Urinating after giving birth can be a challenge for some people and may cause stress, frustration, and pain during the immediate postpartum period. Childbirth educators and other perinatal professionals can provide information to help postpartum people alleviate or reduce concerns about this topic. Pelvic floor physical therapist Ken McGee, PT, DPT, provides some facts and shares useful techniques to overcome these challenges in the next post in the occasional series, The Body in Birth. - Sharon Muza, Community Manager, Connecting the Dots. 

Emptying the bladder after giving birth can be a challenge. Despite having a full bladder, a person might sit down and just release drops, if that. Sometimes there is a feeling that urine is left over inside the bladder. Some studies suggest that about 10% of vaginal births are affected by bladder voiding dysfunction (Perú Biurrun et al., 2020). Here are some of my top tips as a pelvic floor physical therapist to support voiding after giving birth. 

Understanding the issue 

There are a few reasons why urine can be difficult to release postpartum. Sometimes fear of discomfort can cause people to involuntarily clench their pelvic floor muscles, which in turn holds back urine. The way that birth unfolds can also lead to an increased chance of difficulty with bladder emptying. For example, pushing for more than 60 minutes increases the odds of urinary retention (Barba et al., 2021). Any perineal tearing also increases the odds of voiding problems, as does the use of forceps or a vacuum (Hosakoppal et al., 2022). Inductions and epidural use, including a delay or failure to facilitate urine removal after epidural placement, are tied to greater odds of urinary retention postpartum, too (Barba et al., 2021; Dolezal et al., 2022).

1. Get in position 

The pelvic floor muscles hold our bladder up and help control when we keep urine inside and when we let it go. The pelvic floor muscles need to be relaxed in order for us to release urine. Being in a proper posture for urinating can help to lengthen and relax the pelvic floor muscles. Try this next time you are on the toilet: 

1. Plant your feet firmly on the ground. Being on tippy toes and lifting the heels up can cause the pelvic floor muscles to tense up, resulting in urine staying in. 
2. Lean forward. You might even rest your elbows on your thighs. 

Bonus tip: Having support under your feet can help the pelvic floor muscles length and relax further. Some people find it helpful to use a product such as a Squatty Potty. 

Note: Avoid hovering! Hovering over a toilet causes the pelvic floor muscles to contract. As a result, some urine may stay left over in the bladder. Try to sit down on the toilet seat when possible. 

2. Breathe

In addition to having good toilet posture, breathing helps us to release urine. Sometimes three gentle belly breaths are enough to get the stream started. Tip: place your hands on your belly so you can feel the expansion as you breathe in. 

3. Make some noise

If belly breaths don’t do the trick, there are more advanced breathing techniques for lengthening the pelvic floor. Here’s one I like to teach my clients:

1. Breathe IN and expand your belly big – imagine you swallowed a beach ball
2. While keeping your belly out and hard, make a GRRRR, MMMM, or SHHHH sound. These vocalizations provide a nudge of pressure down towards the bladder to encourage urine to empty.  

This trick bulges the pelvic floor while ensuring that you are still breathing. Trying to push urine out while holding your breath can lead too much pressure downward on the pelvic floor—and this can cause perineal stitches to come undone! Overtime, too much pressure can also lead to pelvic organ prolapse, which is when the pelvic organs shift downward in the pelvis. 

IMPORTANT: If you cannot empty your bladder without holding your breath and straining, reach out to your medical team. There may be a health reason you cannot empty, such an injured nerve or neurological condition. If needed, your medical team can also refer you to a pelvic health therapist for training in more easily emptying your bladder. 

4. Grab a straw!

Blowing through a straw while sitting on the toilet is an excellent trick to help get the urine flow started. There are several ways to try it out:  

1. Simply blow through a straw for long 8-second exhales while you sit on the toilet. 
2. Fill a cup with water. Stick a straw in the water. Blow bubbles in the water while you sit on the toilet. 
3. Find a skinny straw. Some people think that thin coffee straws work the best. 

5. Toothbrushes aren’t just for teeth 

The bladder is a muscular sack. It needs to squeeze urine out for complete emptying. If the bladder is not squeezing hard enough, urine can stay stuck inside. One way to get the bladder to squeeze harder is to add vibration (Dasgupta et al, 1997). Many people find that they can place a vibrating toothbrush just above the pubic bone while sitting on the toilet to encourage the bladder to release urine. 

6. Peppermint, coffee, and water 

One small study suggested that half a milliliter of peppermint oil placed in a urine collection device (also known as a “hat”) or commode basin could improve the ease of voiding (Phillips, 1998). Peppermint patches on clothing may also be helpful with getting voiding going (Fryatt & Bell, 2020).

