Urinary Retention

Overview

Urinary retention is the inability to empty the bladder fully or at all. It can be acute, meaning it comes on suddenly and you cannot pass urine even though the bladder is full, or chronic, meaning the bladder never empties completely over a longer period.

Acute urinary retention is painful and is a medical emergency that needs prompt treatment to drain the bladder. Chronic retention may cause few symptoms at first but can gradually harm the bladder and kidneys if left untreated. Urinary retention is more common in older men, largely because of prostate enlargement, but it can affect anyone.

Symptoms

Symptoms differ between the sudden and long-term forms.

Acute retention causes:

• A sudden inability to urinate
• Painful, urgent need to pass urine
• Bloating or swelling in the lower abdomen

Chronic retention may cause:

• Difficulty starting to urinate or a weak stream
• A feeling that the bladder is not empty after urinating
• Frequent urination, including waking at night
• Leaking small amounts of urine (overflow)
• Mild, ongoing lower abdominal discomfort

Sudden, complete inability to urinate is an emergency. Seek immediate medical care.

Causes

Urinary retention happens when something blocks the flow of urine or when the bladder muscle cannot contract properly. Common causes include:

• Blockage: An enlarged prostate in men, a urethral stricture, bladder stones, or severe constipation pressing on the bladder.
• Nerve problems: Conditions such as diabetes, multiple sclerosis, stroke, or spinal cord injury that interfere with the nerve signals controlling the bladder.
• Medications: Certain drugs, including some cold and allergy medicines, antidepressants, and painkillers, can reduce the bladder's ability to empty.
• After surgery or anesthesia: Retention is common temporarily after operations.
• Infection or swelling: Urinary tract infections or, in men, prostate inflammation.

Risk Factors

• Older age
• Male sex, especially with an enlarged prostate
• Diabetes and other conditions affecting the nerves
• Recent surgery or anesthesia
• Taking medications that affect bladder function
• A history of urinary tract obstruction or stones
• Severe or chronic constipation

Diagnosis

Doctors diagnose urinary retention based on symptoms, examination, and tests:

• Physical exam: Checking the lower abdomen for a full bladder, and in men examining the prostate.
• Bladder scan or ultrasound: Measuring how much urine remains in the bladder after you try to empty it.
• Urine tests: To look for infection or blood.
• Further tests: Such as imaging, blood tests of kidney function, or specialized bladder-function (urodynamic) studies to find the underlying cause.

Treatment

Treatment first relieves the retention and then addresses the cause.

• Catheterization: A thin tube is passed into the bladder to drain urine, providing rapid relief in acute retention. Some people learn to use a catheter intermittently at home.
• Treating the cause: This may include medication to shrink or relax an enlarged prostate, treating an infection, stopping a contributing drug, or relieving severe constipation.
• Procedures or surgery: To remove a blockage such as a stone, widen a stricture, or reduce prostate tissue when needed.

With the underlying problem treated, many people regain normal bladder function.

Prevention

You cannot prevent every case, but some steps lower the risk:

• Treat an enlarged prostate or urinary symptoms early
• Manage conditions such as diabetes that can affect the bladder nerves
• Avoid constipation with adequate fiber and fluids
• Review medications with your doctor if they affect urination
• Do not ignore difficulty urinating or a weak stream

When to See a Doctor

Seek emergency care immediately if you suddenly cannot urinate at all, especially with lower abdominal pain or swelling. Acute urinary retention needs prompt treatment to drain the bladder and prevent harm to the bladder and kidneys.

See a doctor in a non-emergency setting if you have ongoing trouble emptying your bladder, a weak stream, a feeling of incomplete emptying, frequent urination, or leaking, so the cause can be found and treated.

Related Topics

Frequently Asked Questions

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Urinary Retention.
2. Mayo Clinic. Urinary retention.
3. MedlinePlus, U.S. National Library of Medicine. Urination - difficulty with flow.
4. Urology Care Foundation. Urinary Retention.