Understanding Urinary Retention(Acute & Chronic)
Causes, Symptoms, Diagnosis, Treatment and Support
What is Urinary Retention?
Urinary retention is a condition where a person cannot completely empty their bladder. It can be classified as acute or chronic.
- Acute urinary retention is a sudden, painful inability to urinate and is considered a medical emergency that requires immediate attention. Without prompt treatment, it can lead to bladder damage or kidney problems.
- Chronic urinary retention develops more gradually. Individuals can urinate but may not fully empty their bladder. This form may not cause immediate discomfort but can lead to complications such as urinary tract infections (UTIs) and bladder damage over time.
Common causes of urinary retention include blockages (e.g., enlarged prostate, kidney stones), nerve issues, medications, and weak bladder muscles. Symptoms include difficulty starting urination, a weak urine stream, or the sensation of incomplete bladder emptying. Treatment varies depending on the cause and severity, ranging from medications to catheterization or surgery.
Causes and Risk Factors of Urinary Retention
The causes and risk factors of urinary retention vary depending on whether the condition is acute or chronic, but the underlying issues generally involve obstructions, nerve problems, muscle dysfunction, or certain medications. Here’s a breakdown of the causes and risk factors:
Causes of Urinary Retention
1. Blockages/Obstructions:
- Enlarged Prostate (Benign Prostatic Hyperplasia, BPH): Common in older men, this condition puts pressure on the urethra, making it difficult to urinate.
- Kidney Stones: Stones that block the urinary tract can prevent urine from passing out of the bladder.
- Urethral Stricture: Narrowing of the urethra due to scarring or injury, which restricts urine flow.
- Bladder or Urethral Tumors: Growths in the bladder or urethra can obstruct the urinary passage.
- Constipation: Severe constipation can compress the bladder or urethra, making it difficult to urinate.
2. Nerve Problems:
- Diabetes: Over time, diabetes can damage the nerves that control the bladder, leading to retention.
- Multiple Sclerosis: This neurological disease can affect the nerves controlling bladder function.
- Spinal Cord Injuries: Damage to the spinal cord can disrupt nerve signals that control the bladder, leading to retention.
- Stroke: A stroke can impair the brain's ability to control bladder function.
3. Medications:
- Antihistamines: These can relax the bladder muscles, making it difficult to empty the bladder.
- Decongestants: These medications tighten the bladder outlet muscles, contributing to urinary retention.
- Antidepressants: Some can interfere with bladder function by affecting the nervous system.
- Muscle Relaxants: These medications can cause weakened bladder contractions, leading to retention.
4. Muscle Problems:
- Weakened Bladder Muscles: This can result from aging or muscle disorders, making it difficult to expel urine.
- Overactive Bladder Muscles: In some cases, the bladder muscles may contract too frequently or not relax enough, causing retention.
Risk Factors for Urinary Retention
1. Age: Older individuals, especially men, are at higher risk due to the likelihood of developing conditions like an enlarged prostate or nerve problems.
2. Gender: Men are more prone to urinary retention, primarily due to prostate enlargement. However, women can also experience retention, particularly after pelvic surgery or due to conditions affecting the pelvic muscles.
3. Medical Conditions:
- Prostate Problems: Men with benign prostatic hyperplasia (BPH) or prostate cancer are at high risk.
- Diabetes: People with diabetes are at risk due to potential nerve damage affecting bladder control.
- Neurological Disorders: Conditions like multiple sclerosis, Parkinson's disease, and spinal cord injuries increase the risk of retention.
4. Surgery: Surgical procedures, especially those involving anesthesia, can temporarily impair bladder function. Pelvic surgeries can also lead to nerve damage affecting bladder control.
5. Infections: Infections like urinary tract infections (UTIs) can cause swelling and block urine flow, leading to temporary retention.
6. Childbirth: In women, vaginal delivery can sometimes result in temporary nerve or muscle damage, leading to urinary retention.
