Urinary Retention – Causes, Symptoms and Treatment
Urinary retention is the inability to fully empty the bladder. It can occur acutely or chronically and often requires prompt medical attention.
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Urinary retention is the inability to fully empty the bladder. It can occur acutely or chronically and often requires prompt medical attention.
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
- European Association of Urology (EAU): Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms (2023). Available at: www.uroweb.org
- Selius B.A., Subedi R.: Urinary Retention in Adults: Diagnosis and Initial Management. American Family Physician, 2008;77(5):643-650.
- 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
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