Urinary Retention – Causes, Symptoms and Treatment

What Is Urinary Retention?

Urinary retention is a condition in which the bladder cannot be fully or completely emptied. It is classified into two main types: acute urinary retention, which occurs suddenly and is considered a medical emergency, and chronic urinary retention, which develops gradually and may go unnoticed for a long time.

Causes

Urinary retention can be triggered by a variety of conditions and factors:

• Mechanical obstruction: An enlarged prostate (benign prostatic hyperplasia), urethral stricture, bladder stones, or tumors can block the flow of urine.
• Neurological causes: Conditions such as multiple sclerosis, stroke, spinal cord injuries, or diabetic neuropathy can impair bladder function.
• Medication-induced causes: Certain drugs including anticholinergics, opioids, antihistamines, and antidepressants can inhibit bladder emptying.
• Postoperative causes: Temporary urinary retention may occur after surgical procedures, especially those involving the pelvic area or general anesthesia.
• Infections and inflammation: Urinary tract infections or prostatitis can also contribute to urinary retention.

Symptoms

Symptoms differ depending on whether the retention is acute or chronic:

Acute Urinary Retention

• Sudden, complete inability to urinate
• Severe urge to urinate with painful pressure in the lower abdomen
• Visibly or palpably distended bladder
• Significant pain and distress

Chronic Urinary Retention

• Frequent urination in small amounts
• Weak or interrupted urine stream
• Feeling of incomplete bladder emptying
• Nocturia (waking up at night to urinate)
• Often little to no pain

Diagnosis

Urinary retention is diagnosed through a combination of clinical and instrumental assessments:

• Medical history and physical examination: Gathering information about symptoms and palpating the lower abdomen for a distended bladder.
• Ultrasound (sonography): The bladder is examined for post-void residual urine. A residual volume of more than 100 ml is generally considered clinically significant.
• Bladder catheterization: Both diagnostic and therapeutic – a catheter is used to drain the bladder and measure the urine volume.
• Urodynamic testing: Measurement of bladder function and urine flow to identify the underlying cause.
• Blood and urine tests: Assessment of kidney function and exclusion of infection.

Treatment

Treatment depends on the underlying cause and the severity of the condition:

Acute Urinary Retention

Acute urinary retention is a medical emergency and requires immediate bladder drainage, usually via the placement of a urinary catheter (transurethral or suprapubic).

Chronic Urinary Retention and Long-Term Management

• Medication: Alpha-blockers (e.g., tamsulosin) or 5-alpha-reductase inhibitors for benign prostatic hyperplasia can improve urine outflow.
• Intermittent self-catheterization (ISC): Patients are trained to regularly catheterize their own bladder.
• Surgical intervention: In cases of mechanical causes such as an enlarged prostate or urethral strictures, surgery (e.g., TURP – transurethral resection of the prostate) may be necessary.
• Medication adjustment: If a drug is the cause, the treatment regimen is reviewed and modified accordingly.

When to See a Doctor

Any episode of acute urinary retention is a medical emergency and requires immediate medical care. Chronic symptoms such as a weak urine stream, post-void residual urine, or frequent nighttime urination should also be evaluated promptly by a doctor, as untreated urinary retention can lead to kidney damage over time.

References

1. European Association of Urology (EAU): Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms (2023). Available at: www.uroweb.org
2. Selius B.A., Subedi R.: Urinary Retention in Adults: Diagnosis and Initial Management. American Family Physician, 2008;77(5):643-650.
3. National Institute for Health and Care Excellence (NICE): Lower urinary tract symptoms in men: management. Clinical guideline CG97 (2010, updated 2015). Available at: www.nice.org.uk