Postpartum bladder dysfunction

The development of postpartum urinary symptoms such as incontinence and voiding dysfunction are not uncommon and often difficult to resolve. The urinary tract undergoes both structural and functional changes during pregnancy and after delivery. These changes may be specific in response to pregnancy and in some women may be compounded by pathological changes that persist after delivery. In labour, factors such as prolonged labour, assisted vaginal delivery, and perineal laceration have been associated with development of bladder dysfunction. Anatomical and functional changes to the pelvic floor may occur secondary to pelvic floor distension during descent of the fetal head and maternal expulsive efforts during the active second stage of labour. This chapter focuses on the effect of pregnancy and childbirth on the lower urinary tract and discusses the possible mechanisms by which pelvic floor damage may occur and their long-term sequelae and management.