Postpartum urinary retention

　　There are many reasons for postpartum urinary retention in pregnant women, mainly because the uterus compresses the bladder and pelvic nerve plexus during the delivery process, causing bladder muscle paralysis and slow, weak movement; the sudden drop in intrapelvic pressure after delivery causes blood stasis in the pelvis; in addition, the long labor process leads to a large consumption of physical strength, resulting in difficulty in urination. Specifically, there are the following several types:

　　(1) Wound pain, which can reflexively inhibit the micturition action, causing spasm of the urethral sphincter, leading to difficulties in urination.

　　(2) Poor bladder tone, insensitivity. After childbirth, the abdominal wall is relaxed, and the bladder tone decreases. The more and longer the urine retention in the bladder, the poorer the sensitivity and contractility of the bladder, forming a vicious cycle.

　　(3) Edema and congestion of the bladder mucosa, forming ecchymosis or bleeding.

　　(4) Cystitis: During the delivery process, catheterization can lead to bacterial infection in the bladder due to the inability to expel urine in time, which can aggravate urinary retention.

　　(5) Psychological factors: Changes in environment, anxiety, fear, fear, pain, and psychological tension.

　　(6) Habitual factors: Changes in environment, limited personal space, not being accustomed to defecating in bed, excessive tension, and being unable to urinate smoothly.

　　(7) Decreased water intake: Insufficient intake, with large amounts of sweat and body fluids excreted, causing difficulties in urination.

　　Women with postpartum urinary retention symptoms not only have uterine contraction affected, but also may lead to increased vaginal bleeding. Urinary retention is also one of the important factors causing postpartum urinary system infection. Due to the inability to eliminate urine or limited excretion of urine, new diseases may occur, common situations include the following two cases:

　　2. Secondary urinary tract infection: Due to the favorable conditions for bacterial proliferation caused by urinary retention, it is easy to develop urinary tract infections, which are difficult to cure and tend to recur, accelerating the deterioration of renal function. For example, patients with benign prostatic hyperplasia in men and women with urethral stricture often have partial urinary retention, but they do not have subjective urinary obstruction. For such patients, early diagnosis and treatment, clearing residual urine, effectively controlling urinary tract infections, and protecting renal function are necessary.

　　1. Secondary reflux nephropathy: Due to increased intravesical pressure caused by urinary retention, urine flows back along the ureter, causing renal pelvis effusion. Subsequently, the renal parenchyma is compressed and ischemic, even necrotic, eventually leading to chronic renal insufficiency.

　　Although postpartum urinary retention is just a minor symptom that may occur after childbirth, if it is not treated in a timely manner, it can easily lead to serious complications and severe consequences. Although the symptoms are minor, they should not be neglected, and immediate measures should be taken upon discovery.

　　Postpartum urinary retention can be divided into acute urinary retention and chronic urinary retention.

　　1. Acute urinary retention

　　The symptoms include acute bladder distension that cannot be voided, often accompanied by pain and anxiety caused by a strong desire to urinate.

　　2. Chronic urinary retention

　　The symptoms include frequent urination, a feeling of incomplete urination, abdominal distension and discomfort, and may even lead to overflow incontinence. Ultrasound examination suggests an increase in residual urine in the bladder.

　　Generally, postpartum women can urinate on their own within 4 to 6 hours after a normal delivery. If they still cannot urinate normally for a long time after delivery and have a feeling of bladder distension, the woman is likely to have developed urinary retention. There are many factors that can trigger postpartum urinary retention, and the following will introduce several possible factors that can cause this symptom, as well as the corresponding methods of treatment.

　　1. Fear of urination

　　New mothers after childbirth may be afraid of pain due to vulvar trauma and dare not urinate with force, leading to urinary retention.

　　Response: In this case, family members should first help the new mother to eliminate various concerns, guide her step by step, and encourage her to get out of bed and urinate.

　　2. Abdominal relaxation

　　Due to the persistent expansion of the abdominal wall during pregnancy, it becomes relaxed after childbirth, the abdominal pressure decreases, and it is无力排尿.

　　Response: If pregnant women exercise more and strengthen abdominal muscle training during pregnancy, they can at least reduce the possibility of this kind of disease to some extent.

　　3. Use of drugs

　　The use of large doses of antispasmodic and tranquilizing drugs before or during childbirth, such as the use of magnesium sulfate and atropine-like drugs for preeclampsia, can reduce bladder tension and cause urinary retention.

　　Response: If this is the case, moderate medication can completely allow the mother to avoid urinary retention.

　　4. Dysfunction of bladder nerve function

　　Postpartum perineal lateral incision or perineal laceration causes trauma and pain to the vulva, leading to dysfunction of the nerves that control the bladder, and reflexively causing spasms of the bladder sphincter, resulting in postpartum urinary retention.

　　Response: If the new mother finds that she has urinary retention, she should seek medical help in a timely manner and should not ignore it. Generally, drinking more water at home and using simple auxiliary methods can help alleviate urinary retention.

