Urinary Retention

What is urinary retention?

Urinary retention is a condition where your bladder doesn’t empty all the way or at all when you urinate. Your bladder is like a storage tank for urine. Urine is made up of waste that’s filtered out of your blood by your kidneys. Once filtered, the urine moves to your bladder where it waits till it’s time to move through the urethra and out of the body.

When you have urinary retention, it can be acute (sudden) or chronic (long-term). Acute means that it comes on quickly and it could be severe. Chronic urinary retention means that you’ve had the condition for a longer period of time.

The acute form of urinary retention is an emergency. In this case, you’ll need to see a healthcare provider right away. The chronic form happens most of the time in older men, but it can also occur in women.

What causes chronic urinary retention?

Urinary retention can happen for several different reasons. These causes can include:

• A blockage to the way urine leaves your body.
• Medications you’re taking for other conditions.
• Nerve issues that interrupt the way your brain and urinary system communicate.
• Infections and swelling that prevent urine from leaving your body.
• Complications and side effects of medications given to you for a surgical procedure.

Blockage

When something blocks the free flow of urine through the bladder and urethra, you might experience urinary retention. The urethra is the tube that carries urine from the bladder to the outside of your body. 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 chronic urinary retention in men. One cause in women is a bladder that sags. This is called cystocele. It can also be caused when the rectum sags into the back wall of the vagina – a condition called rectocele. Some causes can happen to both men and women. The urethra can get narrow due to scar tissue. This is called a stricture. Urinary stones can also block the flow of urine out of your body.

Medications

Urinary retention can also be caused by certain medications. Drugs like antihistamines (Benadryl®), antispasmodics (like Detrol®), opiates (like Vicodin®) and tricyclic antidepressants (like Elavil®) can change the way the bladder muscle works. Other medications can also cause bladder control side effects, including anticholinergics, some blood pressure-lowering medications, antipsychotics, hormonal agents and muscle relaxants.

Nerve issues

Passing your urine happens when the brain tells the bladder muscle to tighten. This squeezes urine from the bladder. The brain then tells the sphincter muscles surrounding the urethra 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. Causes of nerve issues can include:

• Stroke.
• Diabetes.
• Multiple sclerosis.
• Trauma to the spine or pelvis.
• Pressure on the spinal cord from tumors and a herniated disk.
• Vaginal childbirth.

If you have had a thin tube called a catheter in the past, you may be at greater risk for this condition. Your risk is also higher if your healthcare provider has used any other special device on you, such as an ureteroscope or cystoscope (these are telescopes with cameras that look in the urinary tract).

Urinary retention from nerve disease occurs at the same rate in men and women.

Infections 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 or weakness of the bladder, both of which can cause urinary retention. Diseases spread by having sex (called STIs) can also cause swelling and lead to retention.

Surgery

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

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’re all of a sudden not able to go at all, or only able to go very small amounts. This occurs even though you have a full bladder. See a healthcare provider right away if this happens to you.

How is chronic urinary retention diagnosed?

History and physical exam: During the diagnosis process, your healthcare provider 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 your provider additional 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.

Ultrasound of the bladder: The amount of urine that stays in your bladder after urinating may be measured by doing an ultrasound test of the bladder. This test is called a postvoid residual or bladder scan.

Cystoscopy: Cystoscopy is a test in which a thin tube with a tiny camera on one end is put into your urethra. This lets the doctor look at pictures of the lining of your urethra and bladder. This test may show a stricture (scar) of the urethra, blockage caused by a stone, 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.

Urodynamic testing: 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. This is called urodynamic testing.

EMG: Your healthcare provider 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.

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

How is urinary retention treated?

Treatment for urinary retention can depend on whether you have the acute form or the chronic form, as well as the cause of the condition. 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.

Medications for enlarged prostate: For men with an enlarged prostate, certain drugs may be used to try and open it up or shrink it. These include alpha-blockers (tamsulosin [Flomax®], terazosin [Hytrin®] and alfuzosin [Uroxatral®]) and 5-alpha reductase inhibitors (finasteride [Proscar®] and dutasteride [Avodart®]). Also, procedures or surgery to open up the prostate may be tried.

Procedures for enlarged prostate: Many procedures are available when this problem is due to an enlarged prostate. Office-based treatments can be done with just local anesthetic (numbing medicine) only. These include water vapor therapy (Rezum®) and prostatic urethral lift (Urolift®).

There are also several surgeries done under general anesthesia which are available. These include shaving down the inside of the prostate (transurethral resection of the prostate, or TURP) and opening up the prostate with a laser (Greenlight photoselective vaporization of the prostate, or PVP). A laser can also be used to carve out the entire enlarged portion of the prostate through the urethra (Holmium laser enucleation of the prostate, or HoLEP), or this part of the prostate can be removed through the belly (simple prostatectomy). All of these procedures can be effective in opening up the blockage.

Treatments for urethral stricture: For a urethral stricture, opening the scar tissue in 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 scar is also an option. Sometimes the scar tissue needs to be cut out and the urethra fixed with a surgery called a urethroplasty.

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

Treatments for women with urinary retention: 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 provider may suggest estrogen therapy if you are past menopause. Surgery may be required for more severe cases to lift the sagging bladder or rectum.