Urinary retention is defined as the inability to completely or partially empty the bladder. You may be unable to start urination, or if you are able to start, you are unable to fully empty your bladder. Urinary retention can be sudden (acute) or can build up slowly over a period of time (chronic). Acute urinary retention generally means you are unable to pass any urine even though your bladder is full. If you have chronic urinary retention you can usually pass some urine but cannot completely empty your bladder.
Causes
Urinary retention can be attributed to two causes — either obstruction or non-obstruction.
If there is an obstruction (for example, bladder or kidney stones), a blockage occurs and urine cannot flow unimpeded through your urinary tract. This is the basis for acute urinary retention and is potentially life threatening. You must seek immediate emergency treatment. Non-obstructive causes include a weakened bladder muscle and nerve problems that interfere with signals between your brain and the bladder. If the nerves aren’t working properly, your brain may not get the message that the bladder is full.
Prevention
Up until now, there are no studies that link urinary retention to diet, lifestyle and nutrition choices. The best ways to prevent this condition is to treat the most frequent causes.
Urinary retention caused by an obstruction of the urethra requires the removal of the cause blocking the normal urine flow out of the body. If the condition is determined by benign prostatic hyperplasia, this has to be treated first, by closely following the treatment prescribed by the doctor. Urethral stricture, which causes the closure of the urethra, is a painful condition often caused by prostatitis, surgery that corrects pelvic organ prolapse, scar tissue remaining from surgeries, recurring UTIs, or injury. Some of the frequent treatments for urethral stricture include dilation, direct vision internal urethrotomy (DVIU), laser urethrotomy, urethroplasty. Women may suffer from urethral stricture and acute or chronic urinary retention when the muscles around the urethra aren’t able to relax.
Cystocele and Rectocele are conditions that occur in women, when the vagina is pressed against by bulgings formed in the bladder, respectively in the rectum. To prevent the condition to worsen and lead to urinary retention, a urologist or gynecologist will stitch the tissue in the bladder or rectum and then repair the vaginal wall with more stitches, removing any extra tissue.
Preventing constipation or treating it in the early stages can also be a factor preventing urinary retention. Moreover, there are certain medications that usually contain decongestants, which should definitely be avoided, such as over-the-counter cold and allergy medications.
Weakened bladder muscles that lose the ability to fully contract in order to release the bladder completely, can also lead to urinary retention. A common way to counteract this from happening in the later stages of life is by performing Kegel exercises. By regularly working up the muscles in the pelvic floor, women can control continence issues, urine leakage, bowel control. Although frequently performed by women, Kegel exercises can be practiced by men as well.
Symptoms
The symptoms of acute urinary retention may include the following and will require immediate medical attention:
- inability to urinate
- painful, urgent need to urinate
- pain or discomfort in the lower abdomen
- bloating of the lower abdomen
The symptoms of chronic urinary retention may include
- urinary frequency—urination eight or more times a day
- trouble beginning a urine stream
- a weak or an interrupted urine stream
- an urgent need to urinate with little success when trying to urinate
- feeling the need to urinate after finishing urination
- mild and constant discomfort in the lower abdomen and urinary tract
Diagnosis
The doctor will ask about your signs and symptoms and how long you have had them. He or she will also ask about your medical history and your drug use. A physical exam of the lower abdomen (belly) may show the cause or give the doctor clues. For men, the doctor may also perform a rectal exam to check the size of the prostate, a walnut-sized gland located between the bladder and the penis. An enlarged prostate might press the urethra and cause urinary retention. Other additional testing includes:
- Urinalysis to check for infection or blood in urine.
- Ultrasound to see how much urine remains in the bladder after voiding.
- Cystoscopy, a test where a tiny camera is inserted through the urethra, allowing the doctor to see the inside of the urethra and bladder.
- CT scan, which looks for stones or other blockages of the urine flow.
- Urodynamic tests of urine flow.
- Electromyography (EMG), which measures how well the muscles and nerves work around the bladder and the urethra.
Treatment
For the acute form, a catheter is placed into the urethra in order to drain the bladder. Treatment of the chronic form or the acute form that becomes chronic will depend on the underlying 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 remove the prostate or reduce its size may be considered.
