Urinary Retention

Urinary retention is an inability to fully empty the bladder. The condition can be either acute (short- term) or chronic (long-term).

Acute urinary retention usually happens suddenly and lasts only a short period of time. Sufferers of acute urinary retention will find they can’t urinate at all, even though their bladder is full. This form of urinary retention is not only painful, it can also be potentially life-threatening. Acute urinary retention will require immediate treatment.

Chronic urinary retention is usually a long-term condition. Sufferers of chronic urinary retention are able to urinate but aren’t able to fully empty their bladder. Often sufferers aren’t even aware they have the condition until other related problems develop, such as urinary incontinence (loss of bladder control) or urinary tract infections (a bacterial infection of the urinary tract).

Urinary retention can have several causes, including:

• Obstruction of the urethra
• Weakened bladder muscles
• Nerve problems
• Certain medications

Obstruction of the urethra can cause urinary retention as the normal flow of urine is blocked from exiting the body. This blockage can be the result of constipation, urinary tract stones, urethral stricture, cystocele, rectocele and certain tumours and cancers.

As we age, our bladder muscles naturally become weaker. This weakening means that the muscles in the bladder may not be able to contract strongly enough to fully empty the bladder’s contents, which will result in urinary retention Urinary retention can also result from a nerve problem, specifically the nerves responsible for controlling the bladder and sphincters. If these nerves become damaged, the brain may not receive the signal telling it that the bladder is full. Alternatively, the muscles that contract to expel urine may not receive the signal to push, or the sphincters may not be signalled to relax. People of all ages can suffer nerve damage, which potentially could interfere with bladder function. The most common causes include:

• Vaginal childbirth
• Diabetes
• Stroke
• Spinal cord or brain infections
• Pelvic trauma
• Heavy metal poisoning
• Multiple sclerosis

Various classes of medicine can cause urinary retention by interfering with nerve signals sent to the bladder and prostate. The most common medicines that can potentially cause urinary retention include; antihistamines, anticholinergics/antispasmodics, tricyclic antidepressants and decongestants.

Acute urinary retention may include the following symptoms:

• Inability to pass urine
• Urgent, painful need to urinate
• Lower abdominal pain
• Lower abdominal bloating

Chronic urinary retention can present with the following symptoms:

• Increased urination frequency – usually eight or more times daily
• Difficulty initiating a urine stream
• A weak /interrupted urine stream
• Having a strong urge to urinate with little success upon attempting to do so.
• Still feeling the urge to urinate after finishing urination
• Mild and constant pain/discomfort in the lower abdomen
• Discomfort in the urinary tract

Some patients who suffer from chronic urinary retention may be unaware of the condition, due to a lack of symptoms. Sadly, these cases will carry an increased risk of developing complications in future.

If presenting with any of the followings symptoms, seek medical attention straight away:

• A complete inability to urinate
• Severe pain or discomfort in the lower abdomen and urinary tract.

If you suspect you suffer from chronic urinary retention, it is advised to visit your GP who will be able to make an informed diagnosis. This will be achieved through either a physical exam and/or a postvoid residual measurement.

Physical exam – your GP may suspect urinary retention based on your symptoms. They would likely follow up on this suspicion with a physical exam of the lower abdomen. It would involve a light tapping on the lower belly in order to identify a distended bladder.

Postvoid residual measurement – this test can measure the amount of urine that is left in the bladder after urination. This is achieved by using ultrasound, which uses sound waves to create an image of the bladder. This image will then show any remaining urine in the bladder. Another method for measuring postvoid residual involves inserting a catheter into the bladder through the urethra. Any urine left in the bladder can then be drained through the catheter and measured. Any readings in excess of 100ml would indicate urinary retention.

Your doctor may wish to perform the following medical tests to help determine what’s causing the urinary retention. These tests can include:

• Cystoscopy – uses a thin tube-like device to look inside the urethra and bladder.
• Computerised tomography (CT) scans - uses a combination of computer imaging and X-rays to create an image.
• Urodynamic tests – can be performed in a variety of ways using; X-rays, ultrasound, catheters, and special equipment. These tests look to measure how well the bladder stores and expunges urine.
• Electromyography – uses sensors to measure the electrical activity of the muscles and nerves related to the bladder and sphincters.

Urinary retention can be treated in a variety of ways. The method and length of treatment will depend on the type and cause of the urinary retention. The different methods of treatment are outlined below.

Medicines that halt the growth or shrink the prostate:

• Finasteride 5mg (Proscar)
• Dutasteride (Avodart)

Medicines that relax the muscles of the prostate and bladder outlet, to help ease blockage:

• Tamsulosin (Flomax)
• Doxazosin (Cardura)
• Alfuzosin (Uroxatral)
• Terazosin (Hytrin)
• Tadalafil (Cialis)

Bladder drainage – Usually performed under a local anaesthetic, a catheter is fed through the urethra in order to drain the urine from the bladder. If the urethra is blocked, the catheter can be passed through the lower abdomen and directly into the bladder. In these circumstances, anaesthesia will be provided. Bladder drainage is mostly used for cases of acute urinary retention. For chronic urinary retention, this treatment is usually reserved for when all other treatments prove ineffective.

Urethral dilation – is designed to widen urethral strictures (narrowing or closure of the urethra), by inserting increasingly larger tubes into the urethra, aimed to either open or expand the closure. Urethral dilation can also be achieved by using stents, which are artificial tubes that once in place can expand like a spring, pushing back the surrounding tissue. Alternatively, a catheter housing a small balloon can be inserted into the urethra. Once in place, the balloon will inflate to widen the urethra stricture.

Surgery – in some cases, surgery may be required to treat urinary retention. The type of surgery will depend on what’s causing the urinary retention, as well as how you have responded to other treatments. Types of surgical methods for treating urinary retention include:

• Prostate surgery – usually involves removing or destroying enlarged prostate tissue.
• Internal urethrotomy – uses a laser or knife to open urethral strictures.
• Cystocele or rectocele repair – this procedure is for women who require surgery to lift a fallen bladder or rectum into the right position.
• Tumour/cancer surgery – removing tumours and cancerous tissue from the urethra and bladder may help reduce urethral obstructions.

Research has found that diet and nutrition plays a role in either causing or preventing urinary retention. Adopting a healthy diet, and making simple lifestyle changes, can reduce the likelihood of developing urinary retention.

Good urination habits play an important role in maintaining normal bladder function. On average, people urinate between four to six times daily. Frequently holding off on the urge to urinate for prolonged periods can weaken the muscles in the bladder, causing them to overstretch. This may not seem like an immediate problem, however, over the course of twenty or thirty years, this constant overstretching can lead to urination issues.

Exercising your pelvic floor muscles will help strengthen the muscles responsible for holding the bladder in place. This form of exercise will prevent urinary retention, where the cause is a mild descended bladder. An example of a pelvic floor exercise is the Kegel Exercise.

Non-Medicinal Alternatives for Urinary Retention

Good Urination habits can play a very important role in maintaining normal bladder function. On average people tend to urinate between four to six times a day. Holding in your urine frequently for prolonged periods of time can cause the muscles in the bladder to weaken which causes them to overstretch. This may not cause an immediate problem however over time this will lead to urination problems.

Exercising the pelvic floor muscles will help strengthen the muscles responsible for holding the bladder in place. Doing this exercise will prevent urinary retention, but only where the cause is a mild descended bladder.