Definition

Urinary retention is a condition where the bladder cannot empty all the urine that is stored inside it. The bladder, which is part of the urinary system, functions to store urine from the ureters. When the bladder is full, the brain receives a signal to empty it. The brain then instructs the muscles around the bladder to squeeze urine into the urethra and out of the body.

Urinary retention can be sudden (acute) or long-term (chronic). Acute urinary retention occurs suddenly, with severe symptoms appearing rapidly. Chronic urinary retention develops over a longer period, with symptoms gradually appearing. Acute urinary retention is considered an emergency and requires prompt treatment at a health facility. This condition can affect both males and females and can be caused by blockages, certain medications, or neurological disorders.

Causes

Urinary retention can occur due to several causes, some specific to females or males, while others affect both sexes. The causes include:

• Obstruction: Various factors can obstruct urine flow out of the body. In men, this can include enlargement of the prostate gland, while in women, weakening of the bladder muscles causing descent into the vagina (cystocele) or rectum (rectocele), and uterine prolapse can lead to obstruction. Other obstruction causes include urinary tract stones, urethral narrowing due to injury (urethral stricture), tumors or masses in the abdomen or pelvis, and blood clots in the urethra.
• Use of certain medications: Several medications, such as antihistamines, opioids, antispasmodics, tricyclic antidepressants, NSAIDs, muscle relaxants, pseudoephedrine, Parkinson's drugs, antipsychotics, and amphetamines, can contribute to urinary retention.
• Nerve disorders: Bladder emptying and urine excretion rely on signals from the brain to the muscles around the bladder and urethra. Impaired nerve conduction or problems in the brain can disrupt these signals, leading to urinary retention. Conditions associated with nerve disorders include stroke, diabetes, multiple sclerosis, spinal cord and pelvic trauma, Parkinson's disease, pressure on the spinal cord due to tumors or masses, and vaginal childbirth.
• Infection: Infections, such as prostate infections in men or urinary tract infections, can cause swelling in the prostate or urethra, leading to obstruction and urinary retention.
• Complications of surgical procedures: Anesthetic drugs used during surgery can sometimes cause urinary retention afterward. Certain surgeries, such as joint replacement or spinal surgery, are more commonly associated with urinary retention. Procedures like cystoscopy can also lead to urethral injury if not performed correctly.

Risk factor

Several factors can increase the risk of urinary retention, including:

• Male gender
• Older age, especially in men, related to prostate enlargement
• Having diabetes, stroke, or nerve problems
• Taking certain medications
• History of previous surgical procedures

Symptoms

Urinary retention presents various symptoms, depending on whether the condition is acute or chronic. Acute urinary retention occurs suddenly, and the symptoms are immediately severe. This condition must be treated promptly as it can be dangerous. It happens because the bladder continues to enlarge, and the pressure increases. Symptoms of acute urinary retention include:

• Suddenly unable to urinate, even though the bladder feels full
• Able to urinate, but the amount is very small
• Pain in the lower abdomen or pelvis

Meanwhile, chronic urinary retention has a longer duration and gradually worsening symptoms. The accumulation of urine remaining in the bladder increases over time. Some symptoms of chronic urinary retention may include:

• Difficulty initiating urination
• Urinating more than 8 times a day, sometimes feeling the need to urinate urgently
• Weak, small, and interrupted urine flow
• Feeling the need to urinate again shortly after urinating
• Urinating several times during the night
• Urinary leakage during activities due to a full bladder
• Sudden urge to urinate, and difficulty stopping urination
• Inability to differentiate between the urge to urinate or the fullness of the bladder
• Discomfort in the pelvic area

Diagnosis

The diagnosis of urinary retention is made through a combination of medical interview, physical examination, and diagnostic tests. During the medical interview, the doctor will inquire about the symptoms experienced, their onset, duration, and severity. They will also ask about past medical conditions, medications, and surgical history.

