered condition.
In order to gain insight in the clinical consequences of inadequate voiding after delivery, identification of risk factors and management strategies, women after vaginal delivery with symptomatic and asymptomatic postpartum urinary retention were studied.
First of all we observed not only that incomplete bladder emptying after vaginal delivery resolves rather quickly, but also that the currently used cut-off values do not discriminate between physiology and pathology. Additionally we concluded that an automatic scanning device is a valid non-invasive tool to identify increased post void residual bladder volume after vaginal delivery and to prevent unneeded catheterisations. Finally we found that clean intermittent catheterisation (CIC) is preferred over transurethral indwelling catheterisation (TIC) in patients with the inability to adequately empty the bladder after vaginal delivery.
The results presented in this thesis could be used to create evidence based guidelines on the management of bladder emptying problems after vaginal delivery and to increase awareness of clinicians.