Coffee has been shown to improve bladder emptying after some surgeries, although specific research has not been done regarding following Cesareans (Jackson et al., 2019). If it’s safe for someone to drink coffee after a Cesarean, it’s worth a try.

Bonus tip: Coffee consumption can help speed up the first bowel movement after a Cesarean, as well as speed up the time to tolerating eating solid food (Bozkurt et al., 2020). 

A recent study in China, looked at water consumption and cues for bladder emptying after vaginal delivery. People in the treatment group had a 5.67% incidence of urinary retention, compared to 14.67% in the control group (Cui et al., 2022). Here is the drinking schedule they used: 

• During labor: Drink water regularly and void bladder every 2 to 4 hours 
• 30 minutes after birth: drink 300 to 500 mL of warm water 
• 60 minutes after birth: drink 200 to 300 mL of warm water again 
• 90 minutes after birth: sit on the toilet to void, with assistance of running water sound or warm water in peri bottle if needed 

Conclusion

Voiding urine after giving birth is important for both comfort and to reduce the likelihood of hemorrhage (Downey et al., 2019). The uterus contracts as it begins to return to its  pre-pregnancy state, which helps control excessive bleeding.  For some people, it can be difficult to urinate after giving birth for a variety of reasons. Sharing these tips can help people to start urinating again and offers some simple and accessible solutions that can facilitate postpartum recovery and reduce stress.

References 

Barba, M., Frigerio, M., Manodoro, S., Bernasconi, D.P., Cola, A., Palmieri, S., ... & Vergani, P. (2021). Postpartum urinary retention: Absolute risk prediction model. Lower urinary tract symptoms, 13(2), 257-63.

Bozkurt Koseoglu, S., Korkmaz Toker, M., Gokbel, I., Celikkol, O., & Gungorduk, K. (2020). Can coffee consumption be used to accelerate the recovery of bowel function after cesarean section? Randomized prospective trial. Ginekologia polska, 91(2), 85-90.

Cui, G., Zhang, Y., Liu, Z., Li, X., & Sha, M. (2022). Effect of Predictive Nursing Combined with Early Drinking Water Therapy on Patients with Urinary Retention after Vaginal Delivery. Computational and mathematical methods in medicine, 2022, 4204762.

Dasgupta, P., Haslam, C., Goodwin, R., & Fowler, C.J. (1997). The 'Queen Square bladder stimulator': a device for assisting emptying of the neurogenic bladder. British journal of urology, 80(2), 234-7.

Dolezal, P., Ostatnikova, M., Balazovjechova, B., Psenkova, P., & Zahumensky, J. (2022). Covert postpartum urinary retention: causes and consequences (PAREZ study). International urogynecology journal, 33(8), 2307-14.

Downey, J., Kruse, D., & Plonczynski, D.J. (2019). Nurses Reduce Epidural-Related Urinary Retention and Postpartum Hemorrhages. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses, 34(1), 206-10.

Fryatt, J., & Bell, P. (2020). Effect of Peppermint Oil on Postoperative Urinary Retention. Journal of pediatric nursing, 51, 116-8.

Hosakoppal, S., Brown, O., & Peaceman, A. (2022). Postpartum urinary retention after the institution of a universal voiding protocol. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine. the Federation of Asia and Oceania Perinatal Societies. the International Society of Perinatal Obstetricians. doi:10.1080/14767058.2022.2122800

Jackson, J., Davies, P., Leggett, N., Nugawela, M.D., Scott, L.J., Leach, V., ... & Whiting, P. (2019). Systematic review of interventions for the prevention and treatment of postoperative urinary retention. BJS open, 3(1), 11-23.

Perú Biurrun, G., Gonzalez-Díaz, E., Fernández Fernández, C., & Fernández Corona, A. (2020). Post Partum Urinary Retention and Related Risk Factors. Urology, 143, 97-102.

Phillips, S. (1998). Use of Peppermint Oil to Promote Urination in Women Experiencing Postoperative Urinary Retention. [Master’s thesis, Kansas University]. KU ScholarWorks. https://kuscholarworks.ku.edu/handle/1808/27708

Stairs, J., Rolnik, D.L., Pascali, D., & Clancy, A. (2022). Association between obstetrical anal sphincter injury and postpartum urinary retention: a contemporary nationwide cohort study. International urogynecology journal. doi:10.1007/s00192-022-05346-8

About Ken McGee

Ken McGee, PT, DPT, (they/them) is a transgender physical therapist and birth doula based in Seattle. Their practice centers the experience of queer people during birth and gender transition. You can reach Ken through their website.

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