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Urinary retention is a condition where a person is unable to partially or completely empty their bladder. It can be acute (when it begins suddenly) or chronic (when it develops slowly over time). The condition can be caused by a blockage of the urethra, nerve damage, or weak bladder muscles. Infections and inflammation of the urinary tract can also cause urinary retention. Muscle inflammation may be a cause of urinary retention, as it can lead to a blockage of the urethra or affect the nerves and muscles involved in urination.
| Characteristics | Values |
|---|---|
| Definition | The inability to voluntarily void urine |
| Types | Acute (sudden), Chronic (develops over time) |
| Causes | Blockage of the urethra, weak bladder muscle, nerve damage, medications, postoperative swelling, infections, enlarged prostate, bladder outlet obstruction, pelvic organ prolapse, neurological problems, bladder stones, urethral stricture, prostate enlargement, bladder cancer, trauma or injury to the spine or pelvis, tumours, vaginal childbirth, pelvic surgery, kidney stones, constipation, bladder wall edema, pelvic floor dysfunction |
| Symptoms | Lower abdominal pain or discomfort, trouble urinating, frequent urination, leaking urine, fever or chills, blood in urine, severe pain in abdomen |
| Diagnosis | Pelvic exam, digital rectal exam, neurological exam, urine analysis, post-voiding catheterization, cystoscopy, urodynamic testing, electromyography, imaging studies |
| Treatment | Alpha blockers, physical therapy, bladder training, timed voiding, double voiding, relaxation techniques, surgery |
| Prevention | N/A |
| Complications | Urinary tract infections (UTIs), bladder damage, kidney damage, leaking pee, hydronephrosis, permanent renal failure |
| Risk Factors | Age (more common over 60), gender (more common in men), prostate enlargement, neurologic disease, spinal trauma, diabetes, changes in neurologic status, medications (anticholinergics, alpha-adrenergic agonists, opioids, antidepressants), multiple sclerosis, vitamin B12 deficiency, post-operative swelling, infections (UTIs), cystitis, urethritis, vulvovaginitis |
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What You'll Learn
Prostatitis and other prostate issues
Urinary retention is a condition in which it is difficult to partially or completely empty the bladder. It can be acute (when it begins suddenly) or chronic (when it develops slowly over time). It occurs more often in men, and people with an enlarged prostate are most likely to develop it. This is because the prostate pushes on the urethra, blocking the flow of urine out of the bladder.
Prostatitis is inflammation of the prostate gland. It can be caused by bacterial infections, bladder infections, bladder stones, sexually transmitted infections (STIs), urinary catheters, prostate biopsies, prostate stones, urinary retention, or urinary blockage. It can also be caused by non-infectious factors, such as autoimmune diseases, pelvic floor muscle damage, and pelvic nerve irritation or inflammation.
There are four types of prostatitis: non-bacterial prostatitis, acute bacterial prostatitis, chronic bacterial prostatitis, and chronic pelvic pain syndrome (CPPS). Non-bacterial prostatitis causes prostate inflammation but has no symptoms. Acute bacterial prostatitis is characterised by fever and chills, painful and frequent urination, or difficulty urinating. Chronic bacterial prostatitis has similar but milder symptoms that may come and go. CPPS is characterised by pain or discomfort lasting 3 or more months in the pelvic area, genitals, or perineum.
Prostatitis can be diagnosed by examining a urine sample with a microscope or sending it to a lab for culture. Blood tests can also be used to detect signs of infection and other prostate problems. Urodynamic tests examine how well the bladder and urethra store and release urine.
Treatment for prostatitis includes medication and other therapies. Antibiotics are used for bacterial prostatitis, while non-bacterial prostatitis is treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen sodium. Pelvic muscle exercises, such as Kegel exercises, can also help to strengthen the pelvic floor muscles and improve urinary function.
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Neurogenic bladder
The bladder, spinal cord, and brain are connected by a network of nerves that send and receive messages to control bladder functions. When these nerves are damaged due to illness or injury, the muscles may not be able to contract or relax at the right time, leading to improper filling or emptying of the bladder. This can result in symptoms such as urinary tract infections (UTIs), urinary incontinence, and dribbling of urine.
