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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.
Things worth knowing about "Urinary Retention"
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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