What is urinary retention?

Urinary retention is the body’s inability to completely empty the bladder — it can be classed as either acute or chronic.

Acute urinary retention — comes on quite suddenly and can cause great discomfort or pain. With acute urinary retention, a person cannot urinate at all (even if they have a full bladder) and is a potentially life-threatening medical condition requiring immediate emergency treatment.

Chronic urinary retention — can be a long-lasting medical condition. People with chronic urinary retention can urinate, but they cannot completely empty all of the urine from their bladders. Sometimes, a person is not aware they have this condition until other problems present like Urinary Incontinence, or a Urinary Tract Infection.

Urinary retention can affect anyone. However, men in their fifties and sixties are more susceptible, primarily because of an enlarged prostate.

A woman can also be affected by urinary retention if she suffered from a condition called Cystocele, where the bladder starts to sag or moves out of its normal position. It can also be pulled out of position when the lower part of the colon starts to sag — a condition called Rectocele.

What causes urinary retention?

Urinary retention can be attributed to two causes — either obstruction or non-obstruction.

If there is an obstruction (for example, bladder or kidney stones), a blockage occurs and urine cannot flow unimpeded through your urinary track. This is the basis for acute urinary retention and is potentially life threatening. You must seek immediate emergency treatment.

Non-obstructive causes include a weakened bladder muscle and nerve problems that interfere with signals between your brain and the bladder. If the nerves aren’t working properly, your brain may not get the message that the bladder is full.

Obstructive urinary retention causes include:

• Enlarged prostate (BPH) in men
• Certain tumours and cancers
• Urethral stricture
• Cystocele or rectocele,
• Constipation
• Kidney or bladder stones

Common causes of non-obstructive urinary retention are:

• Stroke
• Vaginal childbirth
• Pelvic injury or trauma
• Nerve disease in both men and women
• Impaired muscle or nerve function due to medication or anaesthesia
• Accidents that injure the brain or spinal cord

What are the symptoms of urinary retention?

Symptoms of urinary retention differ according to whether you’re suffering from Acute or Chronic Urinary Retention:

Acute urinary retention symptoms require immediate medical attention:

• Inability to urinate
• Painful, urgent need to urinate
• Severe pain or discomfort in the lower abdomen
• Bloating of the lower abdomen

Chronic urinary retention symptoms may include

• Urinary frequency — urination eight or more times a day
• Trouble beginning a urine stream
• Weak or an interrupted urine stream
• Urgent need to urinate with little success when trying to urinate
• Feeling the need to urinate after finishing urination
• Mild and constant discomfort in the lower abdomen and urinary tract
• Difficulty fully emptying the bladder
• Urge incontinence
• Inability to feel when bladder is full
• Increased abdominal pressure
• Strained efforts to push urine out of the bladder
• Nocturia (waking up more than two times at night to urinate)

How is urinary retention diagnosed?

For acute urinary retention, the signs are often obvious. For example, you will be extremely uncomfortable, unable to pass urine and have a distended bladder. For chronic urinary retentions the diagnosis may only come after your doctor performs a series of tests. This is because some of the symptoms are shared with other conditions related to the bladder and urinary tract.

Very often, and especially in men, an enlarged prostate can be the culprit and treatment can begin accordingly. In these instances, doctors will rely on medical history and a physical examination to determine if urinary retention is a concern. They will also look out for more serious urinary retention causes, such as cauda equina or spinal cord compression.

How is urinary retention treated?

Your doctor/specialist may treat your urinary retention with

• bladder drainage
• urethral dilation
• urethral stents
• prostate medications
• surgery

The type and length of treatment will depend on the type and cause of urinary retention.

Bladder Drainage

Bladder drainage is the use of a catheter to drain urine. Acute urinary retention treatment usually starts with catheterisation to relieve the distress of a full bladder and to prevent further bladder damage. Under local anaesthetic, a doctor passes a catheter through the urethra into the bladder where draining of urine can then begin. Sometimes a urethra can become blocked. If this happens, your doctor will administer anaesthesia, then insert a catheter through the lower abdomen, just above the pubic bone, directly into the bladder.

If other treatments for chronic urinary retention don’t work, you may require occasional or long-term catheterisation and will receive instruction from your doctor on how to self catheterise to drain urine when necessary.

Urethral Dilation

Urethral dilation is used to treat urethral stricture. This is done by inserting increasingly wider tubes into the urethra, or inflating a small balloon at the end of a catheter inside the urethra. Both methods widen the stricture to allow an easier flow of urine. The procedure is usually performed under local anaesthesia, but in some cases you might receive sedation and regional anaesthesia.

Urethral Stents

Another treatment for urethral stricture involves inserting an artificial tube, called a stent, into the urethra to the area of the stricture. Stents may be temporary or permanent and once in place, expands like a spring and pushes back the surrounding tissue, widening the urethra.

Prostate Medications

Your doctor may prescribe one or a combination of medications to stop the growth of or shrink the prostate or relieve urinary retention symptoms associated with Benign Prostatic Hyperplasia (enlarged prostate).

How can urinary retention be prevented?

For men:

If you have an enlarged prostate, be sure to take prostate medications as prescribed by your doctor and avoid medications associated with urinary retention, such as over-the-counter cold and allergy medications that contain decongestants.

For women:

If you have mild cystocele or rectocele, you may be able to prevent urinary retention by doing exercises to strengthen the pelvic muscles.

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