Conclusion
Urinary retention can result from various causes, including blockages, nerve issues, muscle dysfunction, and medications. The risk factors increase with age, gender, certain medical conditions, surgeries, and infections. Understanding these factors can help identify and manage urinary retention early to prevent complications.
The signs and symptoms of urinary retention depend on whether the condition is acute or chronic.
Acute Urinary Retention
This is a sudden and severe inability to urinate, which is a medical emergency. Symptoms may include:
1. Inability to urinate: Complete inability to pass any urine, despite a full bladder.
2. Severe pain and discomfort: Intense pain in the lower abdomen or pelvic region due to the bladder being overly full.
3. Swollen lower abdomen: Visible swelling or bloating in the lower abdomen due to the bladder being distended.
4. Urgent need to urinate: A constant, overwhelming urge to urinate without being able to do so.
5. Nausea and sweating: In some cases, acute retention can lead to nausea, sweating, and even elevated heart rate from the pain and discomfort.
Chronic Urinary Retention
Chronic urinary retention develops gradually, and the symptoms may be more subtle or less severe than in acute cases. These include:
1. Difficulty starting urination: Having to strain or push to begin urinating or having a delayed start when trying to urinate.
2. Weak urine stream: Urine may come out in a weak or dribbling stream, instead of a steady flow.
3. Frequent urination: Needing to urinate often, sometimes as frequently as every hour, due to incomplete emptying of the bladder.
4. Urgency to urinate: Feeling the need to urinate urgently but being able to pass only a small amount of urine.
5. Incomplete bladder emptying: After urinating, you may feel like your bladder is still full or you need to go again shortly after.
6. Nocturia: Waking up multiple times during the night to urinate.
7. Incontinence (Overflow Incontinence): In chronic cases, the bladder can become so full that it overflows, leading to unintentional leakage or dribbling of urine.
8. Lower abdominal discomfort: A feeling of discomfort or fullness in the lower abdomen due to urine retention.
Additional Signs
- Recurrent urinary tract infections (UTIs): Chronic retention can lead to frequent UTIs due to the buildup of stagnant urine in the bladder.
- Blood in urine: In some cases, urinary retention can cause hematuria (blood in the urine) due to bladder damage or infection.
When to Seek Medical Attention
Acute urinary retention is a medical emergency and requires immediate attention. Chronic retention, though less urgent, can lead to serious complications if left untreated, such as bladder damage, kidney problems, and infections. If you experience symptoms like difficulty urinating, frequent UTIs, or lower abdominal pain, it's important to consult a healthcare professional for proper diagnosis and treatment.
Signs and Symptoms of Urinary Retention
Diagnosis and Medical Evaluation of Urinary Retention
The diagnosis and medical evaluation of urinary retention involves a combination of patient history, physical examination, and various diagnostic tests to determine the underlying cause and severity. Here’s how medical professionals typically evaluate urinary retention:
1. Medical History
The first step is for a healthcare provider to take a detailed medical history, which includes:
- Symptoms: Discussing the onset, frequency, and severity of symptoms, such as difficulty urinating, pain, or a weak urine stream.
- Medical conditions: Checking for conditions like benign prostatic hyperplasia (BPH), diabetes, neurological disorders, or a history of urinary tract infections.
- Medications: Reviewing any medications that could contribute to urinary retention, such as antihistamines, decongestants, antidepressants, or muscle relaxants.
- Surgical history: Any previous surgeries, especially involving the pelvic region, bladder, or prostate, that might impact bladder function.
2. Physical Examination
A physical exam will focus on the abdomen and pelvic region, and for men, it will likely include a digital rectal exam (DRE) to assess the size and condition of the prostate.
- Abdominal palpation: To check for signs of bladder distention or tenderness.
- Digital rectal exam (for men): This allows the doctor to check for an enlarged prostate, which can obstruct urine flow.
