Urinary retention is the inability to empty all the urine in your bladder. In some cases this may be a sudden change, and you may not be able to pass urine at all. This is called “acute urinary retention” and is an emergency. If you have acute retention, you should see a doctor right away or seek care at the emergency department.
Urinary retention may also develop slowly over a long period. If you have chronic retention, you may notice difficulty starting your urinary stream or a slow flow of urine. Because the bladder never fully empties, you may also feel a need to urinate very frequently. Those with chronic urinary retention may not always realize that their bladder is not fully emptying with each urination.
Chronic urinary retention is more common in men, but can also occur in women.
Symptoms of Urinary Retention
Acute Urinary Retention:
A complete inability to pass urine
A painful urge to urinate
Pain or swelling in your lower abdomen
Chronic Urinary Retention:
Frequent urination (more than 8 times per day or getting up multiple times at night)
Trouble starting urination
Weak or intermittent urination stream
A feeling of needing to urinate after finishing urination
Urinary Retention
What Causes Urinary Retention?
There are many possible causes of urinary retention
Blockage – Blockage is a common cause of urinary retention in men, especially after age 50, due to an enlarged prostate. The prostate is an organ at the base of the bladder that continues to grow in men as they age. It can constrict the urethra, cutting off the flow of urine. In women, the urethra may be blocked by certain types of vaginal prolapse, such as a cystocele (when the bladder falls into the vagina causing the urethra to be kinked).
Other blockage reasons for both men and women include urethral strictures (scar tissue) or bladder masses, though these are less common.
Infection / Swelling – Acute prostate enlargement caused by infection and swelling can block the flow of urine. In some cases, a urinary tract infection can also lead to retention.
Nerve Problems – Urinary retention could be caused by a problem with the nerves that control the bladder. If the nerves are damaged, it can cause a breakdown in the signals between the brain and bladder. Some causes of nerve damage include:
Stroke
Diabetes
Multiple Sclerosis
Brain or spinal cord infections or injuries
Herniated disc
Pelvic surgery
Damaged Bladder Muscle - Sometimes the bladder muscle becomes damaged and can no longer squeeze to empty urine. This can be a secondary effect of a chronic blockage that causes the bladder to become too stretched out. Other causes include nerve damage, chronic medical problems (like diabetes) and bladder changes that occur with aging.
Medications – Some medications including antihistamines, decongestants, anticholinergics, and some muscle relaxing medications. If men already have BPH, taking these medications may increase the likelihood of urinary retention
Evaluation of Urinary Retention
The evaluation for urinary retention is designed to determine the underlying cause of retention. There are a few different tests that can help me understand why your bladder is not emptying.
A physical exam, including a prostate and groin exam in men and a vaginal exam in women
CT Scan of the abdomen and pelvis
Post-void residual measurement
PSA Blood Test (in men)
Cystoscopy involves the insertion of a small scope into the urethra. This allows me to examine the urethra and bladder from the inside to assess for blockage and assess the prostate size/ shape in men. A cystoscopy lasts about 5 minutes and is often done without anesthesia, instead using a numbing gel inserted into the urethra. Sedation is available for patients who prefer this. Learn more about cystoscopy here.
Urodynamics is a functional test that help me understand exactly how the urethra and bladder function. This is the best test to assess how well the bladder muscles squeezes. Urodynamic testing is performed with a very small catheter inserted into the bladder. This catheter is connected to a sensor, which can sense the pressures inside the bladder and the urethra during certain phases of bladder filling and bladder emptying. The test is relatively painless and lasts 30-45 minutes. Learn more about urodynamic testing here.
Treatment Options
The treatment of urinary retention depends on the cause.
Acute urinary retention is treated with a catheter inserted into the bladder to allow the bladder to drain. After the bladder is allowed to decompress for 7-10 days, you may be able to try voiding on your own. However, in some instance you may need to consider more testing first to understand why you developed urinary retention.
Blockage caused by prostate enlargement may be treated with medications or a procedure the decrease the size of the prostate. We will consider various factors before deciding on the ideal treatment option for you, and you may need further evaluation to examine the size and shape of your prostate before making a final decision.
Blockage caused by vaginal prolapse may be treated with a procedure to correct the prolapse or a device called a pessary to help hold the bladder in place.
Blockage caused by other factors, such as urethral stricture, often require a procedure to correct.
Urinary retention caused by nerve damage or damage to the bladder muscle may respond to sacral neuromodulation.
This is a type of nerve stimulation therapy that delivers an electrical signal directly through the nerve root that supplies the bladder using an implanted lead and generator. Before proceeding with an implant, we usually do a nerve test to see if this type of therapy is beneficial for you. The test device lead is introduced through a small needle in the back and can be placed using local anesthetic with mild sedation. If the testing is satisfactory, the full implant is placed under IV sedation and local anesthesia, and typically can be placed in about 30-45 minutes. Complications are very rare and include mechanical malfunction, pain or infection (extremely rare). Learn more here.