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What Causes Urinary Retention in Women?

Urinary retention is the inability of the bladder to empty completely, or in severe cases, to empty at all.

Urinary retention in women can be caused by a variety of underlying conditions. There can be a physical blockage in the lower urinary tract, which prevents the urine from draining. The cause can be neurological—nerve damages that disrupt the muscle coordinations required to urinate. The effects of aging and certain prescription drugs can also lead to retention.   

Some causes of urinary retention are specific to each sex’s anatomy. For example, many men get UR due to an enlarged prostate, whereas many women get UR for reasons related to childbirth or menopause. 

Urinary retention can be acute or chronic, and the underlying reason needs to be diagnosed by a doctor. If you have suddenly lost the ability to urinate (acute UR), it may be a medical emergency. If you have completely lost the ability to urinate and are experiencing a painful urge to urinate and a discomfort in your lower abdomen, you should go to the emergency room.

For people not in a medical emergency, read on to learn about some common causes of urinary retention in females.

1. Prolapsed bladder 

The prolapsed bladder, also known as anterior prolapse or cystocele, is a frequent cause of urinary retention in women. The tissue in the pelvis that supports the bladder can weaken due to childbirth and menopause, causing the bladder to leave its normal position and droop down, pressing into the neighboring vagina.  

The drooping of the bladder leads to the incomplete voiding of urine. Two common risk factors for prolapsed bladder are childbirth and menopause. 

Childbirth puts great strain on the pelvic muscles and ligaments. Women who have had multiple vaginal deliveries are more likely to develop a prolapsed bladder. 

Women are also more likely to develop a prolapse in menopause. In menopause, women’s bodies start to decrease their production of estrogen, a hormone that keeps the pelvic muscles strong. 

Other factors that can weaken the supportive pelvic tissues and increase the risk of prolapse are:

  • Obesity
  • Chronic coughing 
  • Heavy lifting 
  • Chronic straining during bowel movement

Urinary retention is one of the symptoms of the prolapsed bladder, other symptoms include: 

  • Pressure and heaviness in the vagina
  • Tissue protruding out of the vagina
  • Feeling likes something is going to fall out of the vagina 
  • Discomfort in the pelvis, groin, lower back and abdomen aggravated by sexual intercourse or menstruation. 
  • Frequent urge to urinate and frequent urination

If you have these symptoms, contact your doctor and get a diagnosis. The weakening of pelvic muscles and tissues can also cause rectal prolapse and uterine prolapse (uterus droops into the vagina), both of which may lead to urinary retention. 

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2. Neurological damage 

For urine to be expelled out of the body, the bladder’s detrusor muscle needs to contract and squeeze while the urethral sphincter muscle needs to relax and let urine flow out. Both of these functions are controlled by nerves. Sometimes, nerve damages can occur as a result of diabetes, multiple sclerosis, stroke, spinal cord injuries, etc, and disrupt muscle coordination.  

Neurogenic bladder refers to a condition in which the bladder’s nerve function is damaged. As a result, the bladder can either by overactive or underactive. An underactive bladder leads to urinary retention, whereas an overactive bladder leads to urine leakage and frequent urination. 

With urethral sphincter nerve damage, the result can also go both ways. The urethral sphincter can be unable to relax, causing urinary retention, or unable to contract, causing urinary incontinence. 

3. Physical blockage in the lower urinary tract

For women, any blockage in the lower urinary tract—the bladder and urethra—can also lead to urinary retention. 

The blockage can be inside the bladder, such as in the case of bladder stones or tumors. 

The neck of the bladder (where the bladder connects to the urethra) can be obstructed in what is known as bladder outlet obstruction (BOO). This condition in women is rare and poorly understood. 

The urethra can also be obstructed in what is known as urethral stricture. Scar tissue formed by previous urethral trauma can obstruct the urethra. Infections (urethritis) can also cause swelling which narrows the urethra.

4. Weak or underactive detrusor muscle

The detrusor muscle can be underactive due to nerve damage (neurogenic bladder), but the contractility of the detrusor muscle may also decrease with age. Additionally, drugs with anticholinergic activity can cause the detrusor muscle to become underactive, 

If you have symptoms of urinary retention, It is important to see a doctor and get diagnosed formally. 

Urinary retention symptoms include

  • Frequent urination
  • Difficulty starting a urine stream
  • A weak or broken stream
  • Strong urge to urinate with little success or low volume 
  • feeling the urge to urinate after finishing urination
  • Constant, mild discomfort in the lower abdomen

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