Urinary retention may occasionally be referred to a gynaecologist if the cause is deemed gynaecological.
- The diagnosis is usually clear with a history or inability to pass urine for some hours and increasing abdominal pain. There may not be total inability to pass urine but some patients with chronic retention may find they leak urine due to leakage from an over full bladder. It is important to exclude any acute neurological cause (e.g. cauda equina). History should ask about faecal and flatal incontinence, peri-anal numbness, back pain and or recent trauma. No pain may be reported if the cause is neurological, chronic, the woman is elderly or the retention is associated with regional anaesthesia.
|Abdominal mass||Primary urological||Iatrogenic|
|Pregnancy||Urinary tract infection||Colposuspension|
|Fibroid uterus||Urethral stricture||Anterior colporrhaphy|
|Ovarian cyst||Neuropathic bladder||Insertion of ring pessary|
|Postpartum||HSV infection||Poor bladder management of labour/epidural|
- most women are uncomfortable and restless
- observations may show an increased heart rate due to pain
- palpable bladder
- examine further only once bladder is empty
- a urine dip with or without a mid-stream urine specimen should be taken to rule out infection or presence of blood
- abdominal examination for any mass potentially causing obstruction
- bimanual examination for pelvic masses.
- insertion of a catheter using aseptic technique. Usually a Foley’s catheter is required but on occasion and in-out catheter may be sufficient
- trial without catheter is appropriate after 24–48 hours but depending on the cause this may need to be longer
- consider prophylactic antibiotics to cover the procedure
- check micturition volumes and residual after removal of catheter
- treat the cause.
- urea and electrolytes to exclude any post-nephrotic acute kidney injury
- transvaginal ultrasound scan to rule out any obstructing pelvic mass
- urodynamics if there is a chronic problem with micturition
- consideration of clean intermittent self catheterisation if there is a persistent inability to empty the bladder.
Predisposing factors for postpartum retention
- failure to catheterise with dense epidural
- failure to check for bladder emptying within eight hours of delivery
- lack of sensation to pass urine after spinal or epidural for caesarean or other procedure, e.g. manual removal of placenta
- urinary tract infection
- inhibition of voiding due to painful perineum.
Aslam N, Moran PA. Catheter use in gynaecological practice. The Obstetrician & Gynaecologist 2014;16:161–8.