Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Urinary retention, incontinence and pelvic-floor recovery
Obstetrics and gynaecology · UK scope · Sources checked 7 Sept 2026 · Clinical review pending
!Retention with neurological symptoms needs urgent escalationInability to void with a painful distended bladder requires prompt drainage. New saddle sensory change, leg weakness or bowel dysfunction, particularly after neuraxial procedures, also raises concern for a neurological emergency.
Action: Assess immediately, measure bladder volume and arrange appropriate catheter drainage; seek urgent senior obstetric and anaesthetic or neurological assessment for associated neurological findings, severe pain, sepsis or suspected injury.
Synopsis
Identify impaired bladder emptying and different patterns of leakage after birth, prevent overdistension, and arrange individual pelvic-floor rehabilitation and specialist assessment when recovery is abnormal.
- Ask about emptying as well as leakage at postnatal contacts.
- Passing small amounts does not prove the bladder is empty.
- Investigate failure to void within six hours of birth or catheter removal.
- Measure residual urine when voiding dysfunction is suspected.
- Offer supervised pelvic-floor training for at least three months for stress or mixed incontinence.
- Urgency treatment includes bladder training after retention and infection are addressed.
Key red flags
Painful inability to pass urine or a markedly distended bladder.
New leg weakness, saddle numbness or loss of bowel control.
Severe perineal pain, swelling or fever accompanying urinary difficulty.
Continuous unexplained leakage or persistent haematuria after operative birth.
Investigation priorities
01Voided volume and post-void residualFirst stepDetermine whether the bladder empties effectively after birth.
Management branches
Early recoveryDetect retention before overdistension persistsThe woman cannot void or reports ineffective emptying after birth.
- Review the last effective void or catheter drainage, pain, fluid intake and relevant birth or anaesthetic factors.
- Measure bladder volume and drain promptly when retention is established, documenting the volume and the woman's response.
- Arrange the next trial of voiding and escalation using the maternity bladder protocol, with earlier senior review for neurological or injury concerns.
Sources and review status4 sources · checked 7 Sept 2026 · clinical review pending+
SourcesSources and review status
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 7 Sept 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom