Urinary Retention

Urinary retention at a glance

  • Urinary retention, either acute or chronic, is the problem of being unable to empty the bladder properly.
  • Urinary retention occurs most frequently in older men, but it can affect women and men of any age.
  • Chronic urinary retention may cause few symptoms and sometimes people don’t know they have it until urinary incontinence causes them to seek treatment.
  • Acute urinary retention is a medical emergency and may involve complete inability to urinate and painful, urgent need to urinate.
  • Surgical and other treatments are available to resolve urinary retention.

What is urinary retention?

Urinary retention occurs when a person cannot empty his or her bladder all the way, or cannot urinate at all. Urinary retention may be long-lasting (chronic) or it may come on suddenly (acute).

  • Chronic urinary retention is a condition where people can’t release all of the urine from their bladders. Some people learn they have this condition when they are diagnosed with another problem. Related problems might include a urinary tract infection (UTI) or incontinence. People may have chronic urinary retention for a long time. Chronic urinary retention happens most frequently in older men, but it also can occur in women.
  • Acute urinary retention is potentially life threatening. This condition requires medical attention right away. With acute urinary retention, a person cannot urinate at all, even though the bladder is full. This can be very painful.

Causes of urinary retention

Urinary retention has several potential causes, listed below.

  • An obstruction (or blockage) of the urethra, the tube that carries urine from the bladder and expels it from the body. This obstruction can be caused by benign prostatic hyperplasia (BPH), urethral stricture (due to prostatitis or surgery for prostate cancer), urinary tract stones, pelvic organ prolapse (such as cystocele or rectocele), constipation, and some cancers and other tumors. A urinary tract infection (UTI) or a sexually transmitted infection can cause swelling that blocks the urethra.
  • Infection or inflammation, which can be caused by conditions such as herpes simplex virus or Guillain-Barre syndrome.
  • Weakened bladder muscles.
  • Medications that change the way the bladder works. These may include cold medicines and antihistamines, some antidepressants and antispasmodics.
  • Nerve problems. Sometimes these are caused by chronic medical conditions such as multiple sclerosis, spinal cord injury, stroke and diabetes. Occasionally they are due to damage from vaginal childbirth.
  • Post-operative problems. The pelvic organs sometimes are damaged during surgery. Other problems can result from surgery to the pelvic region or medicines given before or during surgery.
  • Damage due to catheterization.

Symptoms of urinary retention

The symptoms of urinary retention vary, depending upon whether the condition is chronic (ongoing) or acute (sudden).

Chronic urinary retention (CUR). usually develops over months or years. It is usually not painful. The symptoms of chronic urinary retention can include:

  • Frequent or painful urination
  • Difficulty beginning to urinate
  • A weak or interrupted urine stream
  • Leaking in between trips to the bathroom
  • Feeling an urgent need to urinate, but not being able to go
  • Still needing to urinate after finishing
  • Pain or discomfort in the lower abdomen and urinary tract (usually mild and ongoing).

Sometimes these symptoms aren’t worrisome enough for people to seek medical care. However, the risk of not seeking care is that these people may be more likely to have complications from untreated urinary retention. These complications can include urinary tract infection (UTI) or acute urinary retention.

Acute urinary retention has different symptoms and requires immediate medical care. The symptoms may include:

  • Complete inability to urinate
  • A need to urinate that is painful and urgent
  • Painful or uncomfortable lower abdomen
  • Bloated lower abdomen.

Diagnosis of urinary retention

When a person seeks treatment for urinary retention, the doctor will do a physical exam and ask about symptoms and medications.

For men, the doctor may do 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. Doctors might order blood tests to screen for prostate cancer, which is very common among older men.

The doctor also may order tests including:

  • 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.

In some cases, doctors also might order an MRI test of the pelvic region and/or the brain to determine the cause of the urinary retention.

Treatment of urinary retention

Many treatments are available for urinary retention, including medication, devices, procedures and surgery. Treatment will depend on the cause and the disease specifics.

For acute urinary retention, medical providers will use a catheter to drain the bladder. Then the doctor will seek the cause of the urinary retention and determine a course of treatment.

Non-surgical treatments may include:

  • Various medications can stop the growth of the male’s prostate (to release the prostate’s pressure on the urethra) or relax the muscles of the prostate and bladder outlet to relieve the blocked urethra.
  • Some women have urinary retention caused by cystocele or rectocele, in which another organ is prolapsing (bulging) into the vagina and pressuring the urethra. Some women may be helped by doing exercises to strengthen the pelvic muscles.
  • Vaginal pessary. Also for women with urinary retention caused by cystocele or rectocele, a ring called a vaginal pessary is inserted to help support the bladder.
  • Urethral dilation. The urologist might insert increasingly wider tubes into the urethra to widen an area that has been narrowed (also called a stricture).
  • Urethral stents. A doctor alternatively can insert a stent (temporary or permanent) into the urethral stricture to widen it.
  • Home catheterization. People who have urinary retention due to a nerve-related issue may need to use a catheter on themselves at home to release urine from the bladder.

Surgical treatment is necessary for some cases. These treatments might include:

  • Prostate surgery. The most common surgery is transurethral resection of the prostate. In this procedure, the urologist uses a tiny tool, inserted through a catheter, to remove a section of the prostate. This treatment is used frequently for urinary retention caused by BPH.
  • Internal urethrotomy. When there is a stricture that cannot be resolved by widening, a urologist can open the stricture with an incision. The procedure is performed via a special catheter inserted into the urethra.
  • Cystocele or rectocele repair. Women whose bladder or rectum has fallen (prolapsed) may need surgery to return the organs to their normal position. A urologist specializing in female reproductive surgery will repair any defects in the tissue of the vaginal wall. This repaired tissue then will be strong enough to hold the organs in their proper places, restoring normal urinary retention function.
  • Removal of tumors or cancer. If the cause of the urinary retention is a tumor or cancerous tissue in the urethra, bladder or prostate, removing those tissues may reduce the problem.