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.
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 in men than women. The incidence in men between the ages of 40 and 83 is estimated to be . By the age of 80, a man’s chance of having acute urinary retention at least once is .
What are the symptoms?
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. It’s important to see your doctor promptly if you have one or more of the following symptoms:
- 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.
What causes it?
Your lower urinary tract is made up of your bladder, which stores urine, and your urethra, which is a tube between your bladder and the outside of your body. In men, the prostate is also part of this system. There are two sets of muscles called sphincters. The internal sphincter is where your urethra connects to your bladder (the bladder outlet). The external sphincter, further down the urethra, opens and closes to control when urine can leave the bladder. In men, the prostate surrounds the urethra along its course through the pelvis between these two sphincters.
When you urinate, the muscles in your bladder squeeze to push urine out. At the same time, your nervous system tells the sphincters to open and the urine passes through your urethra and out of your body. The two sphincters are made up of different muscle types, so you can’t control the internal sphincter but you can control the external one. A problem in any of these structures or the nerves that make them work can cause urinary retention.
Anything that blocks the flow of urine from your bladder can cause acute or chronic urinary retention. A sudden and complete obstruction causes acute urinary retention. A slow, progressive, partial obstruction causes chronic urinary retention. Causes of obstruction common in both women and men include:
- urinary tract stones
- urethral stricture
- a mass or cancer in your pelvis or intestine
- severe constipation
- a blood clot from bleeding in your bladder
- a foreign object inserted into the urethra
- severe inflammation of the urethra
Some medications make your bladder less able to squeeze urine out or make the internal urinary sphincter contract. Common ones include:
- medication to treat Parkinson’s disease
- medication to treat urinary incontinence
- muscle relaxants
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- some antipsychotics
- some older antidepressants
- some opioid pain medications like morphine
For you to be able to urinate, signals from your brain have to travel through your spinal cord and surrounding nerves to your bladder and sphincters and back again. If one or more of these nerve signals doesn’t work, it can cause urinary retention.
Some things that can cause nerve problems in your bladder include:
- brain or spinal cord injury
- delivering a baby
- long-term diabetes
- multiple sclerosis
- Parkinson’s disease
Often after having surgery, especially joint replacement or spinal surgery, you may experience urinary retention temporarily. One recent showed that people undergoing joint replacement are 1.5 times more likely to have urinary retention than after other types of surgery. Having high blood pressure or diabetes appears to increase this risk. Up to of people can experience this problem after spinal surgery.
Causes specific to men
Over of the time, urinary retention in men is caused by problems with the prostate gland.
Since the prostate surrounds the urethra, both cancerous and noncancerous growth of your prostate can narrow your urethra and reduce urine flow. Most men have noncancerous enlargement of their prostate as they age. By the time they’re 80 years old, of men have it.
There are a number of potential causes of obstruction in men:
- benign prostatic hypertrophy (BPH) or benign prostatic enlargement (BPE) (noncancerous growth of the prostate)
- prostate cancer
- penile constriction bands that are too tight or used too often
For men who are uncircumcised, these conditions can also lead to obstruction:
- Paraphimosis, a medical emergency, occurs when an uncircumcised man’s foreskin gets stuck behind the head of his penis.
- Phimosis is the inability to retract, or pull back, the foreskin from the tip of the penis.
Meatal stenosis, a condition most commonly occurring in circumcised infants, may also cause obstruction. This is a narrowing of the opening of the urethra that can happen when the penis gets inflamed from contact with urine and rubbing against a diaper or there is a change in blood flow to the penis.
Infection and Inflammation
An infection in any part of your lower urinary tract can cause urinary retention. You can develop an infection or inflammation in your bladder (cystitis) or your urethra (urethritis). Prostatitis, or an infection of your prostate, can obstruct the urethra. Balanitis is inflammation or swelling of the foreskin of an uncircumcised man that can also cause an obstruction.
When your penis is injured or gets a cut, it can swell and cause urethral obstruction.
Causes specific to women
Urinary retention is less common in women, but there are a few typical causes.
A mass or cancer in your uterus can push into your bladder outlet or urethra and cause an obstruction. Additionally, a cystocele or rectocele can create a blockage. A cystocele is when your bladder sags and bulges into your vagina. A rectocele is when your rectum pushes out and bulges into your vagina.
When your uterus moves down from its normal position, this is known as a prolapse. It can obstruct your bladder outlet.
Vulvovaginitis, or an infection of the outer part of your vagina, can cause urinary retention in women. Bladder infections, as well as cystitis, can also lead to urinary retention.
