What Is Urinary Retention?

Urinary retention is when you are unable to pass urine even though your bladder is full. It may be experienced as a total inability to empty the bladder, or it may only be noticed by feeling that the bladder has not emptied fully after passing water.

Many men have experienced urinary retention at some point in their lives, often due to an obstruction in the urinary system, but it is more common in women.

Urinary retention can be acute or chronic. Acute urinary retention may be due to an ongoing obstruction that causes the bladder to fill up over several hours, days, or even weeks before symptoms develop.

This is very dangerous as the fluid in the bladder continues to put pressure on your kidneys and can cause damage. Chronic urinary retention means that symptoms have been present for more than six months.

Symptoms of urinary retention

The symptoms of acute and chronic urinary retention are generally the same; however, chronic symptoms gradually develop over a longer period.

• The first sign of urinary retention is usually a strong and uncontrollable need to go to the toilet. There is a feeling of pressure in the bladder that becomes worse and worse.  
• The next signs are pain or a burning sensation in your pelvis or lower back, a constant need to pass urine but without being able to do so, and eventually passing small amounts of dark-colored urine before stopping completely.  
• Sometimes people with urinary retention feel nauseous and vomit.  
• Women with urinary retention may experience pain during sex due to the pressure of the enlarged bladder on the urethra, which runs between the bladder and the outside world.  

If you think that you have urinary retention, see a doctor urgently. If there is a blockage in your urinary system, it’s important to deal with the problem as soon as possible.

What causes urinary retention?

Urinary retention can be caused by a range of factors including:  

• An enlarged prostate gland in men or an obstruction in your urethra caused by a pelvic organ prolapse in women.    In both sexes, the bladder becomes enlarged which puts pressure on the kidneys and may cause kidney damage.  
• Health conditions that affect your nervous systems, such as a stroke or Parkinson’s disease. A loss of feeling in the bladder from these conditions means you might not be aware when your bladder is full and will have to use a catheter to drain your urine.    
• A urinary tract infection.   
• Taking certain medications such as antidepressants, diuretics, and some narcotic painkillers. Some drugs can make it difficult for your bladder to empty completely and result in a build-up of urine, while others can irritate your bladder causing irritation and spasm which makes you want to go to the toilet more often.
• Alcohol and drug use. Drinking excessive amounts of alcohol can irritate your bladder causing increased frequency and pain in urination, while recreational drug use can affect the function of your kidneys and alter the release of hormones that control the urinary system.  
• Having a stroke or spinal cord injury which has damaged nerve signals to your bladder.
• Diabetes or other metabolic conditions such as liver or kidney failure, which can cause your body to retain fluid and lead to swelling in the legs which put pressure on your bladder.   
• A combination of factors including a neurological condition, stroke, spinal cord injury, urinary tract infection, medication side effects, and alcohol use has been linked to the development of neurogenic bladder in some cases.  
• A delayed response in your brain to signals sent from your bladder telling you when you need to use the bathroom.   

How is urinary retention diagnosed?

Your doctor will ask about any symptoms and examine you, paying particular attention to your abdomen and genitals. They will also test for urinary tract infections and other possible underlying causes.  

You may have a number of tests including:  

• Blood pressure measurement. A small loss of blood from the bladder can affect your blood pressure. In some cases, there is no obvious cause for urinary retention so additional tests are required to determine what’s going on.  
• Ultrasound. This uses sound waves to create an image of structures inside your body. Doctors use it to look at the kidneys, bladder, and urethra.  
• Bladder function tests. A small tube called a catheter is inserted into the urethra so that urine can be drained off and tested in a laboratory for signs of infection or other abnormalities.  
• An ultrasound of the abdomen. This can show any masses or problems in your urinary tracts, such as an enlarged prostate gland, kidney stones, or bladder stones.  

What are the treatment options?

The primary goal is to relieve symptoms and unblock your urinary system. Your doctor may recommend one or more of the following:  

• A catheter. Your doctor may insert a thin, soft tube called a catheter into your urethra to drain off urine from the bladder and allow it to refill. This can be uncomfortable and embarrassing for some people but if you’re finding it difficult to use the toilet because of pain or other symptoms such as leaking or dribbling, it may be necessary to get your bladder working again. The catheter is usually inserted for a short period of time until you can use the toilet normally again and in some cases, longer if required.  
• Medication. Anticholinergic medications such as oxybutynin and tolterodine help relax the muscles of the bladder and urethra. They work by blocking messages from nerve cells which tell these muscles to contract. This allows your bladder to fill more easily and makes it easier for you to pass urine.  
• Incontinence pads or clamps. If you’re still leaking urine despite taking medication, you may need a pad or clamp to keep your clothes clean. If the problem is only occasional, you might prefer to try pads or clamps on an occasional basis rather than full-time if desired.  
• Diet changes. Cut down on caffeine and reduce how much alcohol you drink as these can both irritate your bladder. Your doctor may refer you to a dietitian for further advice about your diet.  
• A catheter to drain off urine. If you’re in the hospital, you might need a small plastic tube called a catheter inserted into your bladder through the opening at the end of your penis. This is usually only temporary and may be used when you can’t pass urine normally because of an illness or operation.