Urinary Retention

Urinary retention is the inability to empty the bladder. It occurs when a blocked urinary tract, nerve problem, or other physical condition causes urine to accumulate in the bladder. It is 10 times more common among men than women, especially as they age.

The main cause of urinary retention is an enlarged prostate (in men). Among causes for both men and women:

• A prostate infection that has forced the urethra to swell shut.
• Neurologic conditions, such as a spinal cord injury, multiple sclerosis, or a herniated disc, which interrupt signals between the brain and the bladder so the brain doesn’t know the bladder is full.
• A hypotonic bladder muscle that does not squeeze hard enough to completely empty the bladder. This is the most common cause of urinary retention for women, and may result from vaginal prolapse.
• An overstretched, or decompensated bladder. This can occur after years of infrequent voiding.
• Certain medications, including general anesthesia or anti-histamines.

The most common symptom of urinary retention is the inability to urinate, despite feeling the urge. Other symptoms include:

• Discomfort in the bladder area
• Bloating
• A weak urine stream
• Urine leakage, due to bladder overflow

A urologist will perform a physical exam of the lower abdomen. Other possible tests include:

• Postvoid residual volume: A measure of the urine left in the bladder after urination. This can be done by a bladder scan or by catheterization.
• Urinalysis: An examination of the composition of the patient’s urine.
• Imaging:
  • Bladder scan: An ultrasound of the kidney, bladder, and urethra, to see if the bladder empties completely.
  • An X-ray or CT scan: Detailed imaging to identify potential obstructions of the urethra or to assure the bladder is in its normal position.
  • Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
• Urodynamics: A technique that measures pressure in the bladder and urine flow.
• Prostate screening (PSA): A blood test that measures prostate-specific antigen levels, which could indicate prostate cancer or other problems.

Usually, the cause of the urinary retention will be treated separately. For example, if the blockage is caused by an enlarged prostate, surgery may be required to remove or alleviate the obstruction. To manage the retention itself, the most common treatment is medication, such as the drug Flowmax®.

If the retention is acute or if it persists, a urologist may recommend a catheter.

• Foley catheter: The catheter is placed in the bladder, through the urethra, to drain the urine. It will relieve a distressed bladder and prevent further damage.
• Intermittent catheter: If the urinary retention appears chronic, the patient may be taught to self-catheterize using sterile techniques to avoid urinary tract infections.
• Suprapubic tube: A catheter is placed below the belly button, directly into the bladder through the skin, and can be kept in for short-term or long-term with monthly catheter checks. This can be a good option for patients who may experience difficulty using a catheter through the urethra.