Non-obstructive postpartum urinary retention

What is Non-Obstructive Postpartum Urinary Retention?

Non-obstructive postpartum urinary retention (NOPUR) is a condition in which an individual can no longer control their urinary bladder after giving birth. When the bladder can not relax during labor, it becomes unable to fill enough to empty on its own. NOPUR is a very rare condition, thought to affect less than 0.5% of all postpartum mothers. It is more common in age 40 women and those with pre-existing conditions such as diabetes.

Causes

The exact cause of NOPUR is unknown but some research suggests it may be related to hormone imbalances in the body, specifically an increased level of relaxin. Relaxin is a hormone released during pregnancy that helps to soften the ligaments and relax the pelvic muscles for childbirth. It is believed that an increased level of this hormone may interfere with the bladder’s relaxation mechanisms and make it difficult for it to fill and empty properly.

Symptoms of Non-Obstructive Postpartum Urinary Retention

• Frequency of urination, meaning going every few hours.
• Weak urine stream.
• Painful urination.
• Difficulty initiating urination.
• Inability to completely empty the bladder.
• Urgency of urination.

Diagnosis

NOPUR can be diagnosed through an ultrasound and a urinalysis. The ultrasound will assess the bladder’s ability to fill and empty as well as the size of the bladder. The urinalysis will check for any infection or presence of blood in the urine. Other tests such as a CT scan and an intravenous urography are sometimes also performed.

Treatment

Treatment for NOPUR will depend on the individual and the severity of their case. Some treatments may include:

• Medications such as alpha blockers, anticholinergics, and antiemetics.
• Physical therapy to relax the pelvic muscles.
• Surgery such as cystoscopy or a urinary sphincteriomy.
• Bladder retraining to increase the capacity of the bladder.

If left untreated, NOPUR can lead to long-term health issues such as incontinence or urinary tract infections.

Prevention

Unfortunately, due to the unknown cause of NOPUR, there is no known way to prevent the condition. However, there are some things a pregnant woman can do to ensure proper bladder functioning during and after childbirth.

• Drink plenty of fluids.
• Avoid caffeinated beverages.
• Maintain good bladder health habits.
• Avoid heavy lifting and strenuous activity.
• Take the time to empty the bladder completely after urinating.