Childbirth educators spend a great deal of time preparing families for labor, birth, infant feeding, and newborn care. Yet one common aspect of postpartum recovery is often overlooked: bladder function.

Most new parents expect urination to return to normal immediately after birth. Instead, the first several hours, and sometimes the first few days, can bring unexpected changes. Swelling, perineal discomfort, pelvic floor stretching, epidural analgesia, fluid shifts, and temporary changes in bladder sensation can all make emptying the bladder more difficult. While these changes are usually temporary, understanding what to expect and when something deserves medical attention can help families feel more prepared during this important transition.

While childbirth educators are not responsible for diagnosing or treating bladder dysfunction, we can ensure families understand what is normal, recognize warning signs, and know when to seek support.

Understanding Postpartum Urinary Retention

One of the most common bladder concerns after birth is postpartum urinary retention (PUR), difficulty emptying the bladder after delivery.

The reported incidence of postpartum urinary retention varies because researchers use different definitions and methods of measurement, but studies suggest that approximately 10% of people who give birth vaginally experience some degree of bladder emptying difficulty (Perú Biurrun et al., 2020).

PUR may be overt, meaning a person is unable to urinate despite having a full bladder, or covert, meaning they can urinate but still retain a significant amount of urine afterward (Doležal et al., 2022). Although most cases resolve without long-term complications, prolonged bladder overdistension can impair bladder muscle function and delay recovery, making early recognition and management important (Mulder et al., 2018).

Why Can It Be Difficult to Empty the Bladder?

Normal urination depends on coordinated communication between the bladder, pelvic floor muscles, and nervous system. The bladder muscle contracts while the pelvic floor muscles relax, allowing urine to pass comfortably. Following childbirth, that coordination may be temporarily disrupted by the normal physiologic effects of labor and birth.

Several factors have been associated with an increased likelihood of postpartum urinary retention:

• Epidural analgesia

Epidural analgesia can temporarily reduce bladder sensation, making it more difficult to recognize when the bladder is full. Delayed bladder emptying increases the risk of bladder overdistension and postpartum urinary retention (Barba et al., 2021; Doležal et al., 2022).

• Prolonged pushing

A prolonged second stage of labor places sustained pressure on the pelvic floor, surrounding tissues, and nerves involved in bladder function. Barba and colleagues (2021) found that pushing for more than 60 minutes was associated with an increased likelihood of postpartum urinary retention.

• Perineal trauma

Swelling, bruising, perineal tears, and obstetric anal sphincter injuries can make relaxing the pelvic floor more difficult and are associated with increased risk of postpartum urinary retention (Hosakoppal et al., 2022; Stairs et al., 2022).

• Operative vaginal birth

Forceps- and vacuum-assisted births are also associated with higher rates of postpartum urinary retention, likely because they are more frequently accompanied by pelvic floor trauma and swelling (Hosakoppal et al., 2022).

It is important to remember that these are risk factors, not guarantees. Many people with one or more of these experiences recover normal bladder function without difficulty.

What Should Families Expect?

Many families are surprised when nurses encourage them to urinate soon after birth, even before they feel a strong urge. This recommendation is not simply about comfort. In the immediate postpartum period, healthcare providers frequently monitor bladder function because an overdistended bladder can interfere with uterine assessment and effective uterine contraction (ACOG, 2018; WHO, 2025).

As recovery continues at home, bladder function gradually returns to normal for most people. During the first day or two after birth, it is common to experience:

• increased urination as the body eliminates excess pregnancy fluid
• temporary changes in bladder sensation, particularly after epidural analgesia
• soreness related to swelling, stitches, or bruising
• hesitation to urinate because of discomfort
• needing a little longer than usual to begin the flow of urine

These temporary changes are a normal part of recovery for many families. However, bladder function should gradually improve, not become more difficult or remain unchanged.

Encourage families to contact their healthcare provider if they experience:

• inability to urinate
• only passing a few drops of urine
• persistent bladder fullness after urinating
• increasing lower abdominal pain or pressure
• symptoms that are worsening rather than improving
• concern that something simply doesn't feel right

Remember: postpartum urinary retention is not always obvious. Some people can urinate while still retaining a significant amount of urine in the bladder, which is why persistent symptoms deserve evaluation rather than reassurance alone (Doležal et al., 2022).

Supporting Normal Bladder Recovery

Childbirth educators can encourage parents to utilize comfort measures in those early days.

Simple comfort measures that may support relaxation include:

• sitting fully on the toilet rather than hovering
• taking slow, relaxed breaths
• using a warm peri bottle if urination is uncomfortable
• allowing adequate privacy and time instead of feeling rushed
• staying hydrated and responding to the urge to urinate rather than routinely delaying voiding

These strategies are intended to promote comfort and relaxation rather than treat postpartum urinary retention. Early recognition is important because prolonged bladder overdistension can impair bladder function and delay recovery (Mulder et al., 2018; Doležal et al., 2022).

Key Takeaways

Preparing families for postpartum bladder changes does not require an in-depth lesson on pelvic floor rehabilitation. A brief conversation can normalize an experience that many people find surprising and help families recognize when to seek support.

Key teaching points include:

• bladder function may feel different after birth, particularly after a long labor or epidural analgesia
• some birth experiences increase the likelihood of temporary bladder difficulties
• healthcare providers frequently assess bladder function as part of postpartum care
• persistent difficulty emptying the bladder is not normal and deserves medical attention
• asking for help is part of normal postpartum recovery—not something to feel embarrassed about

Conclusion

Childbirth educators already prepare families for postpartum bleeding, bowel function, infant feeding, and emotional recovery. Bladder health deserves a place in those conversations as well.

Most postpartum bladder changes resolve as the body heals, but preparing families for what to expect and when to seek help can reduce anxiety and encourage timely communication with healthcare providers. A few minutes spent discussing bladder recovery reinforces an important message: postpartum care includes caring for the person who gave birth, not only the newborn.

References

American College of Obstetricians and Gynecologists. (2018). Optimizing postpartum care. Committee Opinion No. 736. Obstetrics & Gynecology, 131(5), e140–e150.

Barba, M., Frigerio, M., Manodoro, S., Bernasconi, D. P., Cola, A., Palmieri, S., et al. (2021). Postpartum urinary retention: Absolute risk prediction model. Lower Urinary Tract Symptoms, 13(2), 257–263.

Doležal, P., Ostatníková, M., Balážovjechová, B., Pšenková, P., & Zahumenský, J. (2022). Covert postpartum urinary retention: Causes and consequences (PAREZ study). International Urogynecology Journal, 33, 2307–2314.

Hosakoppal, S., Brown, O., & Peaceman, A. (2022). Postpartum urinary retention after the institution of a universal voiding protocol. Journal of Maternal-Fetal & Neonatal Medicine.

Mulder, F. E. M., Oude Rengerink, K., van der Post, J. A. M., Hakvoort, R. A., & Roovers, J. P. W. R. (2018). Postpartum urinary retention: A systematic review of adverse effects and management. International Urogynecology Journal, 29, 1605–1612.

Perú Biurrun, G., González-Díaz, E., Fernández Fernández, C., & Fernández Corona, A. (2020). Postpartum urinary retention and related risk factors. Urology, 143, 97–102.

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.

World Health Organization. (2025). Consolidated guideline for the prevention, diagnosis and treatment of postpartum haemorrhage. World Health Organization.

 

 

 

Published: August 06, 2026

Tags

PostpartumResearchKen McGeeSeries: The Body in Birth