The inability to empty the bladder, medically known as urinary retention, is a frequent temporary side effect following the use of an epidural during labor and delivery. This issue arises because the medication used for pain relief affects the nerves responsible for bladder function. While it can be a source of anxiety in the immediate postpartum period, healthcare providers are prepared to manage this condition. The difficulty in urination typically resolves once the effects of the epidural medication have worn off completely.
Why Epidurals Affect Bladder Control
The epidural procedure involves injecting a local anesthetic and sometimes an opioid into the epidural space near the spinal cord. This works by blocking nerve signals from the lower body. This block is intended to stop pain signals from the uterus and birth canal, but it also affects the nerves controlling the bladder. Specifically, the local anesthetic interferes with the sensory nerves that signal the brain when the bladder is full, removing the urge to urinate.
The medication also impacts the motor nerves responsible for contracting the detrusor muscle, which is the main muscle of the bladder wall. By temporarily relaxing this muscle, the epidural reduces the bladder’s ability to squeeze and expel urine effectively. Additionally, the epidural may affect the nerves that control the urethral sphincter. This combination of reduced sensation and impaired muscle function leads to post-epidural urinary retention.
Self-Care Methods to Initiate Urination
Before medical intervention is considered, you can try several non-invasive techniques to encourage your bladder to empty. One effective step is to ensure you have maximum privacy and comfort, as anxiety can inhibit the natural reflex to urinate. If you are medically cleared to stand or sit upright, changing positions from lying down can also help relax the pelvic floor muscles. Leaning slightly forward while sitting on the toilet may also help to stimulate the bladder.
Sensory cues can sometimes override the temporary nerve block, such as listening to the sound of running water from a faucet. You can also try placing a warm compress or warm water from a peri-bottle on your lower abdomen or perineum area. If you are still struggling, try the “double voiding” technique by attempting to urinate, relaxing for a moment, and then trying again to fully empty the bladder. These simple actions focus on relaxation and gentle stimulation.
When Medical Intervention Is Necessary
If you cannot void naturally within a specified time frame, typically four to six hours after delivery or after the epidural catheter has been removed, medical intervention becomes necessary. The first step is usually a bladder scan, which is a non-invasive ultrasound that measures the volume of urine retained in the bladder. This scan helps the medical team determine if the bladder is overly full, which is a risk factor for overstretching and damaging the detrusor muscle.
If the scan reveals a significant volume of retained urine, often over 300 to 400 milliliters, catheterization is performed to empty the bladder. This is most commonly done using a straight, or in-and-out, catheter, which is inserted just long enough to drain the bladder and then immediately removed. In cases where retention is severe, a temporary indwelling (Foley) catheter may be placed to allow for continuous drainage and bladder rest. This intervention is crucial to prevent infection and long-term bladder dysfunction.
Post-Epidural Bladder Recovery Timeline
Normal bladder sensation and function typically return rapidly once the epidural medication has completely cleared your system. For most people, a full return to normal voiding occurs within a few hours to a day after the effects of the epidural wear off. During the initial recovery period, medical staff will monitor your urine output to ensure you are consistently emptying your bladder.
After you are discharged, you should watch for warning signs that may indicate a persistent issue. These include the inability to feel the urge to urinate, frequent small voids with very little output, or a sensation that you are not emptying your bladder completely. If you experience pelvic pain, a fever, or these prolonged voiding difficulties beyond a day or two, contact your healthcare provider for further evaluation.