Urinary retention/ incarcerated uterus - unable to pee

[Sandykk89]

Hi, im currently 14 weeks pregnant with my second baby. Out of the blue, I woke up one morning and realised that I couldn't pee despite an excruciating urge to go. After numerous attempts and drinking water, I went to A&E. They performed a bladder scan which indicated that there was 900mls in my bladder, so they inserted a cathetar. Initial bloods and urine sample did not indicate a UTI, but ive been given a short course of antibiotics as a precaution.

Having been discharged with no answers, Ive found myself goggling and wondering if I have an incarcerated uterus. On a readmission to A&E I've asked about this with very little feedback. Despite several requests for an abdominal ultrasound ive been ive been refused on the basis on the basis that it's not necessary as the "issue" has been resolved by the cathetar. All i want to know is whether the baby is OK.

I'm based in the UK and im wondering if anyone has had any similar experiences and how they advocated? Ive read posts about obstetricians manually moving the uterus but cant find any examples in the UK.

Have you seen an obs/gynae doctor? This sounds pretty suboptimal care to be honest - you’re right that it may be an incarcerated retroverted uterus. Either way it’s not at all normal to suddenly be in retention so they shouldn’t be fobbing you off, they should be trying to find out why this has happened. USS will likely provide the answer. Traditionally if it’s the uterus causing the problem you’ll outgrow the issue (as the uterus gets bigger it’ll come out of the pelvis). There is some stuff out there about changing the position of the uterus either manually or using a transvaginal USS probe but I’m not up to date on what the optimal management is.

either way - you’re right it should be addressed better than this - maybe you can ask your midwife or GP to contact o&g team and arrange review rather than going back through A&E?

For context

"Uterine incarceration is a rare complication. It leads to increased maternal and/or fetal morbidity and mortality. Risk factors include retroversion of uterus and other pelvic abnormalities. Clinical presentation includes severe abdominal and pelvic pain symptoms. Patients can present with concurrent urinary symptoms due to increasing distortion of adjacent structures from the enlarging uterus. A high clinical suspicion of uterine incarceration is confirmed with ultrasound. More advanced imaging such as MRI can be used as an adjunct to ultrasound imaging."

Why does the nhs refuse to scan me?!

Hi,
Yes I had the same earlier this year and was unable to pee at 16 weeks. I had an at home catheter for a week. Once that was taken out, I was fine and able to pee again. 29 weeks pregnant now and I haven't had any more problems, baby doing fine.
They didn't investigate the cause very much. Apparently it's just something which can happen around that stage of pregnancy before your uterus shifts and gives the baby more space.
Good luck, I hope you don't have any further issues.

I literally begged to talk to gynae yesterday. I spoke to the gynae registrar and she said that there's no clinical reason to do an ultrasound, on the basis that it wouldn't change the care they're giving me. I mentioned about changing the position of the uterus and her response was that this is so unusual that's it's unlikely anyone in the Trust will have such experience. For context, this is one of the largest trusts in the UK , university hospitals birmingham!

To be fair to her, she called the maternity ward and asked if they would scan me and they refused. Apparently there's no protocol or guidance on how to manage this, so they just take the easiest option.

Ive found an obstetrician in Bristol who wrote an article in BMJ on this and have asked for help. I'm literally trying all avenues.

Any help on how to advocate would be much h appreciated!

Isn't it mad that they don't investigate?! Surely knowing the cause helps you and them. If we knew what if was, we could manage it and ultimately put less stress on the NHS.

Did they do an ultrasound for you?

How frustrating for you OP. I would say don’t get too too worried at this stage about all the rarer complications, as PP experienced as well it does usually sort itself out rather than becoming trapped - I guess that’s why it’s not so common to manually move it (I believe that option is used in some cases only where it doesn’t come right by itself). Have they given you a plan at least for when you can go back and have the catheter taken out?

