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Urinary tract infection following delivery — Clinical Guidelines

Overview

Urinary incontinence (UI) is a common postpartum complication that can negatively impact a woman's quality of life and participation in physical activities 1 3. It is associated with biomechanical and hormonal changes during pregnancy and childbirth, as well as potential perineal trauma 4.

Diagnosis

Management

Conservative management interventions are recommended as first-line treatment for postpartum UI 3.

Pelvic floor muscle training (PFMT) is a key conservative intervention 3 4.

Supervised PFMT and the use of vaginal cones are more effective than individual PFMT alone in decreasing UI rates 3.

Individual PFMT combined with acupuncture or electroacupuncture, and supervised PFMT combined with moxibustion, are more effective than individual supervised PFMT alone in improving symptom severity 3.

Physical therapist interventions, including pelvic floor muscle exercises, electrical stimulation, and perineal massage, have demonstrated a positive impact on postpartum UI incidence and related symptoms 1.

PFMT with feedback from a physiotherapist (e.g., verbal instructions based on digital palpation) or biofeedback may be more effective than PFMT without feedback 5.

Special Populations

Urological complications, including cystotomy and ureteral damage, can occur in women undergoing Cesarean section for placenta accreta spectrum disorders 6.

Key Recommendations

Pelvic floor muscle training (PFMT) is beneficial for the treatment of postpartum urinary incontinence 4. (Evidence: Moderate)

Supervised PFMT and the use of vaginal cones are more effective than individual PFMT in decreasing rates of postpartum urinary incontinence 3. (Evidence: Moderate)

Physical therapist interventions such as pelvic floor muscle exercises, electrical stimulation, and perineal massage show positive impacts on postpartum urinary incontinence incidence and symptoms 1. (Evidence: Moderate)

References

1 Cabrera-Martos I, Cortés-Alcaraz C, Jiménez-López P, López-López L, Torres-Sánchez I, Díaz-Mohedo E. Physical Therapist Interventions to Prevent Postpartum Urinary Incontinence: A Systematic Review. Physical therapy 2025. link 2 Chu W, Deng X, Gao L, Gao X. Acupuncture combined with pelvic floor rehabilitation training for postpartum stress urinary incontinence: A systematic review and meta-analysis. Clinical rehabilitation 2025. link 3 Chen L, Han Y, Wang L, Zhang H, Zheng Y, Zhang R et al.. Conservative Interventions for Urinary Incontinence on Postpartum Women: A Systematic Review and Meta-Analysis. Journal of midwifery & women's health 2024. link 4 Diz-Teixeira P, Alonso-Calvete A, Justo-Cousiño LA, González-González Y, Cuña-Carrera ID. Update on Physiotherapy in Postpartum Urinary Incontinence. A Systematic Review. Archivos espanoles de urologia 2023. link 5 Höder A, Stenbeck J, Fernando M, Lange E. Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth - a systematic review. BMC women's health 2023. link 6 Lucidi A, Jauniaux E, Hussein AM, Coutinho CM, Tinari S, Khalil A et al.. Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2023. link

Urinary tract infection following delivery