Urinary Retention

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Definition

What is urinary retention?

Urinary retention is a condition in which your bladder doesn’t empty completely even if it’s full and you often feel like you really have to urinate. There are two forms of urinary retention — acute and chronic.

How common is urinary retention?

Urinary retention affects both men and women, but it occurs more often in men, especially as they get older. In fact, research has shown it is 10 times more common in men than women. The incidence in men between the ages of 40 and 83 is estimated to be 4.5 to 6.8 per 1,000 men every year. By the age of 80, a man’s chance of having acute urinary retention at least once is over 30 percent. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of urinary retention?

Acute urinary retention happens suddenly and can become life-threatening. You feel like you need to urinate badly, but you can’t go at all. This causes a lot of pain and discomfort in your lower abdomen. Get emergency medical care right away to release the buildup of urine.

Chronic urinary retention occurs over a long period of time. You can urinate, but your bladder doesn’t empty completely. You may not even know you have this condition because you have no symptoms at first.

Chronic urinary retention can lead to complications.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

You should contact your doctor if you have any of the following:

  • You feel like you have to urinate frequently, often eight or more times a day.
  • It’s hard to start your urine stream.
  • Your urine stream is weak or start and stops.
  • You feel like you need to urinate again right after you finish urinating.
  • You have to get up several times during the night to urinate.
  • Urine leaks from your bladder throughout the day.
  • You have urge incontinence, or the strong feeling you have to urinate immediately followed by the inability to stop yourself from urinating.
  • You can’t tell when your bladder is full.
  • You have an ongoing mild discomfort or a feeling of fullness in your pelvis/lower abdomen.

Causes

What causes urinary retention?

There is more than one cause. It can happen when something blocks the free flow of urine through the bladder and urethra. The urethra is the tube that takes urine from the bladder out of the body. The problem can also be caused by using drugs such as antihistamines (like Benadryl®), antispasmodics (like Detrol®), and tricyclic antidepressants (like Elavil®) that can change the way the bladder muscle works.

Passing your urine occurs when the brain tells the bladder muscle to tighten. This squeezes urine from the bladder. The brain then tells the sphincter muscles to relax. This lets the flow of urine go through the urethra and out of the body. Anything that gets in the way on the path from the brain to the nerves that go to the bladder and the urethra can also cause this problem. Urinary retention from nerve disease occurs at the same rate in men and women.

  • In men, a blockage can be caused when the prostate gland gets so big that it presses on the urethra. This is the most common cause of the chronic form in men. One cause in women is a bladder that sags. This is called a cystocele. It can also be caused when the rectum sags into the back wall of the vagina. This is called a rectocele. Some causes can happen to both men and women. The urethra can get narrow. This is called a stricture. Urinary stones can also block the flow of urine.
  • Infection and swelling. In men, an infection of the prostate can cause it to swell. This causes it to press on the urethra to block the flow of urine. A urinary tract infection (UTI) can cause swelling of the urethra to cause this problem. Diseases spread by having sex (called STDs) can also cause swelling and lead to retention.
  • Nerve causes. The bladder may not work right because there is a problem getting the messages from the brain to the bladder and urethra through the nerve pathway. Causes include stroke, diabetes, multiple sclerosis, trauma to the spine or pelvis, pressure on the spinal cord from tumors and a herniated disk. In women, vaginal childbirth can sometimes damage nerve pathways that control going. If you have had a thin tube called a catheter put in you in the past, you may be at greater risk for this condition. Your risk is also higher if your doctor has used any other special device on you, such as an ureteroscope or cystoscope.
  • Some types of drugs affect bladder muscle function as a side effect and can cause this problem. These include drugs called anticholinergics, the older drugs for depression, antihistamines, some blood pressure-lowering drugs, antipsychotics, hormonal agents, and muscle relaxants.
  • Medicine given before and during surgery to make you sleepy may cause urinary retention right after surgery. Procedures such as hip replacement, rectal surgery, surgery for women’s issues, and surgery to remove hemorrhoids can cause the problem afterward.

Risk factors

What increases my risk for urinary retention?

There are many risk factors for acute urinary retention, such as:

  • Elderly male: Due to an increased occurrence of benign prostatic enlargement in this age group
  • Elderly males with enlarged prostate
  • Urinary tract stones that may be found at the kidneys, ureters, or in the urinary bladder
  • Presence of cystocele in women; cystocele is the bulging of bladder into the vagina
  • Presence of rectocele in women; rectocele is the bulging of rectum into the vagina
  • Recurrent urinary tract infections that may cause urethral strictures
  • Individuals with diabetes
  • Injuries to the spinal cord

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is urinary retention diagnosed?

Your doctor can often diagnose urinary retention just by obtaining a detailed history of your symptoms and performing a physical exam that includes your genitals and rectum.

When your doctor needs more information, they may use one of the following tests or procedures:

  • Urine or blood samples
  • Post-void residual (PVR)
  • Cystoscopy
  • Ultrasound and CT scan
  • Urodynamic tests
  • Electromyogram

How is urinary retention treated?

Treatment of the chronic form or the acute form that becomes chronic will depend on the cause. For men with an enlarged prostate, certain drugs may be used to try and shrink it. These include alpha-blockers and 5-alpha reductase inhibitors (finasteride and dutasteride). Also, surgery to take out the prostate or reduce its size may be tried.

Transurethral resection of the prostate is the most common type of surgery when this problem is due to an enlarged prostate. During this surgery, the doctor puts a tool through a catheter. He or she threads it up the urethra and takes out a section of the prostate. There are other ways to treat this problem that are not surgery. They use energy sources such as microwaves and lasers to break up the blockage.

For women with cystocele or rectocele as the cause, mild or moderate cases may be treated with exercises that strengthen the pelvic floor muscles. They also may be treated by putting in a ring called a vaginal pessary to support the bladder. Your doctor may suggest estrogen therapy if you are past menopause. Surgery may be required for more severe cases to lift the sagging bladder or rectum.

For a urethral stricture, opening the urethra with catheters and balloons may be tried. Surgery using a knife or laser that is moved through the urethra to make a cut to open the stricture is also an option. A stent (a mesh tube) can also prop open a closed urethra in men.

If the retention is due to a nerve-related issue, you may need to use a catheter on yourself at home.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage urinary retention?

Acute urinary retention requires immediate drainage for relief and thus a visit to your health-care provider or a hospital emergency department. You can try very limited care at home, but do not delay medical evaluation if you are in pain. Try sitting in a bathtub full of warm water to relax the pelvic floor muscles or running the water in the bathroom to stimulate the flow of urine.

Discuss your prescribed medications, as well as any over-the-counter medications that you may be taking with your doctor, to determine if one or more of your medications may be affecting your ability to urinate normally.

People with limited mobility (for example, after a medical illness or a surgery with prolonged recovery period) resulting in an inability to urinate can be encouraged to get up and walk, as this increased activity may facilitate urination.

Management of constipation with fiber supplements, stool softeners, and laxatives as recommended by your doctor may be helpful.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: August 24, 2018 | Last Modified: August 24, 2018

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