Urinary Retention in Men
Statistics show that 0.45% to 0.68% of men age 40 to 83 get urinary retention. The incidents of urinary retention in men also increases with age. 10% of men get urinary retention in their 70s and 30% of men in their 80s.
One common cause of urinary retention in men is an enlarged prostate (benign prostatic hyperplasia). This is a cause specific to men since women don’t have prostate glands (they have the skene gland which functions similarly).
However, an enlarged prostate is not the only reason men get UR. UR can also occur as a result of nerve damage, various forms of blockages in the lower urinary tract, weak bladder muscles, and medication.
This article will cover the causes of urinary retention in men, symptoms, and treatments.
How does an enlarged prostate cause urinary retention?
The prostate is a walnut-shaped gland that sits below the bladder. It surrounds the part of the urethra that extends out of the bottom of the bladder. When the prostate grows bigger, it constricts the urethra so that urine cannot pass through easily, leading to urinary retention.
As men age, their prostates naturally enlarge in what is known as BPH (benign prostatic hyperplasia). Men who are 40 and older are more likely to develop it. Half of the men in their 50s have BPH, and so do 90% of men in their 80s. BPH is not cancerous, but when it causes UR it can lead to other urinary tract problems such as UTIs.
Prostatitis: another prostate-related cause of urinary retention
Prostatitis is the swelling and inflammation of the prostate. It can also cause UR because the prostate may swell and block the urethra.
Although both BPH and prostatitis can have symptoms of urinary retention, which includes:
- Frequent urge to urinate with low output volume
- Discomfort or fullness in the lower abdomen and back
- Difficulty starting stream; weak and broken stream
- Feeling like you have not emptied your bladder completely
- Having the urge to urinate soon after you’ve finished urination
- Inability to detect when the bladder is full
- Leakage of urine
- Unable to urinate with a painful, full bladder
If you have suddenly completely lost the ability to urinate, you may be suffering from acute urinary retention and you should seek emergency care.
Although BPH and prostatitis have similar symptoms, they are also different.
- BPH is not caused by infection or inflammation as prostatitis often is (acute/chronic bacterial prostatitis).
- Prostatitis is often painful, causing burning urination, ejaculation and constant pain in the lower back, pelvis, and groin. BPH is often painful only during urination.
- Prostatitis can have flu-like symptoms, BPH doesn’t.
- BPH is more common in men 50 or above, whereas bacterial prostatitis often affects men below 35.
Sometimes, prostatitis’s inflammation is not caused by an infection (chronic nonbacterial prostatitis). Sometimes the prostate may not be inflamed, and sometimes prostatitis doesn’t have any symptoms at all (asymptomatic prostatitis).
People with prostate cancer often exhibit symptoms of urinary retention and enlarged prostate. Other symptoms include:
- blood in the urine and seminal fluid
- Recent onset of erectile dysfunction
- Swelling in the legs and feet
- Pain in the bones (shoulder, back, hips, thighs, etc)
- unexplained weight loss
- constant fatigue
Surgery and radiotherapy that treat prostate cancer can also lead to urinary retention.
Since UR can have a variety of underlying causes, it is important to get a medical diagnosis from a doctor.
Urinary tract infection can cause swelling that constricts urine flow. Some symptoms of UTI include:
- Painful, burning urination
- Cloudy, foul-smelling, and bloody urine
- Frequent urge to urinate with little volume
- Fever, chills, and nausea
- Pain in the pelvic area
UTIs in men are usually rare compared to women. However, if a man is using a urinary catheter to treat UR, then he is at risk for CAUTI (catheter-associated urinary tract infection).
CAUTI is often caused by catheter contamination. To avoid CAUTI, always wash your hands thoroughly with soap and water before catheterization. Using no-touch catheters is also a good idea. A no-touch catheter doesn’t require you to touch the exposed catheter during insertion, and study has shown that it reduces catheter contamination.
Compactcath intermittent catheters are no-touch, pocket-sized, and pre-lubricated with anti-bacterial silicone oil
Neurological cause of urinary retention
For urine to void, the bladder’s detrusor muscle needs to contract to squeeze urine out, and the urethral sphincter needs to relax to let urine pass through. If the nerves that control either of these actions are damaged, urinary retention may occur. The condition is known as neurogenic bladder.
Men of all ages can have neurogenic bladder syndrome. The cause of neurogenic bladder can be spinal cord injuries (SCI), stroke, diabetes, birth defects, etc.
Blockages in the urinary tract
Infection and inflammation of the bladder and urethra can make them swell and block the urine from exiting.
The blockage can come from inside the bladder, such as in the case of bladder stones or tumors.
The blockage can occur at the bladder neck, where the bladder meets the urethra. This is known as bladder outlet obstruction (BOO) and an enlarged prostate is an example of it.
When the urethra has been cut, scraped, or otherwise traumatized, scar tissues can form and obstruct the urethra. This is known as urethral stricture.
Old age and medication
As people age, their bladders age with them. The bladder’s detrusor muscle can lose its power to contract. Certain medications with anticholinergic properties can also lead to UR. Old people are more susceptible to the effects of such drugs as well.
Treatment for urinary retention
If the cause of UR is a bacterial infection, such as in the case of UTI and prostatitis, antibiotics can be used to treat it.
In the case of urethral stricture, the urethra can be dilated, or surgery can be done to remove the scar tissue.
Often times, doctors will prescribe intermittent catheters, which help patients drain their bladder completely several times a day.
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