Postoperative Urinary Retention (POUR) is the inability to pass urine following a surgical procedure, even when the bladder feels full. This condition is a common complication, with incidence rates varying widely depending on the type of surgery performed. POUR is usually temporary and highly treatable through routine medical interventions. Understanding the steps to take and the reasons this occurs can help patients manage their recovery effectively.
Immediate Steps to Encourage Flow
If a patient is experiencing difficulty initiating urination, several steps can be attempted immediately to encourage flow. Early mobilization, such as standing up or walking a short distance, can help stimulate normal bladder function and shift the bladder into a position that favors voiding, provided ambulation is approved by the surgical team. Acoustic stimulation is a simple technique; listening to the sound of running water, such as a faucet, can sometimes trigger the reflex to urinate.
Applying a warm compress or hot pack to the lower abdomen may help relax the muscles surrounding the bladder. Sitting in a warm bath, if permitted, can also relax the body and bladder. Male patients may find that attempting to urinate while sitting down relaxes the pelvic floor muscles more effectively than standing. Patients should avoid drinking excessive amounts of fluid to force urination, as this can overstretch the bladder and worsen the problem.
Why Surgery Can Disrupt Urination
The inability to urinate after surgery is a side effect of the overall perioperative process, involving several physiological mechanisms. Anesthesia, whether general or regional, temporarily interferes with the nerve pathways that coordinate bladder function. These agents prevent the bladder’s detrusor muscle from contracting and dull the sensation of a full bladder. Regional anesthesia, such as spinal or epidural blocks, can directly affect the nerves controlling the bladder, and these effects may linger longer than general anesthesia.
Pain medications, particularly opioid analgesics, compound the issue by inhibiting nerve signals and reducing the contractility of the bladder muscle. Furthermore, patients receive large volumes of intravenous (IV) fluids during the procedure to maintain hydration. This fluid load increases urine production, quickly overfilling a bladder that is slow to empty due to medication effects, which leads to overstretching. Inflammation and pain at the surgical site also cause a reflexive inhibition of the voiding reflex.
Urgent Warning Signs and Timelines
While temporary retention is common, the inability to urinate requires immediate medical attention after a certain timeframe. If spontaneous voiding has not occurred within six to eight hours post-operation or following the removal of a catheter, the medical team must be notified. Although the exact timeline may vary based on protocol, exceeding this window can lead to complications.
There are physical warning signs that indicate a need for urgent care regardless of the elapsed time. Patients should report severe pain in the lower abdomen, which suggests significant pressure on the bladder wall. Visible abdominal swelling or distention is another sign that the bladder is overfilled. The appearance of systemic symptoms, such as a fever or chills, could signal a developing urinary tract infection, which requires prompt evaluation.
Professional Medical Management
The first step in professional management of POUR is an assessment using a bladder scanner, a handheld ultrasound device that measures the volume of retained urine. Once retention is confirmed, immediate treatment involves bladder decompression to relieve pressure and prevent potential damage to the bladder muscle. This is accomplished through catheterization, which drains the accumulated urine.
The medical team typically chooses between two types of catheterization. Intermittent catheterization involves inserting a tube only long enough to empty the bladder, after which it is immediately removed. Alternatively, a temporary indwelling catheter, such as a Foley, may be inserted and left in place for 24 to 48 hours or longer, especially after complex pelvic procedures. Leaving the catheter in place allows the overstretched detrusor muscle to rest and recover tone.
Pharmacological interventions are often used alongside catheterization to improve the chances of successful voiding. Alpha-blockers, such as tamsulosin, may be prescribed to help relax the muscles in the bladder neck and prostate, facilitating the outflow of urine. The goal is to monitor the patient’s output and attempt a trial without the catheter once the underlying causes of retention, like the effects of anesthesia and pain medication, have subsided.