Urinary Retention

Urinary retention is an inability to completely empty your bladder. There are two main types of urinary retention:

Chronic bladder retention is an ongoing condition that develops over time. You may be able to urinate but have trouble starting a stream or emptying your bladder. You may feel the need to urinate frequently, or feel an urgent need to urinate even when you can't or after you've finished.

Acute bladder retention is a sudden inability to urinate. It can cause severe discomfort and is considered a medical emergency.

Possible causes include:

Blockage in the urinary tract.

Bladder stones. A stone formed anywhere in the urinary tract may become lodged in the bladder. Large stones may completely block the opening to the urethra, the tube that carries urine from the body.

Nerve problems or spinal cord injury. Nerve damage can interfere with the transmission of signals between the brain and the bladder that are required for voiding.

Medications. Medications that calm overactive nerves may inhibit the bladder's nerve cells and interfere with urine flow. These can include antihistamines used to treat allergies, antispasmodics used to treat stomach cramps and muscle spasms, and antidepressants.

Surgery. Anesthesia dulls nerve receptors, causing some patients to experience temporary urinary retention.

Infections. Infections of the urethra or bladder, such as urinary tract infections (UTI), can cause swelling or inflammation that compress the urethra and block urine flow.

Constipation. A hard stool in the rectum can push against the bladder and urethra, causing the urethra to be pinched shut.

Cystocele. A condition in which the wall between a woman's bladder and her vagina weakens and allows the bladder to droop into the vagina, enabling urine to remain trapped in the bladder.

Symptoms may include:

• Discomfort
• Difficulty starting a urine stream
• Weak flow of urine
• Frequent need to urinate
• Feel the need to urinate after voiding
• Small amount of leakage

Symptoms of acute bladder retention may include:

• Severe discomfort
• Pain in the lower abdomen
• Urgent need but inability to urinate
• Bloated lower belly

Diagnosis starts with a detailed medical history and thorough physical exam. The doctor may be able to feel your distended bladder by lightly tapping on the lower belly. Additional testing may include:

• Urine sample
• Cystoscopy. Use of a scope to view inside the bladder and urethra
• X-ray and CT scan. To look for narrowing or obstruction in the urinary tract, or determine if the bladder is out of its normal position
• Urodynamic tests. To measure the bladder's ability to empty steadily and completely and identify obstructions
• Electromyography. Used to measure muscle activity when the doctor suspects the urinary problem is related to nerve damage

Treatment will depend on the cause of the urinary retention and the individual patient. Treatment options include:

• Medications
• Self-catheterization. Using a small tube (catheter) inserted at regular intervals into the urinary tract to completely drain the bladder
• Behavioral therapies and lifestyle changes. Including fluid and diet modification and Kegel exercises to strengthen pelvic floor muscles
• Sacral nerve stimulation. Uses mild electrical pulses to stimulate the nerves and improve bladder function
• Cystoscopy/Cystourethroscopy. Use of a scope to examine the bladder lining, take biopsies, and find and remove a stone that may be blocking the bladder opening

For acute bladder retention, initial treatment will involve catheterization, a small tube inserted into the bladder through the urethra to drain the urine and relieve immediate pain and distention. Long-term treatment will depend on the cause.

Complications may include:

• Urinary tract infection (UTI). When urine stays in the bladder, bacteria can grow and infect the urinary tract.
• Bladder damage. If the bladder becomes stretched too far or for long periods of time, the muscle may be permanently damaged and lose its ability to contract.
• Chronic kidney disease. If urine backs up into the kidneys it can lead to permanent kidney damage, reduced kidney function and chronic kidney disease.