Abstract
Background: There is a lack of consensus on best practice for management of postpartum urinary retention (PUR) including and beyond medication, intermittent self-catheterization (ISC), and suprapubic catheterization. Furthermore, there is scant evidence and discussion in the literature regarding the role of physical therapy for PUR. Thus, the purpose of this case report is to evaluate the implementation and outcomes of multimodal physical therapy interventions, with a focus on manual therapy, for PUR.
Case Description: A 35-year-old woman presented with overt prolonged PUR at 22 days postpartum. She was unable to void and needed to perform ISC 8 times per day. Primary examination findings were significant for pelvic floor muscle spasm and incoordination, as well as perineal scar hypersensitivity and hypomobility. Eighteen physical therapy visits utilizing multimodal interventions were completed.
Outcomes: The patient's Female NIH-Chronic Prostatitis Symptom Index scores improved during the course of physical therapy, and were further improved at 5 months of follow-up. During the course of physical therapy, the patient-reported postvoid residual volume and frequency of ISC per 24 hours both decreased. The patient was able to discontinue ISC completely at 15 weeks postpartum and did not need to perform ISC between 15 weeks postpartum and 5-months of follow-up after physical therapy.
Discussion: A multimodal approach with an emphasis on manual therapy is an effective intervention for managing prolonged PUR.
Informed Consent: The patient consented to evaluation and treatment, and participation in this case report.