Single Most Likely Diagnosis
- Postpartum urinary retention with overflow incontinence: This condition is likely due to the epidural anesthesia used during labor, which can cause temporary bladder dysfunction and lead to urinary retention. The patient's ability to void only small amounts (50-75 mL) and the significant postvoid residual volume (300 mL) support this diagnosis.
Other Likely Diagnoses
- Trauma to the urethra or bladder during delivery: Although the episiotomy does not show evidence of hematoma, the delivery process itself could have caused trauma leading to urinary incontinence.
- Postpartum bladder atony: This condition, where the bladder muscle is weakened postpartum, can lead to urinary retention and overflow incontinence.
Do Not Miss Diagnoses
- Urethral or bladder injury (e.g., fistula): Although less common, these injuries can occur during delivery and must be considered to prevent long-term complications.
- Infection or sepsis: Infections can cause urinary retention or incontinence and are critical to identify and treat promptly to avoid severe outcomes.
Rare Diagnoses
- Neurogenic bladder due to epidural anesthesia complications: While rare, complications from epidural anesthesia can lead to neurogenic bladder, affecting bladder control.
- Pudendal nerve injury: Injury to the pudendal nerve during delivery can cause urinary incontinence, although this is less common.