Unable to Urinate (Urinary Retention): Causes and What to Do

What urinary retention feels like

Sudden (acute) retention

• strong, painful urge to urinate but nothing or only drops come out
• lower belly pain, swelling and tenderness above the pubic bone
• restlessness and distress

Gradual (chronic) retention

Chronic retention can go unnoticed for months because the bladder stretches slowly and loses sensation:

• weak or interrupted stream, dribbling at the end
• straining or pushing to pass urine
• hesitancy: waiting for the flow to start
• a feeling of incomplete emptying
• passing urine frequently in small amounts, and at night
• leaking from an overfull bladder, called overflow incontinence
• repeated urinary infections

What to do if you cannot urinate

If you cannot pass urine at all and your belly is painful, go to an ER or urgent care now. A doctor will drain the bladder with a catheter, which gives immediate relief.

If you have some flow but it is difficult, these can help while you arrange to be seen:

• relax, sit down to urinate (men too), and lean slightly forward
• run a tap or put your hands in warm water
• sit in a warm bath, and try to urinate there if needed
• avoid alcohol, caffeine and large volumes of fluid at once
• do not take over-the-counter cold and allergy medicines

Causes of urinary retention

Blockage

• Enlarged prostate: the most common cause in men over 50. Retention is often triggered by cold weather, alcohol, constipation or a cold medicine.
• Urethral stricture: scar tissue narrowing the urethra.
• Constipation: a full rectum presses on the bladder outlet, a frequent cause in older adults and children.
• Bladder stones, blood clots and tumors.
• In women: pelvic organ prolapse, a large fibroid, an ovarian mass, or narrowing after surgery.

Medicines

• anticholinergics: some antihistamines (such as diphenhydramine), bladder medicines, tricyclic antidepressants, antipsychotics
• decongestants such as pseudoephedrine
• opioid painkillers
• muscle relaxants and some anesthetic drugs

Infection and inflammation

• urinary tract infection and prostatitis, which cause swelling and painful urination
• genital herpes, which can cause retention through pain and nerve involvement

Nerve problems

• diabetes (diabetic cystopathy)
• multiple sclerosis, stroke, Parkinson's disease
• spinal cord injury and spinal disc problems, including cauda equina syndrome, a surgical emergency
• pelvic surgery damaging nerves

After surgery or childbirth

Anesthesia, pain medicines, reduced mobility and swelling make retention common after operations (especially hip, hernia and pelvic surgery) and after birth, particularly with an epidural or a long labor.

Weak bladder muscle

Long-term overstretching or nerve damage can leave an atonic bladder that cannot contract to empty.

Urinary retention in women

Retention is less common in women but does occur. Causes include prolapse, constipation, medicines, after childbirth or incontinence surgery, multiple sclerosis, and Fowler's syndrome, a condition in young women where the urethral sphincter fails to relax. It should always be investigated.

How doctors find the cause

The full medical approach, including tests and long-term treatment, is covered on the urinary retention condition page. In short, a doctor will:

1. scan the bladder to measure how much urine is left after urinating
2. examine the belly, and do a rectal exam (prostate and constipation) or pelvic exam
3. check urine for infection and blood tests for kidney function
4. ask about medicines, surgery, back problems and neurological symptoms

Frequently asked questions

What should I do if I can't pee?

If you cannot pass any urine and your lower belly is painful or swollen, go to the ER now. A catheter will drain the bladder quickly. If you can pass some urine, try relaxing in a warm bath and see a doctor the same day.

What causes sudden inability to urinate?

The most common causes are an enlarged prostate in men, medicines such as antihistamines, decongestants and opioids, constipation, urinary infection and recent surgery or anesthesia. Nerve problems, including a spinal emergency, are less common but serious.

Can urinary retention go away on its own?

Mild retention from a medicine or constipation may improve once the cause is removed. Acute retention needs a catheter, and many people can urinate normally once the bladder has rested and the cause is treated. Chronic retention needs assessment and treatment to protect the kidneys.

What is the feeling of incomplete bladder emptying?

It is the sensation that urine is still left after you finish. It can be caused by retention from an enlarged prostate or weak bladder muscle, but also by an irritated bladder from infection or overactive bladder. A bladder scan shows whether urine is really left behind.