Urinary Retention

Urinary retention is a condition characterized by the inability to fully empty the bladder, resulting in the accumulation of urine. It can be a distressing and uncomfortable condition that may have various underlying causes. Here, we provide you with an in-depth overview of urinary retention including the symptoms, causes, diagnosis, and treatment options.

What is Urinary Retention?

Urinary retention occurs when the bladder is unable to expel urine properly. It can be categorized as either acute or chronic. Acute urinary retention is a sudden and complete inability to urinate, while chronic urinary retention involves a gradual or incomplete inability to fully empty the bladder. Both men and women can experience urinary retention, but it is more commonly observed in men, often due to prostate enlargement.

What are different types of urinary retention?

Urinary retention can be classified into two main types:

Acute Urinary Retention:

Acute urinary retention is the sudden and complete inability to pass urine despite having a strong urge to do so. It typically develops rapidly and requires immediate medical attention. Acute urinary retention is often associated with severe pain and discomfort. Common causes of acute urinary retention include:

• Urinary tract obstruction: Blockage in the urinary tract, such as urinary stones, blood clots, or tumors, can obstruct the flow of urine
• Medications: Certain medications, such as anticholinergics, opioids, or alpha-blockers, can cause acute urinary retention as a side effect
• Bladder muscle dysfunction: Conditions that affect the nerves or muscles controlling bladder function, such as spinal cord injury or nerve damage, can lead to acute urinary retention

Chronic Urinary Retention:

Chronic urinary retention is a long-term or ongoing inability to completely empty the bladder. It may develop gradually and may not cause sudden or severe symptoms. Chronic urinary retention is often associated with a weak urine flow and a feeling of incomplete bladder emptying. Causes of chronic urinary retention include:

• Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland, a common condition in older men, can obstruct the flow of urine and lead to chronic urinary retention
• Pelvic organ prolapse: In women, weakened pelvic floor muscles or conditions like cystocele or rectocele can contribute to chronic urinary retention
• Neurogenic disorders: Conditions that affect the nerves controlling bladder function, such as multiple sclerosis, Parkinson’s disease, or spinal cord injuries, can result in chronic urinary retention

It’s important to note that these types of urinary retention are not mutually exclusive, and some individuals may experience a combination of acute and chronic symptoms.

What are the risk factors of urinary retention?

While the exact cause of urinary retention can vary, several risk factors have been identified that may increase the likelihood of developing the condition. These risk factors include:

• Male gender: Urinary retention is more common in males than in females. This is partly due to anatomical differences, such as the longer male urethra and the presence of the prostate gland. Prostate enlargement (benign prostatic hyperplasia) or prostate cancer can obstruct the flow of urine and contribute to urinary retention in men
• Aging: The risk of urinary retention increases with age. As individuals age, the muscles of the bladder and the urethra may weaken, leading to impaired bladder emptying
• Neurological disorders: Certain neurological conditions can disrupt the normal coordination between the bladder muscles and the urinary sphincters, leading to urinary retention. Conditions such as spinal cord injury, multiple sclerosis, Parkinson’s disease, stroke, and nerve damage can interfere with the nerve signals responsible for bladder control
• Medications: Some medications can affect bladder function and increase the risk of urinary retention. Examples include certain antihistamines, anticholinergic drugs, decongestants, and medications used to treat overactive bladder
• Prior surgeries or procedures: Surgeries or procedures involving the urinary tract or adjacent organs can sometimes lead to urinary retention. For example, procedures like prostate surgery, bladder surgery, or pelvic surgery may cause temporary or persistent urinary retention
• Obstruction: Any obstruction along the urinary tract, such as kidney stones, bladder stones, urethral stricture, or tumors, can prevent normal urine flow and contribute to urinary retention
• Chronic constipation: Chronic constipation can lead to a condition known as “fecal impaction,” where a large, hardened stool mass obstructs the rectum and puts pressure on the bladder, leading to urinary retention

It’s important to note that the presence of these risk factors does not necessarily mean that an individual will develop urinary retention. Other factors, such as individual health conditions and lifestyle factors, can also contribute to the development of the condition. If you have concerns about urinary retention or any urinary symptoms, it is recommended to consult with a healthcare professional for proper evaluation and management.

