Overview
Urinary retention is a condition where the bladder does not fully empty during urination, caused by blockages, medications, nerve issues, infections, or surgery. It can be sudden (acute) or gradual (chronic), with acute cases requiring emergency medical attention.
Types and Prevalence
- Urinary retention can be acute (sudden, severe) or chronic (gradual, ongoing).
- Acute urinary retention is a medical emergency.
- Chronic urinary retention affects up to 30% of men over age 80, but is less common in women.
Symptoms
- Acute symptoms: sudden inability to urinate, lower abdominal pain, discomfort.
- Chronic symptoms: difficulty starting urination, weak or slow stream, frequent urge immediately after urinating, nocturia, leakage.
Causes and Risk Factors
- Blockages (enlarged prostate, bladder outlet or ureteral obstruction, cystocele, rectocele, urethral stricture).
- Certain medications (antihistamines, antispasmodics, opiates, antidepressants, antipsychotics, muscle relaxants, antihypertensives).
- Nerve issues (stroke, diabetes, multiple sclerosis, trauma, spinal cord pressure, pelvic surgery, childbirth).
- Infections or swelling (prostatitis, urinary tract infections, STIs).
- Surgery, especially joint or spinal procedures, and anesthesia use.
- More common in men, especially those with enlarged prostate.
Complications
- Increased risk of urinary tract infections (UTIs).
- Bladder damage from overstretching.
- Kidney damage or chronic kidney disease.
- Urine leakage and bladder stones.
Diagnosis
- Acute cases require immediate medical care.
- Evaluation includes symptom review, medical history, physical exam, urine analysis, and digital rectal exam.
- Diagnostic tests: post-void residual urine test, cystoscopy, urodynamic testing, PSA blood test.
Management and Treatment
- Acute retention: immediate catheterization to relieve bladder.
- Chronic retention: treatment depends on cause and may include medication, surgery, or behavioral changes.
- Medications: alpha-blockers, 5-alpha reductase inhibitors for enlarged prostate; antibiotics for infections.
- Surgery: options for enlarged prostate, strictures, prolapse, or stones.
- Nonsurgical treatments: Kegel exercises, pelvic floor therapy, bladder training, vaginal pessary.
- Self-catheterization may be taught for nerve-related cases.
Prevention
- Urinary retention cannot always be prevented, but risks can be reduced by using the bathroom promptly, monitoring urination habits, eating well, maintaining healthy weight, and staying hydrated.
When to Seek Medical Attention
- Contact a healthcare provider for new, frequent, or urgent urinary symptoms, difficulty starting urination, weak stream, or abdominal/genital pain.
Questions for Your Provider
- Ask about causes, recommended tests, treatment options, symptom management, and likelihood of resolution.
Recommendations / Advice
- Follow the treatment plan and attend follow-up appointments.
- Monitor symptoms and communicate changes to your healthcare provider.
- Urinary retention is common and treatable; seek help promptly for any issues.