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Urinary retention is when you are unable to empty your bladder completely. It can affect both males and females and be acute (sudden and severe) or chronic (long-developing).
Symptoms range from mild to severe, with some acute cases causing potentially life-threatening complications. The treatment varies by the underlying cause but may involve medications, urinary catheters, or even surgery.
This article looks at the symptoms and causes of urinary retention in men and women and explains how the condition is diagnosed and treated. It also offers tips on how to cope with this surprisingly common urinary tract symptom.
Urinary retention is not a disease but a symptom related to health problems directly or indirectly affecting the urinary tract. The symptoms can vary based on whether the condition is acute or chronic.
Acute Urinary Retention
Acute urinary retention develops suddenly and sometimes severely. A person with acute urinary retention is unable to pee even if their bladder is full.
Symptoms of acute urinary retention are characterized by:
- A sudden inability to urinate
- Lower abdominal pain, often sharp and severe
- An urgent need to urinate, often painful
- Lower abdominal swelling
When to Call 911
Call 911 or go to the nearest emergency room if you or someone you know has:
- The sudden inability to pass urine with a full bladder
- Lower abdominal swelling
- Intense pain or discomfort in the area above the pubic bone
- Severe anxiety
Chronic Urinary Retention
Chronic urinary retention develops gradually and can worsen over time. People with chronic urinary retention can urinate, but they just can't empty their bladders completely.
Symptoms of chronic urinary retention can vary but may involve:
- Frequent urination (more than eight times per day)
- Trouble starting urination
- A weak or intermittent urine stream
- Discomfort with urination
- Straining with urination
- A feeling that you still need to urinate after peeing
- Having to get up frequently at night to pee
- Mild lower abdominal pain or pressure
Both acute and chronic urinary retention can lead to complications if not treated appropriately. This could lead to the injury of the bladder, kidneys, or other organs of the urinary tract.
Possible complications of urinary retention include:
- Urinary tract infections (UTIs) due to the backflow or incomplete emptying of urine, which allows bacteria to multiply and proliferate
- Overflow incontinence due to damage of urethral sphincters that control urine flow, causing you to dribble or leak urine while having too much urine in the bladder
- Bladder injury due to the persistent stretching of the bladder, which, in turn, increases the risk of bleeding, bladder infection, bladder stones, and rupture
- Kidney injury due to persistent stress/pressure on the kidneys, increasing the risk of chronic kidney disease and acute kidney failure
- Urosepsis, a potentially deadly spread of infection from the urinary tract to the bloodstream
Urinary retention can affect both males and females but is far more common in males. In fact, acute urinary retention is relatively uncommon in females, affecting only three of every 100,000 women each year. By contrast, over a five-year period, one in 10 men over 70 and one in three men over 80 will develop acute urinary retention.
Many of the causes of urinary retention affect both males and females. But there few are more prevalent in—or entirely exclusive to—to one sex.
Causes in Males
The causes of urinary retention in males can be categorized as being obstructive, infectious, neurogenic (related to the nervous system), and pharmacologic (related to medications).
The causes include:
- Urinary blockage due to things like benign prostatic hyperplasia (enlarged prostate), severe constipation, urethral stricture (narrowing of the urethra, the tube leading from the bladder), kidney or bladder stones, phimosis (non-retraction of the foreskin), prostate cancer, and bladder cancer
- Infections, including those that affect the urinary tract directly (causing prostatitis, or urethritis) or others like genital herpes that damage the sacral nerve, which controls urinary muscles
- Nerve damage caused by things like stroke, spinal cord injury, diabetic neuropathy, multiple sclerosis, and Guillain-Barre syndrome that reduce contractions of the bladder muscle
- Medications, the most common of which include anesthesia, selective serotonin reuptake inhibitors (SSRI) antidepressants, and opioid drugs as well as antipsychotics, anticonvulsants, antihistamines, and other drugs with so-called anticholinergic effects
An enlarged prostate is the main reason for the higher incidence of urinary retention in males. Other risk factors include older age, diabetes, high alcohol consumption, physical inactivity, and African American race.
