What's it called when you can't pee after surgery?

Being unable to pass urine after surgery (post-operative urinary retention or 'PO-UR') affects four out of every 10 patients who have had an operation. It is particularly common in older people having hip or knee replacement surgery.

arc-w.nihr.ac.uk - Preventing post-operative urinary retention - NIHR ARC West

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Being unable to pass urine after surgery (post-operative urinary retention or ‘PO-UR’) affects four out of every 10 patients who have had an operation. It is particularly common in older people having hip or knee replacement surgery. PO-UR is managed by inserting a tube to drain the bladder, or ‘catheterisation’. This invasive method can lengthen hospital stay and lead to more problems such as infections and damage to the bladder. It can be incapacitating, undignified, distressing and uncomfortable. Some people leave hospital with a tube still in place. There are many triggers for PO-UR, including age and gender, type of surgery, anaesthetic or pain killers. This project came from an idea by patient contributor Nick, who experienced post-operative urinary retention and was given a catheter after three different common non-urgent surgical procedures. He submitted it as an idea for research through the CLAHRC West open call in 2016. He has worked as a researcher alongside the rest of the project team in a pioneering form of co-production. Project aims This project aimed to review the literature, to identify the factors influencing whether a patient will develop PO-UR and what can be done to prevent and treat it. What we found and what this means We found factors associated with PO-UR included being older, male, and having previous urinary problems or long-term enlargement of the prostate gland restricting the ability to urinate (‘benign prostatic hyperplasia’). Reducing fluids and using a catheter during surgery were associated with a lower risk of PO-UR. Giving tamsulosin (a drug used to help men with prostate disease) before surgery can reduce the number of people who develop PO-UR. All the studies of tamsulosin were in men and none were in UK settings, so more studies are needed to see if similar effects are found in women and in UK settings. Replacing or avoiding morphine in the anaesthetic, administering the anaesthetic in certain ways, and getting patients up and moving as soon as possible after their operation reduced the chance of developing PO-UR. For people who developed it, a small number of studies also suggested that a hot pack or warm gauze and a warm coffee could help. Based on the results of our review, we developed an intervention to reduce the risk of developing PO-UR – the ‘PO-UR prevention package’. This package involves providing hospital staff with training and advice to: Avoid using morphine or reducing the dose, wherever possible

Change other aspects of the anaesthesia or analgesia

Get people moving as soon as possible after their operation

Reduce fluids as far as is safe, before and during the operation

Provide a hot caffeinated drink and hot pack placed on the abdomen around two hours after the operation What next? We are planning a new study to find out whether: introducing the ‘PO-UR prevention package’ giving tamsulosin before surgery will reduce the number of people who develop PO-UR. The main outcomes we’ll be looking at for this study are: whether patients have a catheter before leaving hospital

how long the catheter stays in

how long they need to remain in hospital and whether they go home catheterised Reducing PO-UR should improve patient experience and dignity, shortening their time in hospital and speeding recovery, as well as saving money for the NHS.

ARC BITE Preventing post-operative urinary retention Download the BITE

Lead collaborators Paul Abrams, University of Bristol

Anthony Blacker, University Hospitals Coventry and Warwickshire

Nick, patient contributor

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How long after surgery do people poop?

After surgery, your caregivers will frequently ask whether you have passed gas. This is because passing gas is a sign that your bowels are returning to normal. You may not have a bowel movement for four to five days following surgery.

womans.org - Bowel Function | Woman's Hospital | Baton Rouge, LA

Bowel Function

Woman’s offers the following helpful tips for returning to normal bowel function.

DO

Drink warm liquids

Walk outside your room three to four times daily

After meals: walk, and then sit up in a chair for 30 to 60 minutes

Sit upright in a chair three to four times daily

Lie on your left side rather than on your back to help move gas through your bowels

Eat slowly

Eat small amounts

Chew your food well

DON’T

Stay in bed for long periods during the day

Lie down for 30 to 60 minutes after eating

Eat gas-producing foods (cabbage, melon, carbonated drinks, broccoli)

Drink from a straw

Suck hard candy

Eat foods that you know give you gas

As your bowel function returns to normal, your diet will change from only liquids to soft foods. To help with any nausea you may experience due to sluggish bowels:

Eat small amounts of food

Eating slowly

Chew your food well

In addition to bowel function, your recovery will include returning to normal bladder function and gradually increasing your activity level. Throughout your recovery, take special care to use good hygiene. Always wash your hands before and after you touch your incision, and anytime you use the bathroom. Clean your genital area after you go to the bathroom by wiping from front to back.

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