What is urinary retention?

Urinary retention is when the bladder (where you store your urine or 'water') does not empty all the way or at all. It can be acute (sudden) or chronic (long-term). Acute means it comes on real quick or is very bad. Chronic means you have had it for a while.

The acute form is an emergency. You need to see a doctor right away. The chronic form occurs most of the time in older men, but it can also occur in women.

What are the symptoms of urinary retention?

The signs can vary. Some people with the chronic form have a hard time starting the flow of urine. Some have a weak flow once they start. Others may feel the need to go but can’t start. Others have to go a lot, while others still feel the need to go right after going. You may “leak” urine when you aren’t going because the bladder is full.

With the acute form, you are all of a sudden not able to go at all. This occurs even though you have a full bladder. See a doctor right away if this happens to you.

What causes chronic urinary retention?

There is more than one cause. It can happen when something blocks the free flow of urine through the bladder and urethra. The urethra is the tube that takes urine from the bladder out of the body. The problem can also be caused by using drugs such as antihistamines (like Benadryl®), antispasmodics (like Detrol®), and tricyclic antidepressants (like Elavil®) that can change the way the bladder muscle works.

Passing your urine occurs when the brain tells the bladder muscle to tighten. This squeezes urine from the bladder. The brain then tells the sphincter muscles to relax. This lets the flow of urine go through the urethra and out of the body. Anything that gets in the way on the path from the brain to the nerves that go to the bladder and the urethra can also cause this problem. Urinary retention from nerve disease occurs at the same rate in men and women.

Blockage. In men, a blockage can be caused when the prostate gland gets so big that it presses on the urethra. This is the most common cause of the chronic form in men. One cause in women is a bladder that sags. This is called a cystocele. It can also be caused when the rectum sags into the back wall of the vagina. This is called a rectocele.

Some causes can happen to both men and women. The urethra can get narrow. This is called a stricture. Urinary stones can also block the flow of urine.

Infection and swelling. In men, an infection of the prostate can cause it to swell. This causes it to press on the urethra to block the flow of urine. A urinary tract infection (UTI) can cause swelling of the urethra to cause this problem. Diseases spread by having sex (called STDs) can also cause swelling and lead to retention.

Nerve causes. The bladder may not work right because there is a problem getting the messages from the brain to the bladder and urethra through the nerve pathway. Causes include stroke, diabetes, multiple sclerosis, trauma to the spine or pelvis, pressure on the spinal cord from tumors and a herniated disk. In women, vaginal childbirth can sometimes damage nerve pathways that control going.

If you have had a thin tube called a catheter put in you in the past, you may be at greater risk for this condition. Your risk is also higher if your doctor has used any other special device on you, such as an ureteroscope or cystoscope.

Drugs. Some types of drugs affect bladder muscle function as a side effect and can cause this problem. These include drugs called anticholinergics, the older drugs for depression, antihistamines, some blood pressure-lowering drugs, antipsychotics, hormonal agents, and muscle relaxants.

Surgery. Medicine given before and during surgery to make you sleepy may cause urinary retention right after surgery. Procedures such as hip replacement, rectal surgery, surgery for women’s issues, and surgery to remove hemorrhoids can cause the problem afterward.

How is chronic urinary retention diagnosed?

Urinary Retention

The doctor will ask about your signs and symptoms and how long you have had them. He or she will also ask about your medical history and your drug use. A physical exam of the lower abdomen (belly) may show the cause or give the doctor clues. After this, certain tests may be needed. Men may have a rectal exam to check the size of their prostate.

Your urine may be saved and checked to look for infection.

The amount of urine that stays in your bladder after going may be measured by doing an ultrasound test of the bladder.

Cystoscopy is a test in which a thin tube with a tiny camera on one end is put into the urethra. This lets the doctor look at pictures of the lining of your urethra and bladder. This test may show a stricture of the urethra or blockage caused by a stone or an enlarged prostate or a tumor. It can also be used to remove stones, if found. A computed tomography (CT) scan may also help find stones or anything else blocking the flow of urine.

Tests that use a catheter to record pressure within the bladder may be done to tell how well the bladder empties. The rate at which urine flows can also be measured by such tests.

A prostate-specific antigen (PSA) blood test may be done as a screen for prostate cancer. If the PSA level is raised, a transrectal ultrasound and maybe a biopsy of prostate tissue may also be done.

Your doctor may do certain tests if he or she thinks the retention is caused by a problem with the nerves. One test is electromyography (EMG). EMG uses sensors to measure electrical activity of muscles and nerves in and near the bladder and the urethral sphincter.

How is urinary retention treated?

For the acute form, a catheter is put into the urethra to drain the bladder.

Treatment of the chronic form or the acute form that becomes chronic will depend on the cause. For men with an enlarged prostate, certain drugs may be used to try and shrink it. These include alpha-blockers and 5-alpha reductase inhibitors (finasteride and dutasteride). Also, surgery to take out the prostate or reduce its size may be tried.

Transurethral resection of the prostate is the most common type of surgery when this problem is due to an enlarged prostate. During this surgery, the doctor puts a tool through a catheter. He or she threads it up the urethra and takes out a section of the prostate. There are other ways to treat this problem that are not surgery. They use energy sources such as microwaves and lasers to break up the blockage.

For women with cystocele or rectocele as the cause, mild or moderate cases may be treated with exercises that strengthen the pelvic floor muscles. They also may be treated by putting in a ring called a vaginal pessary to support the bladder. Your doctor may suggest estrogen therapy if you are past menopause. Surgery may be required for more severe cases to lift the sagging bladder or rectum.

For a urethral stricture, opening the urethra with catheters and balloons may be tried. Surgery using a knife or laser that is moved through the urethra to make a cut to open the stricture is also an option. A stent (a mesh tube) can also prop open a closed urethra in men.

If the retention is due to a nerve-related issue, you may need to use a catheter on yourself at home.

References

  • Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician 2008;77:643-650.
  • Muhammed A, Abubkar A. Pathophysiology and management of urinary retention in men. Arch Intl Surg 2012;2:63-69.
  • NIH Urinary Retention Accessed 6/23/2014.
  • McConnell JD, Bruskewitz R, Walsh P, et al. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. N Engl J Med 1998;338:557-563.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/11/2014...#15427