Urinary Retention

What is urinary retention?

Urinary retention is the inability to fully empty the bladder. Urine accumulates, causing discomfort and potential complications. It can be acute (sudden and severe) or chronic (gradual and long-term).

Types of urinary retention

  • Acute urinary retention

    Sudden inability to urinate despite a full bladder. This is a medical emergency, often caused by blockage, infection, nerve injury, medications, or trauma.

  • Chronic urinary retention

    Gradual onset of incomplete bladder emptying. Symptoms may include weak stream, straining, frequent urination, and urinary tract infections, though some have no symptoms.

Causes

Blockages

  • Enlarged prostate (BPH)
  • Urethral stricture or scarring
  • Bladder stones or blood clots
  • Tumors in the bladder, prostate, or pelvis
  • Pelvic organ prolapse in women (cystocele, rectocele)

Nerve problems

  • Diabetes mellitus
  • Parkinson’s disease or multiple sclerosis
  • Spinal cord injury or stroke

Infections and inflammation

  • Urinary tract infections
  • Prostatitis
  • Urethritis and sexually transmitted infections

Medications and treatments

  • Anticholinergics, antihistamines, decongestants
  • Antidepressants, antipsychotics, opioids
  • Radiation therapy to pelvic organs
  • Post-operative effects of anesthesia or pelvic surgery

Other causes

  • Birth defects affecting the urinary tract

Symptoms

Acute urinary retention

  • Unable to urinate despite urgency
  • Severe lower abdominal pain
  • Visible bladder distention

Chronic urinary retention

  • Frequent or nighttime urination (nocturia)
  • Difficulty starting or maintaining a urine stream
  • Feeling of incomplete emptying
  • Dribbling or overflow incontinence
  • Recurrent urinary tract infections

Complications

  • Bladder muscle damage from overstretching
  • Kidney damage due to backflow pressure
  • Urinary tract infections and bladder stones

Diagnosis

  • Medical history and medication review
  • Physical exam (abdominal, pelvic, prostate)
  • Post-void residual measurement by ultrasound or catheter
  • Urinalysis and blood tests
  • Urodynamic studies (cystometry, uroflowmetry)
  • Imaging (ultrasound, CT, MRI)
  • Cystoscopy to inspect the bladder and urethra

Treatment

Acute retention

  • Immediate catheterization to drain the bladder
  • Surgery for obstruction (prostatectomy, stone removal)

Chronic retention

  • Medications: alpha-blockers, 5-alpha reductase inhibitors, antibiotics
  • Intermittent self-catheterization
  • Surgical options: TURP, urethral dilation, UroLift, pessary placement
  • Bladder training and pelvic floor exercises
  • Lifestyle changes: fluid management, diet, weight loss

Sources