In people with neurogenic bladder, the symptoms can vary depending on the type of nerve damage. Some individuals experience overactive bladder, where the bladder muscles squeeze too often or before the bladder is full, leading to urine leakage. Others may have an underactive bladder, where the bladder muscle fails to contract and empty completely or at all, resulting in urinary retention.
Urinary retention is a condition where a person experiences difficulty in partially or completely emptying their bladder. It can be acute, developing suddenly, or chronic, progressing slowly over time. Urinary retention can be caused by blockages, medications, nerve issues, or an enlarged prostate pressing against the urethra.
The treatment for neurogenic bladder aims to prevent kidney damage and improve bladder function. It may include medication, urinary catheters, antibiotics, and, in severe cases, surgery. Doctors may also recommend physical therapy and bladder training techniques to help patients manage their symptoms and improve their quality of life.
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Trauma to the spine or pelvis
Urinary retention is a condition in which a person is unable to partially or completely empty their bladder. It can be acute (when it begins suddenly) or chronic (when it develops slowly over time). Urinary retention can be caused by blockages, medications, nerve issues, or trauma to the spine or pelvis.
In addition to spinal cord injuries, trauma to the pelvis can also cause urinary retention. Pelvic fractures, for example, can lead to bleeding, shock, and blockage of the urethra, resulting in urine backup and potential kidney damage. Pelvic surgery can also increase the risk of nerve issues and urinary retention.
It is important to note that urinary retention can have serious consequences, such as urinary tract infections (UTIs), kidney damage, bladder damage, and leaking urine. Therefore, anyone experiencing sudden difficulty urinating, especially with abdominal pain, should seek immediate medical attention.
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Post-operative swelling
Urinary retention is the partial or complete inability to empty the bladder. It can be acute (when it begins suddenly) or chronic (when it develops slowly over time). Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or other. Blockages, medications, nerve issues, and infections can cause urinary retention.
Postoperative urinary retention (POUR) is a common problem, with an incidence ranging from 5% to 70% depending on the study. It is the inability to urinate after a surgical procedure despite having a full bladder. It can be easily reversible with minimal intervention or may have lasting effects. Certain patient characteristics increase the risk of POUR, including older age, male sex, renal failure, diabetes, depression, benign prostatic hyperplasia, and higher IPSS. Intraoperative factors that contribute to POUR include longer operative time and higher total intravenous fluid volume. The choice of anesthesia also plays a role, with spinal anesthesia carrying a higher risk than epidural or general anesthesia. Opioid medications administered post-surgery can further increase the risk of POUR.
In addition to infection and inflammation, post-operative swelling can contribute to urinary retention by exerting pressure on the urethra. This can occur due to constipation, which is a common side effect of opioid medications administered after surgery. Furthermore, swelling, scar tissue, and trauma from the surgical procedure itself can cause partial or full obstruction of the urethra or bladder outlet, impeding urine flow.
To manage post-operative urinary retention, an interprofessional healthcare team should be involved through all perioperative stages. Surgeons should identify patients at high risk for POUR preoperatively, educate them about the risk, and consider prophylactic alpha-blockers. Anesthesia teams should be mindful of the correlation between intravenous fluid volume and POUR risk. Postoperatively, nurses should monitor patients' voiding and encourage early ambulation.
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Medication
In some cases, urinary retention may be caused by medication side effects. Doctors may switch or reduce the dosage of such medications.
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Frequently asked questions
Urinary retention is the inability to partially or completely empty the bladder. It can be acute (when it begins suddenly) or chronic (when it develops slowly over time).
Urinary retention is usually caused by either a physical blockage of urine flow or a failure of the bladder muscle to squeeze. The most common cause is benign prostatic hyperplasia (BPH), which affects men more often than women. Other causes include nerve issues, medications, and infections.
Treatment for urinary retention aims to relieve symptoms and address the underlying cause. Doctors may recommend bladder training, physical therapy to strengthen the pelvic floor muscles, or medications such as alpha-blockers. In some cases, surgery may be necessary.
Symptoms of acute urinary retention include sudden inability to urinate, abdominal pain, frequent urination, and leaking urine. Chronic urinary retention may cause few or no symptoms, but it can lead to serious health problems if left untreated. It is important to see a healthcare professional if you experience any symptoms of urinary retention.