- Pelvic exam (for women): To examine for any pelvic muscle or organ issues that could contribute to retention.
3. Post-Void Residual (PVR) Measurement
This test helps determine how much urine remains in the bladder after urination, which is key in diagnosing urinary retention. Two main methods are used:
- Bladder Ultrasound: A non-invasive ultrasound scan that estimates the volume of urine left in the bladder after voiding.
- Catheterization: A catheter is inserted into the bladder after urination to directly measure the volume of urine remaining.
A significant amount of urine (usually more than 100 milliliters) left in the bladder after urination indicates urinary retention.
4. Urinalysis and Urine Culture
- Urinalysis: A urine sample is tested to check for signs of infection, blood, or other abnormalities, such as glucose (in cases of diabetes), which might indicate underlying issues contributing to retention.
- Urine culture: If a urinary tract infection (UTI) is suspected, a culture may be done to identify any bacteria present.
5. Urodynamic Tests
These tests assess how well the bladder and urethra are storing and releasing urine. Urodynamic testing may include:
- Uroflowmetry: Measures the rate and strength of urine flow to detect abnormalities in the flow pattern.
- Cystometry: Measures bladder pressure during filling and voiding to evaluate bladder function.
- Pressure-flow study: Measures the bladder pressure while urinating to identify any obstructions or weak bladder muscles.
6. Imaging Studies
Imaging studies may be used to look for anatomical abnormalities or obstructions:
- Ultrasound: Non-invasive imaging of the bladder, kidneys, or prostate to check for enlargement, blockages, or structural issues.
- CT Scan or MRI: These more detailed imaging techniques can help identify tumors, stones, or other structural abnormalities in the urinary tract.
- Cystoscopy: A thin tube with a camera (cystoscope) is inserted through the urethra to visually inspect the bladder and urethra for blockages, strictures, or other abnormalities.
7. Blood Tests
Blood tests may be performed to check for:
- Kidney function: Elevated blood urea nitrogen (BUN) and creatinine levels may indicate that the kidneys are not functioning properly due to urinary retention.
- Prostate-specific antigen (PSA) (in men): Elevated PSA levels can be a sign of prostate problems, such as benign prostatic hyperplasia (BPH) or prostate cancer.
8. Neurological Tests
If nerve damage is suspected as the cause of urinary retention, the doctor may perform:
- Electromyography (EMG): This test measures the electrical activity of the muscles and nerves around the bladder and urethra to detect any dysfunction.
- Reflex tests: To check for proper nerve function controlling bladder and pelvic muscles.
Conclusion
The diagnosis of urinary retention involves a comprehensive evaluation of symptoms, physical examination, and a variety of diagnostic tests, such as bladder ultrasounds, post-void residual measurements, urinalysis, urodynamic studies, and imaging techniques. The goal is to identify the underlying cause, whether it's an obstruction, nerve issue, or muscle dysfunction, to guide appropriate treatment.
The treatment of urinary retention depends on whether the condition is acute or chronic and on the underlying cause. The main goal is to relieve the immediate problem and then address the root cause to prevent recurrence. Here are the common treatment options for urinary retention:
1. Immediate Relief of Acute Urinary Retention
Acute urinary retention is a medical emergency and requires immediate intervention to relieve bladder pressure and prevent damage.
- Catheterization:
- The most common and immediate treatment is the insertion of a catheter into the bladder through the urethra to drain the accumulated urine. This relieves the discomfort and prevents damage to the bladder and kidneys.
- Types of catheters include:
- Intermittent catheterization: A temporary catheter is inserted and removed once the bladder is drained.
- Indwelling catheter (Foley catheter): This remains in place for a period of time, allowing continuous drainage of urine.
2. Medications
- Alpha-blockers: Medications such as tamsulosin (Omnic Tocas) or alfuzosin (Xatral) are often prescribed for men with benign prostatic hyperplasia (BPH). These drugs relax the muscles in the prostate and bladder neck, making it easier to urinate.