　　In the diagnosis of postpartum urinary retention, in addition to relying on its clinical manifestations, auxiliary examinations are also needed. The main examination methods include the following:

    1. Abdominal X-ray shows excessive bladder distension, and this is used to diagnose the presence of urinary tract stones.

　　2. Urinalysis can detect a small amount of red blood cells and bacterial colonies.

　　1. Drink more water, maintain at least 1500 milliliters of urine output per day.

　　2. Eat more diuretic foods, such as watermelons, grapes, pineapples, celery, pears, etc.

　　3. Clams, corn, mung beans, and white scallions can help alleviate symptoms such as frequent urination, urgency, and pain.

　　4. Avoid eating sour and spicy刺激性 food, such as strong alcohol, chili, vinegar, sour fruits, etc.

　　5. Avoid eating citrus fruits because they can cause alkaline urine, which is conducive to bacterial growth.

　　6. Caffeine can cause the bladder neck to contract and lead to spasmodic pain in the bladder, so one should drink less coffee.

　　Traditional Chinese medicine believes that the main pathogenesis of postpartum urinary retention is the disorder of bladder Qi transformation. This symptom is mainly caused by the following four aspects.

　　Deficiency of Qi: Due to inherent weakness, labor during childbirth may injure Qi, or excessive blood loss, resulting in consumption of Qi with blood, leading to deficiency of lung and spleen Qi, the upper part being unable to control the lower, and the waterway cannot be smoothly regulated, resulting in the bladder Qi transformation being unsmooth and leading to difficulty in urination.

　　Kidney deficiency: Due to insufficient congenital endowment and constant deficiency of kidney Qi, further damage to kidney Qi during childbirth, insufficient kidney Yang, decline of the gate of life fire, and loss of warmth in the bladder, the gas transformation is not smooth, leading to difficulty in urination.

　　Liver depression: Chronic depression, postpartum emotional frustration, liver Qi depression, Qi stagnation, and不利of bladder Qi transformation leading to dysuria.

　　Blood stasis: Prolonged labor, prolonged pressure on the bladder, unsmooth flow of Qi and blood, and不利of bladder Qi transformation leading to dysuria.

　　According to different causes, traditional Chinese medicine adopts differential treatment and prescribes medicine according to symptoms.

　　1. Qi Deficiency

　　Syndrome: Postpartum dysuria, acute pain and distension in the lower abdomen, fatigue, lack of energy, low voice, pale complexion, and low speech; pale tongue, thin white fur, slow and weak pulse.

　　Treatment method: Invigorating qi and clearing heat, transforming qi and promoting diuresis.

　　Prescription: Qi-tonifying and Diuretic Drink. Main drugs: Astragalus, Maidong, Tongcao. If the parturient has excessive sweating, thirst, dry throat, add Shudihuang, Shashen, Shihu, and Wuweiizi; if accompanied by soreness and weakness in the lower back and knees, add Duzhong and Baizhitai.

　　2. Kidney Deficiency

　　Syndrome: Postpartum dysuria, acute pain and distension in the lower abdomen, soreness and weakness in the lower back and knees, and dark complexion; pale tongue, thin, moist fur, slow and weak pulse.

　　Treatment method: Tonifying the kidney and warming the yang, transforming qi and promoting diuresis.

　　Prescription: Jisheng Shenqi Pill. Main drugs: Prepared Aconitum, Fuling, Zhishai, Shanyao, Cheqianzi, Mudanpi, Guizhi, Chuan Niuxi, Shudihuang.

　　For those with a heavy sensation in the lower abdomen, add Astragalus, Dangshen, Baizhu, and Cimicifuga; if there is severe lumbar pain, add Baizhitai, Stir-fried Duzhong, and Xu Duan.

　　3. Qi Stagnation

　　Syndrome: Postpartum dysuria, acute pain and distension in the lower abdomen, depression, or chest and rib胀痛, restless and uncomfortable; normal tongue fur, wiry pulse.

　　Treatment method: Regulating qi and promoting the flow of qi, promoting diuresis and urination.

　　Prescription: Mutong Powder. Main drugs: Zhizi, Binglang, Mutong, Huashi, Dongkuizi, Gancao. For those with wood overcoming earth, insufficient intake and loose stools, add Baizhu, Fuling, Yiyiren, Muxiang, and Baishao.

　　4. Blood Stasis

　　Syndrome: Postpartum dysuria or dribbling, distension and sharp pain in the lower abdomen; sudden chills and fever; dark tongue, thin white fur, deep and涩脉.

　　Treatment method: Nourishing blood and activating blood, removing blood stasis and promoting diuresis.

　　Prescription: Modified Four Herbs Decoction. Main drugs: Prepared Rehmannia, White Peony, Angelica Sinensis, Chuanxiong, Pohuashou, Huai麦, Taoren, Niuxi, Huashi, Gancao, Muxiang, Mutong.

　　Acupuncture treatment is used, taking points such as Huiyin, Zhongjuxu, Zhibian, Zhongji, Guanyuan, and Qugu. Adding electroacupuncture, 1-2 times, can be effective.