Urinary Retention: Symptoms, Causes, Treatment

What are the symptoms of urinary retention?

Urinary retention is a condition where a person is unable to fully empty their bladder. The symptoms can vary based on the severity and underlying cause but generally include:

• Difficulty Starting Urination: Trouble initiating the flow of urine despite feeling the need to urinate.
• Weak Urine Stream: A stream of urine that is weak or intermittent.
• Dribbling After Urination: Continuing to leak or dribble urine after finishing urination.
• Feeling of Incomplete Bladder Emptying: A persistent sensation that the bladder is not completely emptied after urination.
• Frequent Urination: Increased frequency of urination, often in small amounts.
• Urgency: A strong, sudden urge to urinate that may be difficult to control.
• Pain or Discomfort: Pain or discomfort in the lower abdomen or pelvic area due to bladder distension.
• Distended Bladder: Noticeable swelling or hardness in the lower abdomen.
• Nocturia: Frequent need to urinate during the night.
• Incontinence: Unintentional leakage of urine due to an overfilled bladder.

In severe cases, urinary retention can lead to acute symptoms, such as:

• Severe Pain: Intense pain in the lower abdomen or pelvic area.
• Nausea and Vomiting: Resulting from the discomfort and the body’s response to an overfilled bladder.
• Difficulty Walking: Due to severe discomfort or bladder distension.

If urinary retention is suspected, it is important to seek medical evaluation and treatment to address the underlying cause and relieve symptoms.

What are the causes of urinary retention?

Urinary retention can be caused by a variety of factors, which may be categorized into obstructive, neurogenic, and functional causes:

• Obstructive Causes:
• Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland in men, which can compress the urethra and obstruct urine flow.
• Prostate Cancer: Tumors in the prostate that can obstruct the urethra.
• Urethral Stricture: Narrowing of the urethra due to scarring or inflammation.
• Bladder Stones: Stones in the bladder that can obstruct the outflow of urine.
• Tumors: Tumors in the bladder, urethra, or pelvis that can block urine flow.
• Constipation: Severe constipation can put pressure on the bladder and urethra, leading to urinary retention.
• Neurogenic Causes:
• Spinal Cord Injury: Damage to the spinal cord that affects nerve signals controlling the bladder.
• Multiple Sclerosis (MS): A condition that affects nerve signaling and can disrupt bladder function.
• Parkinson’s Disease: Neurological disorders that affect bladder control.
• Stroke: Can impact the parts of the brain that regulate bladder function.
• Functional Causes:
• Detrusor Muscle Dysfunction: Problems with the bladder muscle that prevents it from contracting properly.
• Underactive Bladder: A condition where the bladder does not contract strongly enough to expel urine.
• Medication-Related Causes:
• Anticholinergic Medications: Drugs that reduce bladder muscle contractions and can lead to retention.
• Certain Antidepressants: Some can interfere with bladder function.
• Post-Surgical Causes:
• Recent Surgery: Especially surgeries involving the pelvic area or lower abdomen, which can cause temporary urinary retention.
• Hormonal and Systemic Conditions:
• Diabetes: High blood sugar levels can affect nerve function and bladder control.
• Pregnancy: Pressure from the growing uterus can affect bladder function.

Identifying the underlying cause is crucial for appropriate treatment and management of urinary retention.

What is the treatment for urinary retention?

The treatment for urinary retention depends on the underlying cause and severity. It typically involves a combination of medical management, lifestyle changes, and sometimes surgical interventions:

• Medications:
• Alpha-Blockers: Used to relax the muscles in the prostate and bladder neck, improving urine flow (e.g., tamsulosin, alfuzosin).
• 5-Alpha-Reductase Inhibitors: Help reduce the size of the prostate in cases of benign prostatic hyperplasia (BPH) (e.g., finasteride, dutasteride).
• Anticholinergics: May be used for overactive bladder if detrusor muscle dysfunction is involved (e.g., oxybutynin, tolterodine).
• Cholinergic Agents: Stimulate bladder contractions in cases of underactive bladder (e.g., bethanechol).
• Catheterization:
• Intermittent Catheterization: Involves periodically inserting a catheter to empty the bladder.
• Indwelling Catheterization: A catheter is placed in the bladder for continuous drainage, used for more severe or long-term cases.
• Behavioral and Lifestyle Modifications:
• Bladder Training: Techniques to increase bladder control and reduce urinary urgency.
• Timed Voiding: Scheduled urination to prevent retention.
• Fluid Management: Adjusting fluid intake to avoid excessive fluid that may exacerbate retention.
• Surgical Interventions:
• Transurethral Resection of the Prostate (TURP): A procedure to remove part of the prostate in cases of BPH.
• Urethral Dilation: Stretching or widening of a narrowed urethra.
• Surgical Correction: For tumors, strictures, or other obstructive causes that require removal or correction.
• Treatment for Underlying Conditions:
• Managing Diabetes: Controlling blood sugar levels to prevent nerve damage affecting bladder function.
• Treating Constipation: Addressing severe constipation that might be causing pressure on the bladder.
• Neurogenic Bladder Management:
• Neuromodulation Therapy: Using electrical stimulation to improve bladder function in cases of neurogenic bladder.

Each treatment approach should be tailored to the individual based on the specific cause of the urinary retention, overall health, and response to initial treatments.