Management of Dysuria After Cesarean Section
Etiology and Diagnosis
- Urinary tract infection is one of the most common complications after cesarean delivery, often associated with indwelling urinary catheters 3, 4
- Dysuria may present with urinary frequency, urgency, burning on micturition, and suprapubic pain 2, 5
- Diagnostic approach should include urine dipstick testing for nitrite and leukocyte esterase and urine culture before starting antibiotics to guide targeted therapy 6
Prevention Strategies
- Immediate removal of urinary catheters after cesarean delivery significantly reduces the risk of urinary tract infection and associated dysuria 1, 2, 5
- A prospective randomized clinical trial showed that immediate catheter removal versus 12-hour removal resulted in significantly lower incidence of postoperative bacteriuria, dysuria, and burning on micturition 5
- For women who do not need ongoing strict assessment of urine output, the urinary catheter should be removed immediately after cesarean delivery 5
Treatment Algorithm
- Confirm diagnosis by obtaining urine sample for culture and sensitivity testing and performing dipstick testing for nitrite and leukocyte esterase 6
- Initiate empiric antibiotic therapy if UTI is suspected, with third-generation cephalosporins showing superiority over fluoroquinolones for urinary infections 7
- Adjust antibiotic regimen based on culture results 6, 7
- Use NSAIDs as first-line treatment for pain relief, with opioids as second-choice when NSAIDs are contraindicated 7
- Encourage increased fluid intake to help flush bacteria from the urinary tract and promote early mobilization to promote bladder emptying 1, 6