3 Urinary Retention and Integrated Postoperative Risk Review

Recognize urinary retention

Postoperative urinary retention (POUR) is difficulty emptying the bladder after surgery. Anesthesia, some pain medicines, immobility, and the effects of surgery can interfere with normal urination.

A patient may report being unable to urinate, passing frequent small amounts, or feeling pressure or discomfort in the lower abdomen. Retention can also occur without obvious discomfort, so assess voiding and follow the care team’s monitoring plan.

Assess and respond safely

Assessment may include asking when the patient last urinated, measuring urine output, checking for bladder fullness, and using a bladder scan to estimate bladder volume or postvoid residual. The scan can help determine whether catheterization is needed.

Follow facility protocol and provider orders because assessment thresholds and interventions vary. When catheterization is indicated, use the least invasive appropriate method. Remove indwelling catheters as soon as they are no longer needed because catheters can increase infection risk.

If a patient cannot urinate, assess the voiding history and symptoms and follow the organization’s assessment and escalation protocol. Do not assume the problem is harmless, encourage forceful straining, restrict fluids without clinical direction, or catheterize without an appropriate indication and an order or authorization under protocol.

Identify bleeding and infection concerns

Watch for persistent or increasing bleeding, a rapidly enlarging stain on a dressing, weakness, dizziness, or faintness. Report concerning bleeding promptly; severe bleeding or collapse requires an emergency response.

A surgical-site infection may be indicated by increasing redness or pain at the incision, drainage, or fever. Confusion, clammy skin, severe discomfort, rapid breathing, or shortness of breath may indicate a serious systemic response such as sepsis and requires urgent evaluation.

Recognize breathing and clotting risks

Anesthesia, pain, shallow breathing, and immobility can contribute to lung complications. When appropriate for the patient’s condition, follow instructions for getting upright, moving, coughing, and taking deep breaths. New or worsening shortness of breath or sharp pain with breathing needs prompt evaluation.

Deep vein thrombosis (DVT) may cause swelling, warmth, redness, or pain in one limb. Report these symptoms promptly for evaluation; do not massage a suspected clot. Use prescribed movement, compression devices, or medication as directed.

A clot that travels to the lungs can cause a pulmonary embolism (PE). Warning signs include sudden difficulty breathing, chest pain, a rapid or irregular heartbeat, or coughing blood. Suspected PE is an emergency.

Monitor wounds and other postoperative effects

Contact the surgical team promptly about increasing wound swelling or bleeding, a wound that opens or deepens, or new or worsening pain. Follow the surgeon’s specific wound-care instructions.

Pain medicines and anesthesia may contribute to nausea, constipation, drowsiness, or falls. A patient who feels weak or dizzy should ask for help before getting up, and medicines should be taken only as directed.

Across postoperative recovery, follow the patient’s orders and discharge instructions, monitor for changes, and escalate urgent warning signs promptly.