What are the symptoms of urinary retention?

Below is a list of common symptoms associated with urinary retention:

• Difficulty initiating urination: A primary symptom of urinary retention is difficulty starting the flow of urine. The sensation of needing to urinate is present, but the actual release of urine may be challenging or incomplete
• Weak urine flow: When experiencing urinary retention, the urine flow may be weak, and the stream may feel inadequate or diminished. The urine may come out in a slow or interrupted manner
• Incomplete bladder emptying: Despite attempting to urinate, a person with urinary retention may feel as though the bladder hasn’t fully emptied. This sensation can persist even after urination
• Urgency and frequent urination: There might be a persistent feeling of urgency to urinate, even shortly after voiding. The frequency of urination may increase, with small amounts of urine being passed each time
• Pain or discomfort: Urinary retention can cause pain or discomfort in the lower abdomen, pelvic region, or perineum (the area between the genitals and anus). The discomfort may range from mild to severe and can be accompanied by a sense of pressure
• Abdominal distension: In some cases, prolonged urinary retention can lead to distension or bloating of the lower abdomen. The abdomen may feel swollen or enlarged
• Urinary incontinence: In some instances, urinary retention can result in overflow incontinence, where small amounts of urine leak involuntarily due to an overfilled bladder
• It’s important to note that symptoms can vary based on the severity of urinary retention and any underlying conditions. If you experience any of these symptoms or suspect urinary retention, it is advisable to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

What are the treatment and management options for urinary retention?

The treatment and management options for urinary retention depend on the underlying cause and severity of the condition. The primary goal is to relieve the obstruction or dysfunction that is causing the retention and restore normal bladder function.

• Catheterization: Inserting a catheter into the bladder is often the first step in relieving urinary retention. This can be done as an immediate temporary measure or as a long-term solution. Catheterization can be done intermittently (intermittent catheterization) or continuously (indwelling catheter) based on the individual’s needs
• Medications: Medications may be prescribed to help relax the muscles of the bladder or shrink an enlarged prostate gland (in cases of benign prostatic hyperplasia) that is causing obstruction. Alpha-blockers, anticholinergics, or 5-alpha reductase inhibitors are commonly used medications
• Bladder training: Bladder training techniques involve scheduled voiding and gradually increasing the time intervals between urination to retrain the bladder and improve its capacity and control. This approach can be effective for individuals with weak bladder muscles or overactive bladder
• Urethral dilatation: In cases of urethral strictures (narrowing of the urethra), a procedure called urethral dilatation may be performed. It involves gently stretching the narrowed area of the urethra to improve urine flow
• Surgery: Surgical intervention may be necessary if the urinary retention is caused by structural abnormalities, such as bladder or urethral obstruction, prostate enlargement, or pelvic organ prolapse. The specific surgical procedure will depend on the underlying cause
• Pelvic floor exercises: Strengthening the pelvic floor muscles through exercises, such as Kegels, can help improve bladder control and support normal urination. These exercises are particularly beneficial for individuals with weak pelvic floor muscles contributing to urinary retention
• Lifestyle modifications: Making certain lifestyle changes can help manage urinary retention. This may include maintaining a healthy weight, avoiding excessive fluid intake before bedtime, practicing regular voiding habits, and managing underlying conditions like diabetes or constipation

The treatment approach will be individualized based on the underlying cause, overall health, and specific needs of the individual. It’s important to consult with a healthcare professional to determine the most appropriate treatment plan for urinary retention.

How is urinary retention diagnosed?

