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 (pee). Your bladder is like a storage tank for your pee (or urine). Pee is made up of the waste that your kidneys filter from your body. After your kidneys make your pee, it moves to your bladder where it sits until you empty it. Your urethra is the tube that carries your pee from your bladder out of your body. 

What are the types?

When you have urinary retention, it can be acute (sudden) or chronic (long-term). Acute means that it comes on quickly and it can be severe. Chronic urinary retention means that your symptoms are more gradual. Blockages, medications and nerve problems are common reasons a person may have urinary retention.

The acute form of urinary retention is an emergency. In this case, you’ll need to see a healthcare provider right away. Chronic urinary retention is most common in men who are between 60 and 80 years old.

How common is this condition?

About 10% of men over age 70 and up to 30% of men over 80 will develop urinary retention. While women can get acute urinary retention, it’s far less common.

What are the signs of urinary retention?

The signs can vary depending on if you have acute or chronic urinary retention.

Acute urinary retention symptoms

With the acute form, symptoms come on more suddenly. You may not be able to pee at all, or only be able to go very small amounts even though you have a full bladder. In severe cases, it can cause digestive discomfort and lower abdominal pain. See a healthcare provider right away if this happens to you.

Chronic urinary retention symptoms

Symptoms of chronic urinary retention can vary from one person to another. Some symptoms include:

• Difficulty starting to pee.
• Weak, slow or uncontrollable urine stream.
• Feeling the need to pee immediately after you’ve just peed.
• Feeling like you always need to pee.
• Leaking pee.
• Waking up several times at night to pee (nocturia).

What causes 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 or swelling that prevent pee from leaving your body.
• Surgery.

Blockage

When something blocks the free flow of urine through your bladder and urethra, you might experience urinary retention. Blockages (obstructions) are one of the most common causes of urinary retention.

Some reasons you may experience a blockage include:

• Enlarged prostate: A blockage can happen when their prostate gland gets so big that it presses on their urethra.
• Bladder outlet obstruction: These obstructions affect the neck of your bladder, which is the area just before your pee leaves your body.
• Ureteral obstruction: Ureteral stones, blood clots, tumors or other factors can lead to a blockage in your urethra.
• Cystocele: This is a condition where your bladder can sag into your vagina.
• Rectocele: This is a condition in which your rectum sags into your vaginal wall.
• Urethral stricture: Your urethra narrows due to scar tissue.

Medications

Certain medications can cause urinary retention. Drugs like antihistamines (Benadryl®), antispasmodics (like Detrol®), opiates (like Vicodin®) and tricyclic antidepressants (like Elavil®) can change the way your bladder muscle works. 

Other medications that may cause bladder control side effects are:

• Some blood pressure-lowering medications.
• Antipsychotics.
• Muscle relaxants.

Nerve issues

You may not know this, but your brain plays a role in urination. Passing urine happens when your brain tells your bladder muscle to tighten to squeeze your pee out. Your brain then tells your sphincter muscles surrounding your urethra to relax. This lets the flow of urine go out of your body. If there’s an issue in how your brain talks to your nerves, it can cause a problem with urination.

Causes of nerve issues can include:

• Stroke.
• Diabetes.
• Multiple sclerosis (MS).
• Trauma to your spine or pelvis due to an accident or injury.
• Pressure on the spinal cord from tumors and a herniated disk.
• Vaginal childbirth.
• Some types of pelvic surgery.

You’re also at a higher risk of nerve issues if you’ve had a catheter (thin tube that removes pee directly from your bladder).

Infection or swelling

Infection and swelling (inflammation) can also affect how pee flows through your urethra. Some examples of urinary retention due to infection or inflammation are:

• Prostatitis: Infection or inflammation in your prostate causes it to swell and press up against your urethra, blocking the flow of pee.
• Urinary tract infection (UTI): An infection in your urinary tract can cause your urethra to swell or cause weakness in your bladder, both of which can cause urinary retention.
• Sexually transmitted infections (STIs): Infections spread through sexual contact can also cause swelling and lead to urinary retention.

Surgery

You may experience urinary retention after having joint replacement surgery (such as hip replacement) or spinal surgery. Having general anesthesia during a procedure can also cause temporary urinary retention. 

What are the risk factors for urinary retention?

Anyone can have urinary retention, but it occurs more often in men. People with an enlarged prostate (benign prostatic hyperplasia or BPH) are most likely to develop urinary retention because their prostates push on their urethras, blocking the flow of urine out of their bladder.

What are the complications of urinary retention?

Left undiagnosed or untreated, urinary retention can lead to:

• UTIs: Pee that stays in your bladder is a breeding ground for bacteria. This can cause infection in your urinary tract that can spread up to your kidneys.
• Bladder damage: When pee stays in your bladder, it can overstretch your bladder muscles and damage them.
• Kidney damage: An infection in your urinary tract can spread up to your kidneys, causing them to inflame and swell. This pressure can damage your kidneys and lead to kidney disease.
• Leaking pee: When your bladder doesn’t fully drain, it can lead to you accidentally leaking pee.
• Bladder stones: When pee stays in your bladder, it could lead to bladder stones.

