Urinary retention symptoms & treatment

If you have urinary retention, you may be unable to empty your bladder when you go to the bathroom or be unable to urinate at all. This uncomfortable and sometimes painful condition can affect anyone, but is more common in older men.

Urinary retention has two types: acute and chronic. If you suddenly cannot urinate and have extreme pain in your lower abdomen, you may have acute urinary retention. This is a dangerous condition.

You should seek emergency care if you can’t urinate and have pain in your lower abdomen.

If you are experiencing chronic urinary retention, you may have a weak or slow urine stream or urinate in frequent, small amounts. Your body is retaining urine, which can lead to complications since wastes are not being released from your body. Chronic urinary retention will need to be managed with your urologist or urogynecologist.

Urinary retention causes

Your kidneys produce urine, which passes through the rest of your urinary tract and out of your body. The urinary tract includes the kidneys, the ureters (tubes that carry urine from the kidneys to the bladder), the bladder (organ that stores urine) and the urethra (tube that carries urine out of the body).

When these muscles weaken or become infected, inflamed or blocked (obstruction), your body has difficulty moving urine out of your body. The buildup of waste products in the bladder from leftover urine can damage your bladder and kidneys.

Benign prostatic hyperplasia (BPH) is the most common cause of urinary retention in males. The bladder is weakened when the prostate gland – which sits below the bladder and wraps around the urethra – is enlarged. This can cause you to lose the ability to empty the bladder completely.

Pelvic floor dysfunction due to genetics, age, obesity or childbirth is a common cause of urinary retention in females. This may include a prolapsed bladder (a cystocele), a common type of pelvic organ prolapse that can cause obstruction of urinary flow. Supportive tissues in the pelvic floor are weakened and can no longer support the bladder, causing it to drop into the vaginal canal.

Other causes of urinary retention include:

• Urethra stricture: Rare in women, a urethra stricture narrows the urinary tract.
• Kidney stones: The stones crystallize, creating an obstruction that blocks the flow of urine.
• Uterine fibroids: Large fibroids may press against one of the ureters, causing bladder issues.
• Prostatitis: Inflammation of the prostate gland, causing the prostate to press on the urethra.
• Urethritis: A lower urinary tract infection which leads to swelling and urine retention.
• Catheter use: Urinary retention after catheter removal is common in both inpatient and outpatient treatments.
• Medications: Certain medications taken for other conditions, including antihistamines, antispasmodics, opiates and tricyclic antidepressants can impact the nerves that signal the bladder muscle to contract, resulting in decreased function.
• Neurologic issues: Conditions such as multiple sclerosis, diabetes or a stroke can affect the connection between your brain and bodily functions, leading to bladder issues.
• Constipation: Pressure on the bladder from a large amount of stool in the colon can cause the bladder to not contract as it should or empty well.
• Urinary tract infections (UTIs) and sexually transmitted infections (STIs): Inflammation and infection of the urinary tract and genitals, which can lead to urinary retention.

Symptoms of urinary retention

Symptoms can range from acute pain to having little or no symptoms at all, depending on your type of urinary retention and the underlying cause of the condition. Many of the symptoms are also similar to urinary incontinence (loss of control of your bladder) or UTIs.

It’s important to seek medication attention so you can rule out other bladder issues and get the treatment you need.

Acute urinary retention symptoms:

• Unable to urinate, even though you feel the need to
• Experiencing severe pain or discomfort in your lower abdomen
• Feeling of fullness in your abdomen

Chronic urinary retention symptoms:

• Feeling of your bladder not emptying or being full, but not sure if you need to urinate
• Reduced urine output (called oliguria); the stream is not consistent or stops before you are finished
• Mild discomfort in your hip and abdomen areas
• Feeling like you need to urinate frequently and urgently
• Hesitant to urinate; trouble when you start to urinate
• Bladder leakage
• Frequently waking at night to urinate with the urine not passing

Urinary retention can be life threatening, especially in acute cases. If left untreated, you’ll continue to experience symptoms that impact the quality of your life, and it may turn into a chronic condition. You may also develop other conditions such as swollen kidneys, kidney failure, change in urine flow, bladder decompensation (failure of the organ) and more.

Diagnosis of urinary retention

Acute urinary retention is usually obvious to diagnose and needs immediate care. For chronic cases, you’ll meet with a urologist or urogynecologist first for a physical exam and to discuss your symptoms.

A urine sample to check for infection and a post-void residual test (bladder scan) will help diagnose your condition. A post-void residual test uses a catheter or ultrasound to measure the amount of urine left in your bladder.

Other tests may include:

• CT scan: Looks for stones or any other causes that block the flow of urine.
• Urodynamic testing: Tests the urine flow rate and the amount of pressure within the bladder to see how well it is emptying using a catheter.
• Cystoscopy: A tiny camera in a thin tube (cystoscope) is inserted through your urethra, allowing for images of the lining of your urethra and bladder to check for possible scarring, blockages like stones or an enlarged prostate or tumor.
• Electromyography (EMG): Sensors measure electrical activity in the urinary muscles and nerves for possible damage.
• Prostate-specific antigen: A blood test to check for prostate cancer, which could lead to urinary retention issues.

Treatment for urinary retention

Your treatment plan will depend on your type and cause of urinary retention. In acute cases, your bladder will be immediately drained. This will provide immediate relief. Your provider will work with you on a treatment care plan tailored to your needs.

A long-term care plan will be determined for chronic urinary retention. This may include using catheters at home. Catheters will need to be changed several times a day to prevent infection. Your provider will teach you or a caretaker how to manage using catheters.

Other treatments may include:

• Alpha-blocker medications to reduce the size of the prostate (for BPH)
• Antibiotics for infections and inflammation in the urinary tract, bladder or prostate
• Medications to relax the prostate to improve urine flow
• Myomectomy (surgical procedure to remove uterine fibroids)
• Laparoscopic pyeloplasty (surgical procedure to remove blockages in the upper urinary system)
• Pelvic organ prolapse repair

Lifestyle changes to improve bladder health

Certain changes to your lifestyle may help improve or prevent urinary retention and other bladder issues.

• Eat a high fiber diet to avoid urinary retention caused by constipation
• Monitor your water intake to better predict when you must urinate
• Pelvic floor exercises to strengthen pelvic floor muscles and improve urinary muscle function
• Behavioral techniques, such as bladder training