- 5-alpha reductase inhibitors: Drugs like finasteride (Proscar) or dutasteride (Avodart) are used to shrink an enlarged prostate over time.
- Antibiotics: If urinary retention is caused by a urinary tract infection (UTI), antibiotics are prescribed to treat the infection.
- Cholinergic agents: These medications, like bethanechol, stimulate bladder contractions to help empty the bladder more completely in cases of weak bladder muscles.
- BOTOX - Botulinum toxin injections: In certain cases of neurological conditions or overactive bladder, Botox injections into the bladder wall can help reduce muscle overactivity and improve bladder function.
3. Surgery
Surgical interventions may be necessary if urinary retention is caused by an anatomical issue, such as an enlarged prostate, bladder stones, or urethral strictures.
- Prostate Surgery:
- Transurethral resection of the prostate (TURiS): A common procedure for men with benign prostatic hyperplasia (BPH). TURP removes part of the enlarged prostate to improve urine flow.
- HoLEP Laser surgery: Laser therapy can also be used to remove or shrink part of the prostate.
- Prostatectomy: In severe cases, removal of the entire prostate may be necessary.
- Urethral Dilation or Urethrotomy:
- If the urethra is narrowed (urethral stricture), dilation or surgical cutting of the stricture may be needed to open the passage and restore urine flow.
- Cystolitholapaxy:
- For bladder stones causing obstruction, this procedure uses a small scope to break up and remove stones.
- Sacral Neuromodulation:
- This is a surgical procedure that involves implanting a device to stimulate the nerves that control bladder function. It is used in cases of urinary retention caused by nerve dysfunction.
- Suprapubic Catheterization:
- For individuals who cannot tolerate urethral catheterization or require long-term drainage, a catheter may be inserted directly through the lower abdomen into the bladder.
4. Behavioral and Lifestyle Modifications
For chronic urinary retention, certain behavioral techniques can help manage symptoms:
- Bladder training: Gradually increasing the time between urinations can help improve bladder control.
- Scheduled voiding: Setting regular intervals to go to the bathroom can help prevent the bladder from becoming overly full.
- Double voiding: After urinating, waiting a few minutes and trying again can help empty the bladder more completely.
- Pelvic floor exercises: Strengthening the pelvic floor muscles through exercises like Kegels can help improve bladder control, particularly in women.
5. Management of Underlying Conditions
- Benign Prostatic Hyperplasia (BPH): For men, managing an enlarged prostate with medication or surgery can relieve urinary retention.
- Urinary Tract Infections (UTIs): Treating infections with antibiotics can help relieve temporary urinary retention.
- Neurological Conditions: If urinary retention is due to a condition like multiple sclerosis, diabetes, or spinal cord injuries, managing the underlying neurological disorder is essential to improving bladder function.
6. Long-term Management and Monitoring
In cases of chronic retention or after surgery, ongoing management and monitoring may be required:
- Intermittent self-catheterization: Some people with chronic urinary retention may need to periodically insert a catheter themselves to drain the bladder.
- Regular follow-ups: Monitoring bladder function with post-void residual tests and other evaluations to ensure the bladder is emptying properly and prevent complications like urinary tract infections or kidney damage.
7. Alternative and Minimally Invasive Procedures
- Prostatic Urethral Lift (PUL): This is a minimally invasive procedure that uses small implants to hold enlarged prostate tissue away from the urethra, improving urine flow.
- Rezum (Water vapor therapy): A minimally invasive technique that uses steam to shrink prostate tissue, offering an alternative to more invasive prostate surgeries.
Conclusion
Treatment of urinary retention focuses on immediate relief and addressing the underlying cause. Options range from catheterization and medications to surgical interventions for more severe cases, such as prostate enlargement or anatomical obstructions. Lifestyle modifications and long-term management strategies are also important, especially for those with chronic urinary retention.