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What Is Urinary Retention?
Symptoms, Causes
& Treatments

Published 2018/08/17

Urinary retention can happen at any age, though it most commonly occurs in males aged 50+, and often due to an enlarged prostate (BPH). However, urinary retention can also occur in females, typically due to a condition known as cystocele – which is when the bladder sags or moves out of its normal position.

 

A condition known as rectocele can also cause urinary retention in both sexes when the bladder is pulled out of position by the colon. In addition to age-based conditions, people of all ages, male or female, can have nerve disease or damage that can interfere with the bladder function.

 

Urinary retention is the inability to empty urine from the bladder and can be characterized as acute or chronic. Acute urinary retention usually occurs suddenly and temporarily. Individuals suffering from acute urinary retention are unable to empty their bladder at all — they can feel the urge to urinate, but can’t go at all.

This can be potentially life-threatening as pressure is built up in the bladder and may lead to a rupture. This causes a great deal of discomfort or pain in the lower abdomen. If you experience any of these symptoms, it is important to seek emergency medical attention immediately to release the buildup of urine.

 

Chronic urinary retention, on the other hand, typically lasts a long period of time. Individuals with chronic urinary retention are usually able to urinate, but cannot empty their bladder completely. It is extremely common for people with chronic urinary retention to be unaware of their condition as symptoms may not be as clear at first.

What are the symptoms of urinary retention?

Symptoms of chronic urinary retention include:

 

  • Urinating frequently, often 8+ a day
  • Difficulty starting your urine stream
  • Weak urine stream and/or urine stream that starts and stops
  • Feeling like you need to urinate again immediately after urinating
  • Waking up several times during the night to urinate
  • Bladder leakage throughout the day
  • Inability to tell when your bladder is full
  • Constant feeling of fullness/discomfort in your lower abdomen
  • Urge incontinence, the involuntary expelling of urine associated with an urgent feeling to urinate.

If you experience any of these symptoms, it is important to seek medical attention from a urologist. If left untreated, it can lead to the development of other conditions, such as urinary incontinence, kidney disease, bladder damage, and/or urinary tract infections (UTIs).

Urinary Retention Facts

  • Urinary retention is the inability to empty the bladder. Urinary retention can be acute or chronic, depending on a number of factors and an individual’s medical condition.
  • Urinary retention is most common in men in their 50s and 60s because of prostate enlargement.
  • Women may experience urinary retention with a condition called cystocele when the bladder sags or moves out of the normal position, or rectocele, where the bladder is pulled out of position by a sagging of the lower part of the colon.
  • Causes of urinary retention include urethral obstruction due to conditions such as enlarged prostate (BPH) or urethral strictures, nerve damage that disrupt neurological signals between the bladder and the brain, post-surgery related issues, and certain medications.
  • Symptoms of acute urinary retention are severe discomfort and pain, bloated lower belly, an urgent need to urinate but the inability to do so.
  • Chronic urinary retention symptoms often include mild but constant discomfort, difficulty starting a stream of urine, weak flow of urine, the urge to urinate frequently, or feeling like you still need to urinate when you’re finished.
  • Complications from urinary retention can include urinary tract infections (UTIs), bladder damage, and chronic kidney disease.
  • Urinary retention diagnosis may include these tests to measure the effectiveness of the bladder’s ability to empty:
    1. Urine samples
    2. Bladder scans
    3. Cystoscopy
    4. X-ray and CT scan
    5. Prostate-specific antigen (PSA) blood test
    6. Prostate fluid sample test
    7. Urodynamic tests

What causes urinary retention?

To understand the different causes of urinary retention, it is useful to understand the different parts of the urinary system and how they work together to help the body create, store and release urine:

 

  • Kidneys filter waste products from the blood to make urine.
  • Ureters are hollow, narrow tubes that carry urine from the kidneys to the bladder.
  • The bladder is a muscular organ that stores and empties urine.
  • The urethra carries urine from the bladder out of the body. In females, it is about 1 inch long, and about 8-10 inches long in males.
  • Internal and external sphincters are sets of muscles that work to both keep urine in and push urine out.

Problems in any of these organs or the nerves that control them can cause urinary retention, but some of the more common causes of urinary retention include:

Urethral Obstruction

The primary function of the urethra is to carry urine out of the body, so any obstruction in this structure can cause both acute or chronic urinary retention, as the normal flow of urine is blocked. Acute urinary retention is caused by a sudden, complete obstruction of the urethra; whereas chronic urinary retention is caused by the progressive and often partial obstruction of the urethra.

Common causes of urethral obstruction include:

  • Enlarged prostate
  • Benign prostatic hyperplasia (BPH)
  • Urinary tract stones
  • Urethral strictures
  • Bladder organ prolapse – cystocele, rectocele
  • Tumors or cancers in the pelvis or intestine
  • Severe constipation
  • Blood clot in the bladder
  • Foreign objects inserted in the urethra
  • Urethral inflammation

Nerve Damage

Two things occur when you urinate: the muscles in the bladder wall contract to push urine out, and the brain sends signals down the spinal cord and surrounding nerves to contract the sphincters, causing the urethra to open and close, allowing the urine to leave the bladder.