Causes in Females
Females can also experience urinary retention due to urinary tract obstruction, infections, nerve injury, or medications. With that said, the underlying cause can be different.
Among the causes in women are:
- Urinary blockage due to things like severe constipation, pelvic organ prolapse (the dropping of pelvic organs), kidney or bladder stones, vaginal hematoma (a pocket of blood in vaginal tissues), and vaginal surgical complications
- Infections, most commonly cystitis (bladder infection), a condition that occurs 30 times more frequently in women than in men
- Nerve injury, often due to damage sustained during pelvic surgery, including those used to treat stress incontinence
- Medications, involving the same types of drugs that cause urinary retention in males
Older age can increase the risk of urinary retention in both females and males. This is especially true with respect to postoperative urinary retention, a condition that affects adults over 60 twice as often as those under 60.
Surgeries that last longer than two hours also increase the risk of urinary retention by threefold.
Although urinary retention can affect both men and women, the condition is seen far more frequently in men. Causes include urinary tract obstruction, infections, certain medications, and nerve injuries that impair the function of the bladder.
Although urinary retention can often be recognized by the symptoms, the underlying cause may take longer to pinpoint. The diagnosis generally starts with a physical exam and a review of your medical history.
To better narrow the causes, the doctor may ask you questions such as:
- How frequently do you have the sensation of not being able to empty your bladder?
- Have you found yourself having to urinate less than two hours after having already peed?
- Is your urine stream steady or broken?
- How often do you find yourself rushing to the bathroom to pee?
- Do you have to push or strain to start urinating?
- How often do you get up at night to pee?
Based on the initial findings, the doctor will order tests to further narrow suspected causes. These may include:
- Blood tests like a complete blood count (CBC), comprehensive metabolic panel (CMP), and for males, a prostate-specific antigen (PSA) test
- Urinalysis to analyze the chemistry of your urine
- Bladder ultrasound, a noninvasive handheld device that uses sound waves to create highly detailed images of the bladder (including post-void residual, how much urine is left in the bladder after peeing)
- Magnetic resonance imaging (MRI), an imaging tool that can be very useful in detecting spinal cord injuries
- Voiding cystourethrogram (VCUG), an imaging test that uses X-rays with a urinary catheter to see how the bladder fills and drains
The diagnosis of urinary retention typically involves a physical exam, a review of your medical history, and various blood and urine tests. Other procedures such as a bladder ultrasound, spinal MRI, or voiding cystourethrogram can help narrow the causes.
The treatment of urinary retention varies by whether the condition is acute or chronic as well as the severity of symptoms and underlying cause.
Acute Urinary Retention
The primary treatment of acute urinary retention is a urinary catheter. A urinary catheter is a flexible tube that is inserted into the urethra and fed to the bladder to help drain it. This helps to decompress the bladder and relieve discomfort.
The size (gauge) of the catheter can vary based on the cause of the obstruction. If the blockage is related to an enlarged prostate, for example, a larger-gauge catheter may be needed.
There are so-called straight catheters that are used simply to drain the bladder, after which the tube is removed. There are also Foley catheters intended for longer-term use.
In cases of urethral stricture, in which the urethra narrows to the point of obstruction, a device called a cystoscope may be inserted into the urethra to dilate (widen) it and aid with the placement of a catheter.
If a urinary catheter is not possible, a suprapubic catheter may be used. This is a type of catheter that is inserted into the bladder through an incision in the lower abdomen. The procedure may be performed with either local or general anesthesia.
Once the bladder pressure is adequately relieved, the treatment will be focused on either resolving or managing the underlying cause.
Chronic Urinary Retention
The treatment of chronic urinary retention may involve prescription medications, catheters, surgery, or a combination of these.
Males with mild benign prostatic hyperplasia (BPH) may be treated with drugs that reduce the swelling of an enlarged prostate or relax the lower urinary tract. This may be all that is needed to restore normal urine flow and resolve chronic urinary retention.
The drugs used to treat BPH include alpha-blockers that work by relaxing blood vessels and lowering blood pressure. Options include:
- Cardura (doxazosin)
- Flomax (tamsulosin)
- Hytrin (terazosin)
- Minipress (prazosin)
- Rapaflo (silodosin)
- Uroxatral (alfuzosin)
Alpha-blockers can also provide relief of urinary retention following the removal of a catheter in both men and women.
