I am a 24 year old female who recently had a baby via c-section on January 2nd, 2008. During the labor process I was having a hard time urinating, but thought nothing of it. When they removed my catheter the next day, I was unable to void. They put the catheter back in...and still was not able to completely empty the day before I was discharged (during my 5 day stay I was probably catheterized 4 times).
I was sent home with a foley catheter and returned 3 days later for a voiding trial...I was still unable to void on my own. I then went to a urologist who said that the baby probably bruised my bladder and it just needed time to heal...so I was sent home for another week with a foley catheter. I had another void trial (one week later) and voided 100cc with a residual of 300cc. I was taught to self-catheterize and was told to do so and keep a record of the residual. I saw no improvement in two weeks and was then scheduled for uro-dynamics. The tests showed that my bladder was functioning normally and the pelvic muscle was normal.
The urologist told me that he thinks it is the neck of the bladder that is not contracting with the bladder causing the urine flow to cut off. He said that "they" don't know why this happens. I was instructed to continue self-catheterizing for 2 months and to call if there is no improvement. If there is no improvement we can consider a drug that is generally used for men (I think flomax).
My questions are:
Is there anything that could have happened during my labor and delivery/c-section (malpractice by a nurse or doctor) that could have caused this?
Does my doctor's diagnosis sound right...or should I seek a second opinion?
Is there anything I should be concerned about with self-catheterizing long term (if I have to)?
Should I push to have other tests done (cystoscopy, neurological, etc.)?
Postpartum urinary retention is a very uncommon occurrence. I doubt that there was anything done wrong in your care. Your urologist has been pursuing the standard procedures that are necessary to evaluate your problem and has not been able to arrive at a definite answer. His logic, that by relaxing the bladder opening with drugs he may restore your ability to urinate spontaneously, does sound reasonable. You might consider a second opinion from a specialist in female urology or neurourology. You would need to contact an academically based urology center. They will probably want to repeat your studies, possibly using x-ray to visualize what is happening and even measuring the nerve activity in your bladder/urethra area.
Self-catheterizing does have an increased incidence of urinary tract infections compared to urinating on your own, but this is seldom a long term problem. You should try to keep your bladder from becoming over filled. Ideally you're bladder volumes (voided volumes plus residual volumes) are not greater than about 300-400 ml. If the volumes are greater, the incidence of infection and of problems regaining normal function may be affected. You may need to increase the frequency of self catheterization or decrease your fluid intake to achieve this.
Good luck with this. Time often solves such issues.
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Vattikuti Urologic Institute. Please consult your physician for diagnostic
and treatment options pertaining to your specific medical condition
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