BLADDER FUNCTION AFTER SURGERY
Why do I have trouble urinating after my surgery?
Trouble urinating is a common complication after gynecological surgeries. The most common problem with urination after surgery is called urinary retention. This means that you have a full bladder but cannot fully empty it. Your chance of having di culty emptying your bladder depends on the type of surgery you have. Your surgeon will tell you what the chances are for urinary retention after surgery.
How does the urinary system work?
Urine is made in the kidneys, and travels to the bladder through two tubes called the ureters, one from each kidney. The bladder is the organ that stores urine, before it leaves the body through the urethra. The bladder is a muscle: it can expand like a balloon to store urine, and get smaller by shrinking down to push the urine out of the body. The urethra is normally closed to make sure your urine stays in the bladder. When the bladder gets full and you sense the urge to urinate, the bladder muscle squeezes, the pelvic muscles relax, and the urethra opens to let the urine leave the bladder.
What are symptoms of urinary retention?
You might have urinary retention if you have:
• Hesitant, poor or slow urinary flow
• Frequent urination
• The sense of not emptying your bladder
• To strain, or bear down to empty your bladder
• Many urinary tract infections (UTIs)
• Accidental, or “overflow” urination
What causes urinary retention?
Bladder muscle dysfunction:
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Medications given during surgery to manage pain, called anesthetics, can affect the nerves of the bladder. This is usually short term, but if there are other problems with urinary retention, these medications can make your bladder worse.
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Inflammation of the tissue around the nerves from surgery can affect the bladder muscle function. A rare cause is damage to the nerves in surgery. Your surgeon will explain to you how common this is.
Tightening around the urethra:
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The urethra is where the urine leaves your body. If there is something pushing on this area like swelling from the surgery, or, a collection of blood (which goes away on its own), it may block the urine from coming out and will cause trouble with urination.
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Some operations tighten the area near the urethra (to fix a problem with urine leaking) and these operations are more likely to result in difficulty urinating after surgery on a short term basis.
Failure of pelvic floor relaxation:
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The pelvic floor muscles are the muscles that support your uterus and bladder and keep them from falling.
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After surgery, some women tighten these muscles (due to pain from the surgery) and this may make urination more difficult. It is important to take the pain medications your surgeon gives you after surgery to help avoid this.
Will I get urinary retention?
You have a higher chance of getting urinary retention if you:
• Are over the age of 50
• Have had difficulties with urination before your surgery
• Have a neurologic disease: like Multiple Sclerosis (MS)
• Have a long surgery
• Have regional anesthesia (like epidural)
• Have incontinence surgery (a type of surgery that fixes a problem with urine leaking)
Ask your surgeon about your chance of having urinary retention after surgery and how this can be treated.
How do you test for urinary retention?
Your doctor may want a urination trial (“voiding trial”). This means your nurse will measure how much you can urinate
on your own. Your nurse will then measure how much is left behind in your bladder after you urinate. The urine left in your bladder after you urinate can be either measured by a bedside ultrasound or by brie y putting a small plastic tube (catheter) in the bladder through your urethra to drain the urine. The amount of urine left in the bladder is called a “post-void residual”.
Your doctor may also test your urine for signs of infection, because a urinary tract infection can have the same symptoms as urinary retention and can be treated with antibiotics.
I have urinary retention. What treatments are there?
The treatments for urinary retention depend on the cause.
Common Situations:
Urinary retention usually goes away on its own with time (1-2 weeks after surgery) as it is related to some swelling in the area near the urethra because of your surgery. During this time you may need to have a catheter (small plastic tube that is connected to a drainage bag) left in the bladder to drain the urine. If this happens to you, it is only for a short period of time and your surgeon will arrange to have a “voiding trial” done at home with a home care nurse.
It is important to remember that everyone will urinate again in time.
If the urinary retention is a result of a bladder infection, antibiotics will help this problem settle faster.
Rare cases:
In very rare cases (less than 1% chance), the bladder may take a long time (3 months or more) to empty on its own and may mean that you will need a catheter during this time. If your surgeon feels your urinary retention is because of the surgery near the urethra being too tight (for example with a sling procedure),
then a second surgery (day surgery) to loosen the sling may be suggested.
How can I help prevent urinary retention?
It is very important to prevent over-fillling of the bladder after surgery as this can make your chance of having di culty emptying your bladder higher. Remember to urinate regularly.
Sunnybrook Health Sciences Centre
2075 Bayview Avenue Toronto, ON M4N 3M5
Telephone: 416.480.6100
PR xxxxx (Feb 2017)