A physical examination will be conducted, focusing on the lower abdomen. Specific examinations, such as a digital rectal examination in males, may be performed to assess prostate enlargement.

Additionally, the doctor may use questionnaires to assess symptoms experienced over the past month. Diagnostic tests that may be performed include:

• Urinalysis: To evaluate for infections and other abnormalities in the urine.
• Blood tests: To assess various indicators such as urea, creatinine, electrolytes, and blood sugar levels.
• PSA (prostate-specific antigen) test: Specifically for assessing benign or malignant prostate enlargement. Elevated PSA levels may indicate prostate cancer.
• Urodynamic testing: This evaluates bladder function using a catheter to observe pressure changes in the bladder during voiding.
• Bladder ultrasound (USG): Conducted to assess for masses or cancer near the bladder and to determine postvoid residual urine volume.
• MRI or CT scan: May be performed if ultrasound results are inconclusive.
• EMG (electromyography): Conducted if there is suspicion of nerve disorders, assessing the electrical activity in bladder and urethral muscles and nerves.
• Cystoscopy: Involves inserting a camera-equipped tube into the urethra to examine the bladder and urethra for tumors, stones, or strictures.

Management

The management of urinary retention depends on the cause and whether it is acute or chronic. However, the primary goal is to relieve the bladder of urine accumulation and subsequently address the underlying cause. In cases of acute urinary retention, catheterization is typically performed either through the urethra or via a suprapubic catheter insertion if urethral catheterization is not feasible. Close monitoring follows catheterization to mitigate potential complications associated with rapid bladder emptying.

Catheterization remains a common approach for chronic urinary retention, although long-term catheter use raises the risk of infection, necessitating periodic catheter replacement.

Management strategies for addressing underlying causes may include:

• Prostate enlargement: Medications such as alpha-blockers and 5-alpha reductase inhibitors can reduce prostate size, while surgical procedures may be necessary for prostate opening.
• Urinary tract infections: Antibiotics are the primary treatment.
• Urethral strictures: Urethral dilation with a catheter and balloon can gradually expand the stricture to allow urine flow.
• Urinary stones: Endoscopic procedures using small tubes with cameras can visualize and remove stones.
• Neurological issues: Catheterization and specific treatments tailored to the underlying neurological condition.
• Cystocele in women: Education on pelvic floor muscle-strengthening exercises, consideration of bladder support ring insertion, and surgical options in severe cases.

Complications

Complications of urinary retention can vary and may arise during and after treatment. Following treatment, potential complications include hypotension (low blood pressure) and hematuria (blood in the urine). These complications are often related to the rapid removal of urine, which can result in electrolyte imbalances and dehydration, leading to hypotension. Close monitoring by a healthcare professional is essential to manage these complications effectively. Fluid and electrolyte levels should be closely monitored, and continued catheter use may be recommended to regulate urine output until levels normalize.

Prolonged catheter use carries its own set of complications, including:

• Urinary tract infections, which can progress to bloodstream infections (sepsis).
• Urethral injuries and damage.
• Urethral strictures, resulting in the narrowing of the urethra and potential obstruction of urine flow.

Complications may also arise in cases of chronic urinary retention if not managed appropriately. This condition can lead to kidney damage due to the incomplete removal of urine. Potential complications of chronic urinary retention include:

• Hypertension (high blood pressure).
• Fluid accumulation in the body, particularly in the lower extremities (edema).
• Kidney damage, ultimately resulting in kidney failure.

Prevention

Urinary retention is sometimes unavoidable. However, there are several preventive measures that can be taken, including:

• Maintaining hygiene of intimate organs.
• Taking prescribed medications.
• Exercising to strengthen pelvic floor muscles.
• Consuming a balanced diet.
• Managing existing diseases such as diabetes.

When to see a doctor?    

Promptly seek medical attention if you notice any changes during urination. If you experience symptoms of acute urinary retention, seek medical help immediately for prompt treatment. Additionally, consider undergoing regular check-ups if you have risk factors.

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