If the nerves controlling the bladder and sphincters are damaged, the brain may not receive signals that the bladder is full, or that the sphincters need to relax, which can cause urinary retention.

 

Many events can interfere with the nerve functions of the bladder. Some common causes include:

 

  • Spinal Cord Injuries
  • Multiple Sclerosis
  • Spina bifida
  • Stroke
  • Vaginal childbirth
  • Diabetes
  • Pelvic injury or trauma
  • Heavy metal poisoning
  • Parkinson’s disease

Surgery-Related Problems

It is common for patients to experience temporary or acute urinary retention after surgeries. This occurs due to anesthesia, which blocks pain signals in the nerves, which can impair overall bladder function. This, in combination with IV fluid administration, can sometimes cause urinary retention temporarily.

 

However, acute urinary retention usually disappears after the anesthesia has worn off, and the patient usually regains full bladder control.

Medication

A side effect of some medications can cause impaired function in the bladder muscles, making it difficult to push urine out of the bladder, causing urinary retention.

 

These medications may include:

 

  • amphetamines
  • antihistamines
  • medication to treat Parkinson’s disease
  • medication to treat urinary incontinence
  • muscle relaxants
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • pseudoephedrine
  • some antipsychotics
  • some older antidepressants
  • some opioid pain medications like morphine

Treating Urinary Retention

Acute

Acute urinary retention is considered a medical emergency, and your doctor will place a catheter directly into the bladder to let out the urine. If this method of catheterization isn’t effective the doctor will create a small hole in the skin directly over your bladder and through the wall of the bladder. A suprapubic catheter would then be inserted directly into your bladder and the urine should quickly be drained.

Chronic

Chronic urinary retention affects hundreds of thousands of people every year, impacting their quality of life with constant symptoms and complications.

Below are the number of ways in which chronic urinary retention is treated.

Self-Catheterization for Urinary Retention

Self-catheterization, or the use of a catheter, such as an Intermittent catheter, is one of the most popular ways to alleviate the symptoms of chronic urinary retention. Intermittent catheters require the individual to use a different catheter every time they need to urinate, typically 4 – 5 times per day.

 

While intermittent catheters are the most popular, there are other urinary catheteroptions:

Urethral Dilation and Stents

Chronic urinary retention is often the cause of urinary stricture, or the narrowing of the urethra commonly due to injury or infection, which prevents urine from flowing through.

 

To widen or dilate the urethral stricture, stents, or small tubes, are inserted into the urethra. As they are inserted into the urethra, stents widen, opening up the stricture and increasing urine flow. Depending on the severity of the stricture, stents can either be inserted temporarily or remain in the urethra permanently. This procedure is used to widen the urethral stricture to allow more urine to flow through.

Cystoscope

When it’s determined that chronic urinary retention is caused by bladder stones or blood clots, a flexible, lighted tubular scope called a cystoscope will usually be inserted into the urethra to find and remove foreign objects from the urethra, bladder, and/or bladder outlet.

Urinary Retention Prescription Medication

Some medications that may help with urinary retention include:

  • antibiotics to treat infections such as urinary tract infection, prostatitis, or cystitis
  • medications that help urethral muscles relax, widening the channel and increasing urine flow
  • medications that decrease the size of the prostate for men suffering from BPH

Behavior modifications

For less severe cases of urinary retention, some lifestyle/behavior modifications can be done to alleviate symptoms:

  • Time and manage the daily intake of fluid
  • Strengthen muscles in the pelvic floor
  • Practice bladder retraining techniques.

Urinary Retention Surgery

Your doctor may suggest surgery as a treatment if other therapies were unsuccessful in treating urinary retention. Most surgeries to treat urinary retention are outpatient procedures and minimally invasive, reducing pain and speeding up recovery time:

 

  • minimally invasive procedures via the urethra
  • transurethral resection of the prostate, often called a TURP procedure to remove extra prostate tissue that’s blocking the urethra
  • urethrotomy to permanently open urethral strictures
  • removal of the prostate

 

If urinary retention is caused by a structural abnormality in a bladder organ, laparoscopic or open surgical procedures may be required to:

 

  • remove part or all of the prostate due to cancer
  • remove an abnormal uterus
  • fix a cystocele or rectocele
  • remove cancerous tissue or tumors in the bladder, urethra, or pelvic organs

For many with urinary retention, self-catheterizing becomes an essential part of daily life, requiring individuals to use a catheter multiple times a day.

 

However, the bulky and uncomfortable nature of traditional intermittent catheters often causes inconvenience and embarrassment to catheter users, which can lead to infrequent usage and eventually increased the risk of infection and/or further complicated.

 

CompactCath has been designed to fit in one’s palm, providing a smaller, easier and more discreet experience than traditional catheters.

 

It is a compact intermittent urinary catheter that aims to reduce the inconvenience or embarrassment felt by some patients about self-catheterizing. It does this by minimizing catheter size, noisy packaging, and risk of developing infections and creating a mess.

 

CompactCath® Classic comes ready to use right out of the package. It is pre-lubricated, has a drainage control mechanism, and lastly features an opaque packaging that brings users more privacy.

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