Diagnosing urinary retention involves a comprehensive evaluation by a healthcare professional. The diagnostic process could include the following:

• Medical history: The healthcare provider will ask about your symptoms, medical history, and any underlying conditions that may contribute to urinary retention. They will also inquire about any medications you are taking that might affect bladder function
• Physical examination: A physical examination may be conducted to assess the abdomen, pelvis, and genitals for any signs of swelling, tenderness, or abnormalities. For men, a digital rectal examination may be performed to assess the prostate gland
• Urinalysis: A urine sample may be collected to check for signs of infection, blood, or other abnormalities that could be causing or contributing to urinary retention
• Bladder scan/Ultrasound: An ultrasound examination of the bladder can help determine the amount of urine retained after voiding. This test helps evaluate the extent of the retention and assess bladder function
• Urodynamic testing: Urodynamic testing measures the pressure and flow of urine during voiding. It provides information about bladder function, muscle activity, and potential obstructions
• Imaging studies: In some cases, imaging studies such as an ultrasound, CT scan, or MRI may be ordered to evaluate the urinary tract and identify any structural abnormalities that could be causing urinary retention
• Cystoscopy: Cystoscopy involves inserting a thin, flexible tube with a camera (cystoscope) into the urethra and bladder to visually inspect the urinary tract for any blockages, strictures, or abnormalities

Based on the findings from these diagnostic tests, the healthcare professional can determine the cause and severity of urinary retention and develop an appropriate treatment plan.

It’s important to seek medical attention if you experience symptoms of urinary retention, as it can lead to complications if left untreated. A healthcare professional will guide you through the diagnostic process and recommend the most suitable treatment options for your specific condition.

What are the complications of Urinary Retention?

Urinary retention, if left untreated or inadequately managed, can lead to various complications including:

• Urinary tract infections (UTIs): When urine remains in the bladder for extended periods, it increases the risk of bacterial growth and infection. UTIs can cause symptoms such as frequent urination, pain or burning during urination, cloudy or bloody urine, and pelvic discomfort
• Bladder damage: Prolonged or recurrent urinary retention can put pressure on the bladder, leading to bladder distension and stretching. Over time, this can weaken the bladder muscle and affect its ability to contract effectively, potentially resulting in long-term bladder dysfunction
• Kidney damage: Severe or chronic urinary retention can impair kidney function and lead to kidney damage. When urine cannot flow freely from the bladder, it can cause back pressure on the kidneys, interfering with their ability to filter waste products and maintain fluid and electrolyte balance
• Bladder stones: Urinary retention can increase the likelihood of developing bladder stones. These are hard mineral deposits that can form in the bladder due to the concentration of minerals and stagnant urine. Bladder stones can cause discomfort, pain, and recurrent urinary tract infections
• Urinary incontinence: Prolonged urinary retention can affect the coordination and control of bladder muscles, leading to urinary incontinence. The inability to fully empty the bladder can result in overflow incontinence, where small amounts of urine leak involuntarily due to an overfilled bladder
• Acute urinary retention episodes: In some cases, urinary retention can recur intermittently, leading to repeated episodes of acute urinary retention. These episodes can be painful, distressing, and require immediate medical attention for relief

What urinary retention support organisations are there available to support me in the UK?

• Bladder & Bowel UK: Bladder & Bowel UK is a national charity organization that focuses on promoting bladder and bowel health. They provide support and information for individuals with UR and other bladder and bowel conditions. They offer a helpline, resources, and educational materials. They also work with healthcare professionals to improve continence services
• The Urology Foundation: The Urology Foundation is a UK charity that supports research, education, and awareness of urological conditions, including Urinary Retention. They provide information resources, support for individuals with Urinary Retention, and funding for urological research
• Age UK: Age UK is a national charity that provides support and resources for older people, including those with Urinary Retention. They offer information, advice, and local services that can help individuals manage Urinary Retention and maintain overall well-being

What medications are used in urinary retention?

• Alpha-1 blockers:
  • Tamsulosin
  • Terazosin
  • Doxazosin
• 5-alpha reductase inhibitors:
  • Finasteride
  • Dutasteride
• Anticholinergic medications:
  • Oxybutynin
  • Tolterodine
  • Solifenacin
  • Trospium
  • Darifenacin
• Mirabegron
• Cholinesterase inhibitors:
  • Bethanechol (Urecholine)
• Desmopressin (DDAVP)

Summary

Urinary retention is a condition characterized by the inability to fully empty the bladder. It can be caused by various factors, including prostate enlargement, urinary tract obstruction, neurological conditions, medications, and more. Prompt diagnosis and appropriate treatment are crucial to prevent complications and improve quality of life. If you experience symptoms of urinary retention, it is important to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan tailored to your specific needs.