Urinary retention is the inability to empty the bladder. It occurs when a physical condition, such as a blockage of the urinary tract or a nerve problem, causes urine to accumulate in the bladder. Older men account for the majority of urinary retention issues, at 90 percent.
The main cause of urinary retention is an enlarged prostate (in men). But there are several other causes for both men and women:
- A prostate infection that has forced the urethra to swell shut.
- Neurologic conditions that interrupt the signals between the brain and the bladder – meaning the brain does not get the message that the bladder is full – resulting in a neurogenic bladder. This can occur from neurologic conditions such as a spinal cord injury, multiple sclerosis or a herniated disc.
- A hypotonic bladder muscle, or lazy bladder, that does not squeeze hard enough to completely empty the bladder. Among the most common causes of urinary retention for women, a hypotonic bladder may result from vaginal prolapse.
- Decompensated (overstretched) bladder can occur after years of infrequent voiding. This can also occur when patients are bedridden after surgery or during hospitalization, when patients cannot not get up to the bathroom to void.
- Certain medications, including general anesthesia or anti-histamines, may precipitate urinary retention.
The most common symptom of urinary retention is the inability to urinate, despite feeling the urge. Other symptoms include:
- Discomfort in the bladder area
- A weak urine stream
- Urine leakage, due to bladder overflow
A urologist will perform a complete physical exam of the lower abdomen. Other possible tests include:
- Postvoid residual volume: A test that measures the amount of 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.
- An X-ray or CT scan: Imaging to identify potential obstructions of the urethra or to assure the bladder is in its normal position.
- Bladder scan: An ultrasound of the kidney, bladder and urethra, to see if the bladder empties completely.
- Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
- Urodynamics: A special technique that measures pressure in the bladder and urine flow.
- Prostate screening (PSA): Men may give blood so it can be tested for prostate-specific antigens, which indicate prostate cancer or other problems.
Oftentimes, the treatment regimen for urinary retention will be dictated by the cause of the condition, which will be treated separately. To manage the retention itself, the most common treatment is medication, such as the drug Flowmax. If the blockage is caused by an enlarged prostate, sometimes a surgery is needed to open up the obstruction from the prostate.
If the retention is acute or if it persists, your physician may recommend a catheter.
- Foley catheter: This initial treatment, often used to relieve acute temporary urinary retention, will relieve a distressed bladder and prevent further damage. A catheter is placed in the bladder, through the urethra, to drain the urine.
- Intermittent catheter: If the urinary retention appears chronic, you may be taught to catheterize yourself as needed. The physician staff will teach you sterile techniques to avoid urinary tract infections.
To learn more about Urinary Retention, visit the National Kidney and Urologic Diseases Information Clearinghouse's Urinary Retention Page.