​How is urinary retention diagnosed?

Acute urinary retention is a medical emergency. You should seek care right away if you have trouble urinating suddenly, especially if you feel pain in your abdomen or belly.

If you have chronic urinary retention, you’ll see a urologist who will:

• Ask you about your symptoms and how long you’ve had them.
• Get your complete medical history.
• Perform a physical examination.
• Collect a urine sample to check it for infection. 
• Perform a digital rectal exam to check your prostate. 

There are other tests your provider may use to find the causes of urinary retention. These could include:

• Post-void residual urine test (PVR): This is a test that measures how much pee is left in your bladder after you urinate. 
• Cystoscopy: A test that allows your healthcare provider to examine the inside of your bladder and urethra with a cystoscope. This is a pencil-sized lighted tube with a camera or viewing lens on the end.
• Urodynamic testing: This test measures nerve and muscle function, pressure in and around your bladder, and urine flow rate. 
• PSA test: A prostate-specific antigen (PSA) blood test screens for prostate cancer. 

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.

Treatment for acute urinary retention

Since the acute form of urinary retention is a medical emergency, your healthcare provider will insert a catheter to drain your bladder. This should provide almost immediate relief. After that, they’ll work to determine the cause and the appropriate treatment.

Treatment for chronic urinary retention

Treatment of the chronic form will depend on the cause. It could include one or a combination of the following:

• Medication.
• Surgery.
• Nonsurgical options (behavioral changes).

It could also include temporarily using a catheter at home, especially if nerve issues are causing the urinary retention. Your provider will teach you how to self-catheterize.

Medication

Your provider may prescribe medication to treat the underlying cause of urinary retention. This could include medication for:

• Enlarged prostate: Medications like alpha-blockers and 5-alpha reductase inhibitors work by either shrinking your prostate or relaxing the muscles around your prostate. 
• Infections: Antibiotics help treat the infections that cause urinary retention.

Surgery

Surgical procedures may be necessary to treat urinary retention depending on the cause. Your provider may recommend surgery to treat things like:

• Enlarged prostate: Many types of surgery can treat an enlarged prostate. Examples include transurethral resection of the prostate (TURP), prostatic urethral lift or holmium laser enucleation of the prostate (HoLEP). All of these procedures (and others) can be effective in opening up the blockage causing urinary retention.
• Urethral stricture: Your provider may open the scar tissue forming the stricture using a catheter or balloon. Surgery that involves opening up your urethra and then repairing it is also an option (urethroplasty).
• Cystocele or rectocele: If a sagging or bulging bladder or rectum is the cause of your symptoms, your provider may recommend a pessary or surgery to lift the organs back to their usual position. Surgery may be an option to fix any type of pelvic organ prolapse.
• Urinary tract stones: Your provider may perform a cystolitholapaxy to break up and remove stones in your bladder or urethra. 

Your healthcare provider will begin with less invasive procedures and treatments first. But, if none of these help, they may need to consider more invasive procedures like:

• Removing your prostate (prostatectomy).
• Spinal cord stimulation.
• Bladder surgery.
• Performing urinary reconstruction and diversion.

Nonsurgical treatments

Sometimes, nonsurgical approaches can provide relief of your symptoms. Some examples of nonsurgical treatments could include:

• Kegels or pelvic floor therapy: Kegel exercises and physical therapy help strengthen your pelvic floor muscles.
• Vaginal pessary: This is a ringlike device that supports your bladder if it’s sagging.
• Bladder control: Certain behaviors like drinking fluids only at certain times to manage when you’ll need to pee can improve urinary retention.

Can you prevent urinary retention?

You can’t prevent it, but you can take steps to lower your risk. Some of these steps include:

• Use the bathroom as soon as you have the urge to go. Don’t hold your pee.
• Pay attention to your urination habits and alert your healthcare provider if you notice a change.
• Eat well-balanced meals, maintain a weight that’s healthy for you and drink plenty of water.

Can you still pee with urinary retention?

Yes, some people still pee a little bit. Urinary retention can mean either you don’t pee at all or you don’t empty your bladder completely when you pee. You may also pee because your bladder is overflowing with urine.

What can I expect if I have urinary retention?

If you receive a urinary retention diagnosis, be sure to follow your provider’s treatment plan. Attend follow-up appointments and keep track of if your symptoms are improving. Many people find relief from their symptoms with the right treatment.

When should I see my healthcare provider?

See your healthcare provider if you:

• Feel a frequent urge to urinate, often shortly after you just went.
• Have trouble starting to pee or if your urine stream is weak or stops and starts.
• Feel pain in your lower abdomen, genitals or low back.

What questions should I ask my healthcare provider?

If you have urinary retention, it’s normal to have questions. You may want to ask your provider:

• What do you think is the cause of my symptoms?
• Do you recommend additional tests?
• What treatment would you recommend?
• How can I best manage my symptoms?
• Will my urinary retention go away?