Another class of drugs called 5-alpha reductase inhibitors is able to block the hormones that promote the growth of the prostate gland in males. These include:
- Avodart (dutasteride)
- Proscar (finasteride)
People with chronic urinary retention may benefit from the occasional or ongoing use of urinary catheters. This includes intermittent catheterization in which a catheter is inserted and removed as needed, either by a healthcare professional or the person themselves.
When performed correctly, self-catheters—also known as clean intermittent self-catheterization (CISC)—reduce the risk of infection that can occur with Foley catheters that are kept in place for a longer period of time.
Chronic urinary retention may sometimes require surgery to treat an obstruction caused by BPH. The most common is transurethral resection of the prostate (TURP), in which a section of the prostate gland is removed via a camera (cystoscope) inserted into the urethra of the penis.
If a urethral stricture cannot be dilated with a cystoscope, a surgeon may perform an internal urethrotomy, in which a urethral catheter equipped with a knife cuts through the narrowed passageway.
If the stricture is too long to be treated with urethrotomy or cystoscopic dilation, another surgery called urethroplasty may be used. This involves the reconstruction or replacement of a narrowed urethra by open surgery.
The first-line treatment of acute urinary retention is a urinary catheter to drain excess urine and decompress the bladder. Chronic urinary retention may also be treated with catheters as well as medications and surgery to relieve urinary tract obstructions.
The prognosis of people treated for acute urinary retention tends to be better if the underlying cause is temporary, such as can occur with medications or an acute infection.
Because most people with acute urinary retention are males over 70, there is a higher incidence of co-occurring conditions that can increase the risk of complications such as urosepsis or kidney failure. The older the individual, the greater the risk of complications.
By contrast, the prognosis is generally good for people with chronic urinary retention if the condition is recognized and treated early. With that said, the outlook may be poorer for people who require ongoing catheterization due to the risk of infection and other complications.
As effective as catheters are in dealing with chronic urinary retention, they can take time to get used to. They also need to be used correctly to avoid infection or injury.
To better cope with urinary catheters, whether for the short term or the long run:
- Drink plenty of water, ideally around two liters per day, to reduce the risk of infection.
- Tape the catheter tube to your leg so that it is not accidentally wrenched from the bag as you move about.
- Take spare equipment with you whenever you go out. This can prevent mishaps if there is an accidental leak or rupture.
- Clean the catheter tube and bag regularly with warm, soapy water.
- Check the smell and color of urine. If it is foul-smelling, cloudy, pinkish, or has clots floating around in it, let your doctor know. The same applies if the volume of urine is decreasing or stops completely.
If you don't need a catheter but are still having trouble emptying your bladder, try sitting instead of standing while peeing. The so-called "sitting voiding position" can increase urine flow and make it easier to empty the bladder completely.
Urinary retention is the inability to empty the bladder completely. It can be acute or chronic and range in severity from mild to life-threatening. Men tend to be affected more than women, with most cases of acute urinary retention affecting males.
Causes and risk factors include older age, an enlarged prostate, severe urinary tract infections, and medication such as anesthesia, opioid drugs, and SSRI antidepressants. Neurological causes include spinal cord injury, stroke, multiple sclerosis, and surgical complications.
The diagnosis of urinary retention may involve a rectal exam, pelvic exam, blood and urine tests, and imaging tests like an ultrasound or MRI. The treatment of urinary retention may involve urinary catheters, medications to alleviate an enlarged prostate, or surgeries to overcome urinary blockages or strictures.
A Word From Verywell
The inability to empty the bladder should not be considered "one of those things" you have to deal with as you get older. You stand a greater chance of the condition progressing and worsening if you ignore the problem.
On the other hand, the early recognition of urinary retention can help you pinpoint the underlying cause when it tends to be more treatable. If you have any problems with urination, don't just live with them; speak with your doctor. If needed, your doctor can refer you to a urologist specially trained in diseases and disorders of the urinary tract.