The bladder may have been traumatized or bruised during delivery. Temporarily paralyzed, it may not send the necessary signals of urgency even when it’s full.
Having had an epidural may decrease the sensitivity of the bladder or your alertness to its signals.
Pain in the perineal area may cause reflex spasms in the urethra (the tube through which the urine exits), making urination difficult. Swelling of the perineum may also stand between you and an easy pee.
The sensitivity of the site of a tear or episiotomy repair can cause burning and/or pain with urination. Burning may be alleviated somewhat by standing astride the toilet while urinating so the flow comes straight down, without touching sore spots. Squirting warm water on the area while you pee can also decrease discomfort (use the squirt bottle the nurse probably gave you; ask for one if she didn’t).
Dehydration, especially if you didn’t do any drinking during a long labor, and didn’t receive any IV fluids.
Any number of psychological factors may keep you from going with the flow: fear of pain, lack of privacy, embarrassment or discomfort over using a bedpan or needing assistance at the toilet.
As difficult as peeing may be after delivery, it’s essential that you empty your bladder within six to eight hours to avoid urinary tract infection, loss of muscle tone in the bladder from overdistension, and bleeding (because an overfull bladder can get in the way of your uterus as it attempts the normal postpartum contractions that staunch bleeding). Therefore, the nurse will ask you frequently after delivery if you’ve accomplished this important goal. She may even request that you make that first postpartum pee into a container or bedpan, so she can measure your output, and may palpate your bladder to make sure it’s not distended. To help get things flowing:
Be sure you’re drinking plenty of fluids: What goes in is more likely to go out. Plus, you lost a lot during delivery.
Take a walk. Getting up out of bed and going for a slow stroll as soon after delivery as you’re able will help get your bladder (and your bowels) moving.
If you’re uncomfortable with an audience (and who isn’t?), have the nurse wait outside while you urinate. She can come back in when you’ve finished and give you a demonstration of perineal hygiene, if she hasn’t already.
If you’re too weak to walk to the bathroom and you have to use a bedpan, ask for some warm water to pour over the perineal area (which may stimulate the urge). It will also help to sit on the pan, instead of lying on it. Privacy, again, will be key to success.
Warm your perineal area in a sitz bath or chill it with ice packs, whichever seems to induce urgency for you.
Turn the water on while you try. Running water in the sink really does encourage your own faucet to flow.