[20F] Postpartum with urinary urgency and pelvic pressure

Patient Description

A 20-year-old female, 6 weeks postpartum, reports experiencing a sudden onset of frequent and urgent need to urinate over the past two days. When attempting to urinate, the flow is extremely fast but stops abruptly, causing pain and a sensation of incomplete emptying. The patient also describes an immense amount of pelvic pressure and throbbing when sitting on the toilet, which has been ongoing for about 2-3 weeks. Additionally, she has had difficulty starting to urinate for the past three weeks. Following childbirth, she experienced a UTI, a kidney stone, and a hematoma, but recent follow-up indicated no current UTI. There has been no follow-up imaging for the kidney stone or hematoma. The patient denies any blood in the urine, fever, burning sensation during urination, lower back pain, or flank pain. She is experiencing lochia but no changes in her menstrual cycle or unusual vaginal discharge. The patient is not on any medications and has no pre-existing conditions or chronic illnesses.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  1. Urinary Tract Infection (UTI):

    • Rationale: UTIs are common postpartum and can cause symptoms like frequent urination, urgency, and pain during urination. However, you mentioned that you were told you do not currently have a UTI.
    • Typical Treatments/Testing: A urine test to check for bacteria, and if confirmed, antibiotics are usually prescribed.
  2. Postpartum Urinary Retention:

    • Rationale: This condition can occur after childbirth and may cause difficulty starting urination, a feeling of incomplete emptying, and pelvic pressure.
    • Typical Treatments/Testing: A physical exam and possibly a bladder scan to measure residual urine volume. Treatment may include bladder training exercises or, in some cases, catheterization.
  3. Kidney Stones:

    • Rationale: Given your history of a kidney stone, it's possible that another stone could be causing urinary symptoms and pelvic pressure.
    • Typical Treatments/Testing: Imaging tests like an ultrasound or CT scan to detect stones. Treatment may include pain management, increased fluid intake, or procedures to remove the stone.
  4. Pelvic Floor Dysfunction:

    • Rationale: Childbirth can weaken the pelvic floor muscles, leading to symptoms like pelvic pressure, difficulty urinating, and a feeling of incomplete emptying.
    • Typical Treatments/Testing: A pelvic exam and possibly referral to a pelvic floor specialist. Treatment may include pelvic floor physical therapy.

What you can do

Frequent and painful urination:

  • See a doctor: Given the severity and sudden onset of your symptoms, it's important to see a healthcare provider as soon as possible. They may perform a urine test, physical exam, or imaging to determine the cause.
  • Stay hydrated: Drink plenty of water to help flush out your urinary system.
  • Avoid irritants: Avoid caffeine, alcohol, and spicy foods, which can irritate the bladder.

Pelvic pressure and difficulty urinating:

  • Pelvic floor exercises: Try doing Kegel exercises to strengthen your pelvic floor muscles. These can help improve bladder control.
  • Warm baths: Taking a warm bath may help relax your pelvic muscles and relieve pressure.
  • Bladder training: Try to urinate at regular intervals, even if you don't feel the urge, to help train your bladder.

General postpartum care:

  • Follow-up appointments: Make sure to attend any scheduled follow-up appointments with your healthcare provider to monitor your recovery and address any ongoing issues.
  • Rest and recovery: Ensure you are getting enough rest and allowing your body to recover from childbirth.

What you should look out for

Given the complexity of your symptoms and recent postpartum status, it's important to seek medical care promptly. Reasons to seek care even more urgently include:

  • Fever or chills: These could indicate an infection.
  • Severe pain: Especially in your lower back or sides, which could suggest a kidney stone or other serious issue.
  • Blood in urine: This could be a sign of a more serious condition.
  • Inability to urinate: If you are unable to urinate at all, seek immediate medical attention.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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6 mo ago

People Also Ask


What are common causes of frequent and urgent urination postpartum?

Common causes of frequent and urgent urination postpartum include urinary tract infections, postpartum urinary retention, and pelvic floor dysfunction. It's important to consult a healthcare provider to determine the exact cause.


How can postpartum urinary retention be managed?

Postpartum urinary retention can be managed through bladder training exercises, pelvic floor exercises, and in some cases, catheterization. A healthcare provider may also perform a bladder scan to assess residual urine volume.


What are the symptoms of pelvic floor dysfunction after childbirth?

Symptoms of pelvic floor dysfunction after childbirth can include pelvic pressure, difficulty urinating, a sensation of incomplete bladder emptying, and sometimes pain. Treatment often involves pelvic floor physical therapy.


How can kidney stones affect urination postpartum?

Kidney stones can cause symptoms such as severe pain, frequent urination, urgency, and pelvic pressure. They may require imaging tests for diagnosis and treatments like increased fluid intake, pain management, or medical procedures to remove the stones.


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