Amy Pannullo and Alexandra Hill published a compelling case report detailing physical therapy interventions for a 35-year-old postpartum patient experiencing urinary retention following a spontaneous vaginal delivery. The patient (G3P2) was discharged with a Foley catheter in place and transitioned to intermittent self-catheterization (ISC)—8 times per day and once overnight—with average voids of 350 mL.
Initial PT Evaluation (22 Days Postpartum)
Key findings included:
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Pelvic floor muscle spasm and incoordination
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Perineal scar hypersensitivity and hypomobility
The patient had been prescribed Bactrim prophylactically at Foley placement and discontinued upon initiating ISC. She was also taking Flomax.
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Treatment Approach
Manual Therapy (Day 1):
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External pelvic floor muscle release
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Trigger point release
Following OB clearance, internal treatment included:
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Pelvic floor muscle stretching
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Thiele’s massage
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Fascia and trigger point release
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Urethral mobilization
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Strain-counterstrain techniques
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Scar tissue mobilization (patient was also trained in self-mobilization)
Neuromuscular Reeducation:
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EMG biofeedback using a vaginal sensor
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Techniques practiced while seated on a commode
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Verbal and tactile cueing, and diaphragmatic breathing to promote coordinated pelvic floor activation during voiding
Outcomes:
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NIH Chronic Prostatitis Questionnaire score improved from 25 to 5
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Post-void residual volumes and ISC frequency both decreased over the course of 18 PT sessions
Clinical Takeaway:
This case highlights the potential of manual therapy and neuromuscular reeducation as first-line treatment for postpartum urinary retention. It is the first published report to document manual therapy as the primary intervention for this condition and offers valuable guidance for clinical practice.
Pannullo A, Hill A. Physical Therapy Interventions for Prolonged Postpartum Urinary Retention. Journal of Women’s Health Physical Therapy. 2018;42(1):23-31.
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