Yes, they did do an ultrasound but couldn't see any issues with my bladder as baby was in the way. To be honest I didn't push too much to figure out the cause, I was just grateful to be able to pee again! As I say, everything has been absolutely fine since and hopefully will be for you too. The hospital were very chilled about it, just said it's one of those weird things that can happen during pregnancy and usually sorts itself out.

Ive managed to get through to the urology team and the next available appointment they have for me to take the cathetar out is 1st September! That would mean having a cathetar in place for 5 weeks. Surely this is mad?

That sounds strange. The catheter I had (indwelling) was removed after a week and removal took about 2 mins. Then I stayed in hospital for the day drinking water to make sure I could pass urine again normally before they let me go home.

That's what i have but apparently the next available appointment in the clinic is 1st September! Arrghhh

If you have had a baby already any abnormalities of the uterus or pelvis would have been found surely. Have you got severe abdominal and pelvic pain or just water retention? Sounds like you are jumping to the most unlikely scenario unless there is more you are not telling.

Can they arrange for your GP nurse to take it out? You would have to make sure you can pee afterwards so they may be reluctant and if you couldn't you would have to go back to the hospital.

I had urinary retention during my second pregnancy and it was so bad that it refluxed back into my kidneys. They used a catheter to resolve it and then it just resolved. They said babies head was likely laying on my urethra and once my bladder cleared it resolved itself with baby moving. They never investigated it much either.

A district nurse might be able to deal with your catheter

this.
but also is there no gynae service available? This seems mad that it’s somehow needing urology and not being dealt with by gynae/obs. Is your midwife aware?
disclaimer, I am not in the UK, but 100% we would not be waiting 5 weeks via urology where I am - maybe 1-2 weeks and then sorting as a gynae issue via the acute gynae or early pregnancy service. As pp said you do need to be able to pass urine after the catheter removal so can involve sticking around and having output measured.

Presumably they checked with you about no other symptoms for other causes of retention (particularly anything like back pain, weakness/numbness lower legs etc) as I think the assumption that it’s retroverted uterus is probably correct, but important nothing else got missed

A really common reason for urinary retention in pregnancy is a loaded rectum. Have you been constipated at all? The reason is often due to bowels getting a bit sluggish (normal) and eating stuff like bran to try and fix it. Then you end up with a massive blockage that can obstruct the urethra. Avoiding high roughage, eating prunes and, if necessary, using a couple of glycerine suppositories will usually fix it.

Did they do a rectal exam when you were in hospital?

I had this in my second pregnancy first trimester and it was just after I got out of bed so I assumed it was just from where I had been laying down all night. It only happened twice and it was quite scary! but I found that if I got on my hands and knees for a while and moved my body around then the uterus sort of shifted and I was able to go to the toilet so I never sought medical advice.It stopped in second trimester.

I'd just wait to see what happens once catheter comes out. I'm sure they'll further investigate if problem persists.

I've read this too, but have suffered with constipated throughout this pregnancy.

Update:

GP cant take it out.

Apparently im technically not a maternity patient because im less than 16 weeks (which is bonkers considering i have antenatal appointmens). Gynae don't consider me an emergency for a scan because they would only consider an ectopic pregnancy as an emergency, and my 12 week scan didn't suggest an ectopic pregnancy. 12 week scan was suboptimal, they didn't get a good view of the baby.

Ive begged gynae for a scan, and the nurse has agreed to go outside protocol and scan me on Saturday. Fingers crossed everything is ok. Based on what they say, I'll make a decision about taking out the cathetar.

The biggest learning point so far for me has been keep pushing the NHS isn't breaking, it's broken and if you don't fight you'll easily become forgotten.

Re query about previous pregnancy- retroverted uterus noted at 12 week scan, no issues throughout pregnancy, spontaneously went into labour at 35 weeks and gave birth to DD. Due to previous premature birth im considered high risk. You woild think that would warrant them to do an ultrasound but clearly not.

Thanks for the advice and experiences

I tried this before going to A&E but nothing.

Ive later learnt that knee to chest and glute bridges are the ideal exercises to move baby.