Long-term urinary tract disorders after cesarean section, postpartum

The article is written by Master, Doctor Nguyen Nhu Thu Truc - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Nha Trang International General Hospital.

After cesarean section or vaginal birth, the urinary tract is susceptible to damage due to catheterization, side effects of analgesics, anesthetics or trauma during childbirth due to causes such as large births, alkalosis, etc. smoking, often causing urinary tract disorders.
Postpartum urinary tract disorders include: urinary retention, urinary frequency, urinary incontinence, and other mixed urinary tract disorders, in which postpartum urinary retention is the case most women encounter. Postpartum urinary tract disorders cause many discomforts for the patient, affecting the patient's life.
Postpartum urinary tract disorders can occur immediately after 3-4 hours of birth or in the long run, symptoms of the disease appear.

Postpartum urinary tract disorders usually come from the following causes:
During labor, it is possible that the baby's head will press on the bladder neck or urethra, causing urine stagnation, causing the bladder to stretch. If the bladder is stretched too much, it will lose the tone of the bladder neck muscles, causing urinary tract disorders. In case of normal delivery, the doctor will cut the woman's perineum, after suturing, the stitches may be swollen, making the mother not dare to strain when urinating for fear of pain. Urinary tract disorders after cesarean section are caused by causes such as:
Due to the use of anesthetics and anesthetics: Usually these drugs have the rate of causing urinary retention after birth up to 10-15%. Because the mother is too stressed, it will also lead to urinary retention after birth.

Disorders immediately after birth and caesarean section:
Usually occurs 3-4 hours after vaginal birth, 6-8 hours after cesarean section (after catheter removal). Symptoms are usually: Painful urination: the patient does not dare to urinate because of the pain. Urinary shaking prompts: the patient urinates many times each time, less surgery, uncomfortable. Urinary retention: the patient feels the need to urinate but cannot urinate or the patient does not feel the need to urinate but the bladder is very distended. Treatment: practice holding urine and practice urinating at a certain time, usually every 3 hours, drink plenty of water, relax when urinating. Exercise helps with pelvic rehabilitation. Clean the wound after giving birth with warm water. Treat wound infection if present. The bladder can be heated with warm water. If you still can't urinate, the medical staff may put a catheter, use some drugs to stimulate bladder contractions to help you urinate. Long-term urinary tract disorders after cesarean section or postpartum:
Urinary incontinence: is incontinence, which can leak urine on its own, especially after coughing, exertion, or laughing. It is caused by damage to the pelvic floor muscles that support the bladder after birth. Usually the above condition will return to normal but may persist forever after giving birth, affecting life and activities. How to treat: practice according to exercises to treat urinary incontinence: practice holding urine, exercise to restore pelvic muscles such as Kegel exercises, Knack .., use with electric stimulation pelvic floor muscle exercise machine. If urinary incontinence is severe, surgery to restore the urethra such as endoscopic cystectomy, anterior vaginal lift... Urine retention after childbirth or surgery: is chronic urine stagnation in the bladder after childbirth. or surgery. The consequences will cause urinary retention, which puts pressure on the kidneys to create the following conditions: hydronephrosis, kidney infection, kidney failure, bladder atony. Symptoms that are easy to notice include: leaking urine, feeling that you do not urinate completely, urine flow is not strong, feeling of burning on the pubic bone. Caused by trauma to the bladder muscles or untreated cystitis after surgery. Principles of treatment: the more you have to drink more water and exercise more, urinate on time. After urinating, use your hands to press on the area above the pubic bone and change the position of urine such as standing up, squatting until the urine is out. . In addition, it is necessary to thoroughly treat urinary tract and genital tract infections. Urinary tract disorder after cesarean section or normal birth, although not very dangerous for the mother, but causes discomfort in daily life, greatly affects the psychology of the patient and easily causes post-natal stress.
Treatment of postpartum urinary tract disorders is essential to avoid causing discomfort in life, affecting psychology, causing dangerous complications later if left for a long time. The principles to treat these disorders are training the patient to urinate to create a reflex, using antibiotics to fight urinary tract infections, using anti-inflammatory drugs to prevent edema compressing the bladder neck and supporting the bladder. Support to increase bladder tone helps the patient's bladder contractility return to normal. In case the patient has too much urinary incontinence, it is necessary to perform laparoscopic or vaginal surgery to restore the urethra.

To prevent postpartum urinary tract disorders, doctors often give some advice to pregnant women as follows:
After giving birth, the mother should be active as soon as possible, should not sit or lie down for too long. . Drink plenty of water and relax while urinating.

Do not hold urine for fear of episiotomy pain due to incision during normal delivery. The mother should sit on the toilet in the normal position after giving birth. Soak the vulva in warm water or clean it with feminine hygiene solutions. Keep the vulva clean and dry, avoid infection at the perineal stitches. Eat and drink enough nutrition to help the body recover as soon as possible after giving birth. . You can do gentle exercises to restore pelvic muscles. You should practice holding your urine and urinating at the prescribed time. To get the best care during pregnancy and postpartum, you should use all-inclusive maternity services at reputable medical facilities. In order to protect the health of pregnant women and babies during pregnancy, Vinmec International General Hospital provides a package of maternity services as a solution to help pregnant women feel secure because of the companionship of the medical team. throughout pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of highly qualified doctors Regular check-ups, early detection of abnormalities The package pregnancy helps to facilitate Convenience for the delivery process Newborns receive comprehensive care >>See more: Prevention and treatment of chills in cesarean section - Posted by Specialist Doctor II Nguyen Thi Hoai Nam - Head of Pain Relief Unit - Department of Surgical Anesthesia - Vinmec Central Park International General Hospital