How it’s 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:
How it’s treated
Acute urinary retention is a medical emergency, and your doctor will quickly place a catheter into your bladder to let out the urine. This is the quickest and easiest procedure.
If this method can’t be done or doesn’t work, a small tunnel can be made in the skin over your bladder and through the bladder wall. A suprapubic catheter can be inserted this way.
Your doctor will use local anesthesia. Emptying your bladder will make you feel better right away and help prevent complications. Your doctor will then diagnose and treat the cause.
Chronic urinary retention is treated if you develop symptoms that affect your quality of life or if you are experiencing urinary tract complications.
You’ll probably need catheterization to release the urine from your bladder unless the cause of your urinary retention can be fixed right away.
Doctors try to avoid keeping a urethral or suprapubic catheter in place for a long period of time because these can lead to a variety of complications. When done intermittently, a catheter often needs to be placed several times a day. You’ll be taught how to insert the catheter to minimize getting bacteria into your bladder.
Urethral dilation and stents
This procedure can be used to widen a urethral stricture in order to allow more urine to flow through. Tubes of increasing width are inserted into your urethra. This slowly opens the stricture. Another way to do this is to insert a tube with a balloon into your urethra and inflate the balloon in the stricture.
Sometimes a stent, a small tube that widens as it opens, is inserted at the stricture. This opens the stricture and increases urine flow. The stent may remain in your urethra permanently to keep your urethra open.
A lighted, flexible tubular scope called a cystoscope can be inserted through your urethra into your bladder. There, it can be used to find and remove stones or foreign objects from your bladder, bladder outlet, or urethra.
There are several medications that your doctor might prescribe to help your urinary retention:
- antibiotics or other medications for urinary tract infection, prostatitis, or cystitis
- medications that make your urethral sphincter and prostate relax so urine can flow through the urethra better
- medications that make your prostate smaller to relieve obstruction in men with noncancerous prostate enlargement
There are some things you can do to learn to control your bladder or make it less likely that you’ll retain urine:
- Manage the amount and timing of drinking fluids.
- Strengthen the muscles in your pelvis.
- Use bladder retraining exercises and techniques.
If medication and other therapies haven’t worked to relieve symptoms, surgery may be an option. In men, most surgical procedures are done by inserting an instrument through the urethra. The surgeon then uses an attached tool or laser to fix the problem. These are outpatient procedures, which means they don’t require you to stay in the hospital. Many of them are less invasive to help reduce pain and aid in a faster recovery. Several options for treatment include:
- minimally invasive procedures done through the urethra that involve the use of small needles and heat waves
- transurethral resection of the prostate (TURP) to remove extra prostate tissue that’s blocking the urethra
- urethrotomy to open a stricture in your urethra
- removal of the prostate
Other surgical procedures may be needed depending on the cause of the urinary retention. Certain conditions may require laparoscopic (using small incisions for lighted cameras and instruments) or open surgical procedures (using larger surgical incisions):
- to remove part or all of your prostate because of cancer
- to remove an enlarged or abnormal uterus
- to fix a cystocele or rectocele by lifting your bladder or rectum back to its normal place
- to remove cancer in your bladder or urethra
- to remove other tumors or cancer of your pelvic organs
Are there complications?
Suddenly emptying a full bladder with a catheter can make your body produce a lot more urine than usual. This usually lasts about . However, if this process lasts longer than expected, it can result in your body losing too much water and salt. This causes your blood pressure to go down. Because this can become life-threatening, your doctor will monitor your fluid and electrolyte losses and replace them as needed. Usually the catheter will be left in place to accurately measure the amount of urine you produce until urine production returns to normal.
Sometimes chronic or ongoing urinary retention is caused by a poorly functioning bladder. This can increase the pressure within your urinary tract and affect the kidneys, which in turn can lead to high blood pressure, leg swelling, and further kidney damage.
A catheter, especially when left in continuously, can cause several complications including:
- urinary tract infections, which can lead to infections in your blood
- urethral injury or breakdown
- urethral strictures
What’s the outlook?
Both acute and chronic urinary retention are often easy to diagnose. They are both accompanied by an inability to urinate effectively. They can usually be treated by a combination of options in order to avoid long-term complications. If the problem can’t be permanently fixed with surgery or other treatment, you may need to use a catheter on your own intermittently. You’ll get used to this and it won’t limit your daily activities or quality of life.
Acute urinary retention is a medical emergency, so seek medical help right away if you’re unable to urinate or have a sudden change in urination.