Postpartum Urinary Retention

Introduction of Postpartum Urine Retention

Lower urinary tract has two main functions, namely: as a place to accommodate the production of urine and the excretion function. During pregnancy, urinary tract morphological and physiological changes. Physiological changes that occur in the bladder when the pregnancy predisposes to urinary retention the first hour to a few days post partum. These changes can also give symptoms and pathological conditions that may have an impact on the development of the fetus and the mother.

Residue of urine after urination normally less than or equal to 50 ml, if the residual urine more than 200 ml of said abnormal and can also be said urinary retention. The incidence of postpartum urinary retention range 1.7% to 17.9%. In general, treatment begins with catheterization. If residual urine more than 700 ml, prophylactic antibiotics can be given for the use of catheters in the long term and repetitive.

Postpartum urinary retention may occur in patients with normal birth as a result of stretching or trauma from the base of the bladder trigone edema. Other predisposing factors of urinary retention include epidural anesthesia, the temporary interruption of nerve control of the bladder, and genital tract trauma, especially on a large hematoma, and sectio cesaria.

Pathophysiology of Postpartum Urine Retention

The process of urination involves two distinct processes, namely filling and urine storage and bladder emptying. It is contradictory and turns normally. Activity of the muscles of the bladder in terms of storage and urine output is controlled by the autonomic and somatic nervous system. During the charging phase, the influence of the sympathetic nervous system to a low-pressure bladder with increasing resistance of urinary tract. Urinary retention is coordinated by the sympathetic system barriers of contractile activity of the detrusor muscle is associated with increased pressure of the bladder neck and proximal urethra.

Normal urine expenditures arising from the simultaneous contraction of the detrusor muscle and relaxation of the urinary tract. It is influenced by the parasympathetic nervous system which has the main neurotransmitter acetylcholine, a cholinergic agent.

During the charging phase, afferent impulses are transmitted to the sensory nerves in the sacral spinal dorsal ganglion end segments 2-4 and inform the brain stem. Nerve impulses from the brain stem parasympathetic blocking the flow of urine from the sacral spinal center. During the phase of bladder emptying, inhibition of sacral parasympathetic flow was stopped and the resulting contraction of the detrusor muscle.

Barriers sympathetic outflow to the bladder causing relaxation of the muscle trigonal and proximal urethra. Runs along the pudendal nerve impulses to relax the smooth and skeletal muscle of the external sphincter. The result is the release of urine with minimal channel resistance.

The most common postpartum retention. After a spontaneous vaginal birth, bladder dysfunction occurs 9-14% of the patients after birth using forceps; this figure rises to 38%. This usually occurs due to retention of dissinergis between detrusor-sphincter with incomplete relaxation of the urethra which then causes pain and edema. Conversely patients who cannot empty his bladder after sectio Cesaria usually a result of not contracting the detrusor muscle and less active.

Etiology of Postpartum Urine Retention

Involves normal urination urethral relaxation followed by contraction of the muscles detroser. Bladder emptying in the overall controlled micturition center is tampered and the sacred. Occurrence of bladder emptying disorders result from a disturbance in the function of the central and peripheral nervous system or in the genital and lower urinary tract.

In women, urinary retention is the most common cause of incontinence is excessive. In this case there is a cause of acute and chronic urinary retention. In the more acute cause permanent damage especially disorders of the detrusor muscle, or parasympathetic ganglion in the bladder wall. In the case of chronic urinary retention, attention is devoted to increasing intravesical pressure which causes ureteral reflux, upper urinary tract disease and decreased kidney function.

Patients post surgery and post partum is the part that most causes of acute urinary retention. This phenomenon occurs due to bladder trauma and edema secondary to surgery or obstetrics, epidural anesthesia, narcotic drugs, stretching nerves or pelvic trauma, pelvic hematoma, episiotomy incision or abdominal pain, especially in patients with bladder emptying with Valsalva maneuver. Urinary retention post surgery usually improves with time and adequate bladder drainage.

Clinical Features of Postpartum Urine Retention

Urinary retention provide urinary disorders symptoms, including difficulty urinating; weak urinary stream, slow, and intermittent; existing dissatisfaction, and a desire to put pressure on straining or suprapubic micturition.

One study reported that the most significant symptoms in predicting the presence of urinary problems is a weak urinary stream, emptying the bladder is not perfect, straining during urination, and nocturia.

Diagnosis Of Postpartum Urine Retention

In patients with lower urinary tract complaints, the history and a complete physical examination, pelvic cavity examination, neurologic examination, the amount of urine which is released spontaneously within 24 hours, urinalysis and urine culture examination, measurement of residual urine volume, is needed.

Voiding function should also be checked, in that it can be used uroflowmetry, pressure checks during urination, or voiding cystourethrography.

Said to be normal if the residual urine volume is less than or equal to 50ml, so if the residual urine volume of more than 200ml can be said to be abnormal and called urinary retention. However, residual urine volume between 50-200ml into question, so it was agreed that the volume of residual urine is normally 25% of the total volume of the bladder.

Management of Postpartum Urine Retention

When it became very swollen bladder catheterization necessary, Foley catheter left in the bladder for 24-48 hours to keep the bladder empty and still allow the bladder to rediscover normal tone and sensation.

When the catheter is removed, the patient must be able to urinate spontaneously within 4 hours. After spontaneous voiding, bladder should be re-fitted catheter to ensure that the minimal residual urine. When the bladder contains more than 100 ml of urine, bladder drainage was continued again.

Complications of Postpartum Urine Retention

Because of the prolonged retention of urine, the bladder capacity decreased elasticity, and an increase in intra-bladder pressure that cause reflux, so it is important to do an ultrasound of the kidneys and ureters or can also do photo BNO-IVP.

Conclusion of Postpartum Urine Retention

Women with symptoms urinary incontinence and other bladder disorders increase the risk and difficulty urinating and retention. Retention is a result of the onset of recurrent urinary tract infections with possible disturbances in the upper urinary tract. The detection of these conditions is essential in pharmacological and surgical treatment in women with urinary incontinence are likely to be exacerbation of chronic retention and voiding difficulty.

This paper was prepared by: Andi Visi Kartika

References of Postpartum Urine Retention

1. Germain MM. Urinary Retention and Overflow Incontinence In Bent.AE, Cundiff GW, Ostergard DR, Seift SE. Ostergard’s Urogynecology and Pelvic Floor Dysfunction,5th ed. Lipiincoltt Willian & Wilkins, USA,1992: 285-91
2. Hellerstein S. Voiding Disfunction. Available at: www.emedicine.com. Accessed 25 February 2006
3. Saultz JW, Toffler WL, Shackles JY. Postpartum urinary retention. Available at: www.pubmed.gov. Accessed 25 February 2006

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