Postnatal urinary retention: trouble passing urine after birth

Cambridge University Hospitals describes postnatal urinary retention, also called voiding dysfunction, as being unable to fully empty your bladder when it is full. It is common in the first day or two after childbirth, and about 1 in 500 (0.2%) women and birthing people have bladder emptying problems lasting longer than three days. The NHS advice on your body after birth also lists a very hard time passing urine as something to tell your midwife about.

The Cambridge leaflet says that after birth, or after a catheter is removed, you should feel a normal urge to pass urine within four hours. Your midwife will ask you to catch all of your urine the first time so the volume can be measured, with questions about how it felt. NICE postnatal guidance says to assess bladder function by measuring the volume of the first void after the birth, and to assess bladder function at each postnatal midwife contact.

If you cannot pass urine by four hours, have no sensation, or pass a small amount (less than 250 ml), the midwife checks you are well hydrated and have good pain relief. If you still cannot pass a good volume with normal sensation by six hours you may have retention, confirmed by a bladder scan or catheter to see how much urine remains. The NHS says to tell your midwife if you are finding it really difficult to pee, feel very sore or notice an unpleasant smell.

The Cambridge leaflet lists pain in the vulva and perineum, swelling in and around the vagina, an epidural or spinal anaesthetic that alters sensation in the lower body, and loss of bladder tone or injury to pelvic nerves during childbirth. You are more likely to have problems with a first baby, after an epidural or spinal, a prolonged labour, an instrumental delivery, a tear or stitches, a urine infection, constipation, or previous problems.

Because stitches and swelling are common after birth, retention often overlaps with perineal pain; the NHS says to bathe stitches daily and that drinking plenty of water dilutes urine and may make it sting less.

The leaflet suggests regular pain relief if needed, getting up and walking about to reduce swelling, ensuring privacy and relaxing (for example using a quieter bathroom and having someone mind the baby), sitting with your feet on the ground rather than hovering above the seat, a warm shower, and telling your midwife if you are constipated because that can cause retention and is easily treated. The NHS adds that squatting over the toilet or pouring warm water over the area may reduce stinging. Check with your midwife or pharmacist before taking any painkiller while breastfeeding.

If retention is confirmed, the Cambridge leaflet says your midwife or doctor will recommend a urinary catheter for 24 hours to rest the bladder. It describes a thin sterile silicone tube passed through the urethra into the bladder, held in place by a small balloon, inserted with consent, a chaperone offered and local anaesthetic gel. You can shower with it, should keep the perineum clean and record what you drink and pass on a fluid chart. The catheter is usually in for at least 24 hours.

When it is removed (a trial without catheter, or TWOC), your urine is measured the first time you pass it, and a bedside bladder scan checks you have emptied fully. If you cannot pass urine by four hours, are leaking uncontrollably or pass only a small amount, an individual plan is made, which may include waiting a further two hours, a scan or an in-and-out catheter. If retention persists, a new catheter for at least 7 days is advised; you can go home with it and have an outpatient repeat trial. Some people are taught clean intermittent self-catheterisation while the issue resolves. Procedures vary between hospitals and UK nations.

The Cambridge leaflet says to contact the maternity team if you feel unwell with flu-like symptoms, fever or shivers, if you have discharge around the catheter that persists or smells, or if you notice fresh red blood in your urine. NICE lists fever, shivering and abdominal or pelvic pain among symptoms of possible infection that need medical advice without delay. If you have severe tummy pain and cannot pass urine at all, seek urgent help from your maternity unit or NHS 111, or call 999 if you feel very unwell.

The Cambridge leaflet says that in most cases retention is temporary but sometimes takes a few weeks to resolve. NICE says the GP check at 6 to 8 weeks should respond to any concerns, which may include referral to physiotherapy, so mention ongoing bladder symptoms there.