What is Urinary Retention?
Urinary retention is the inability to completely empty the bladder, or in acute cases, the inability to pass urine at all. It can be sudden (acute) or gradual (chronic), and it’s more common than people realize—especially in elderly men due to prostate issues. However, it can occur in all age groups, including women and children, for a wide variety of reasons.
Understanding the underlying causes, risk factors, and treatment strategies is crucial for timely intervention and long-term management.
Types of Urinary Retention
Acute Urinary Retention
This is a sudden, painful inability to urinate, often requiring emergency catheterization. It is usually caused by an obstruction or severe nerve dysfunction.
Chronic Urinary Retention
This involves a long-term inability to completely empty the bladder, often painless but may cause a weak stream or dribbling. Over time, it can lead to bladder damage.
Overflow Incontinence
A related condition where the bladder is so full that urine leaks out involuntarily. It’s a sign of underlying retention.
Intraluminal Causes of Urinary Retention
These are obstructions within the urinary tract, particularly inside the urethra or bladder.
Blood Clots
May occur due to trauma, surgery, or tumors in the bladder leading to blockage.
Bladder Stones
Can form due to urinary stasis and block the outlet of the bladder.
Prolapsing Bladder Tumor
A tumor that projects into the urethra may obstruct urine flow.
Urethral Valves (Congenital)
Common in male neonates, these are abnormal flaps in the urethra that restrict flow.
Intramural Causes: Problems in the Wall of the Urethra or Bladder
Benign Prostatic Hyperplasia (BPH)
One of the most common causes in elderly men. Enlarged prostate presses on the urethra.
Prostatitis
Inflammation of the prostate can cause swelling and retention.
Prostate Cancer
A growing tumor may compress the urethra.
Urethral Stricture
Scarring of the urethra after infection, injury, or catheterization can narrow the passage.
Urethral Trauma
Injury from pelvic fractures or instrumentation.
External Compression: Causes Outside the Urinary Tract
Pregnancy
The growing uterus can compress the bladder and urethra.
Fibroids
Large uterine fibroids can exert pressure on the urinary tract.
Ovarian Cysts or Pelvic Masses
May push against the bladder or urethra, restricting flow.
Neurological Causes of Urinary Retention
Damage to the nervous system can impair bladder control.
Spinal Cord Injury
Disrupts nerve signals between the brain and bladder.
Diabetes
Can lead to autonomic neuropathy, affecting bladder contraction.
Multiple Sclerosis and Polio
Cause neurogenic bladder dysfunction.
Postoperative Retention
Due to anesthesia or pelvic nerve disturbance.
Prolapsed Disc
May compress nerves controlling the bladder.
Functional and Drug-Induced Causes
Medications
Drugs that affect bladder muscle or sphincter tone:
- Anticholinergics
- Antihistamines
- Antipsychotics
- Narcotics
Post-Surgery
Common after pelvic or spine surgeries due to anesthesia or reflex inhibition.
Signs and Symptoms of Urinary Retention
- Painful inability to urinate (acute)
- Lower abdominal fullness or bloating
- Weak urine stream or dribbling
- Frequent urination with small volumes
- Urgency with no relief
- Recurrent urinary tract infections (chronic)
Differential Diagnosis by Age Group
In Children
- Congenital abnormalities (posterior urethral valves)
- Abdominal pain or medications
In Young Adults
- Postoperative, trauma, drug-induced, UTI
In Elderly
- BPH, prostate cancer, strictures, diabetes
Key Investigations
To diagnose urinary retention and its causes, doctors may recommend:
- Urine tests (U&E, MSU): Check for infection and kidney function
- Bladder ultrasound: Measure post-void residual volume
- Cystoscopy: Visual inspection of the urethra and bladder
- Urodynamic studies: Assess bladder pressure and flow
- IVU (Intravenous Urography): Evaluate kidney and bladder structure
Management of Urinary Retention
Emergency Relief
- Bladder catheterization to relieve acute retention
- Suprapubic catheter if urethral route is blocked
Addressing Underlying Causes
For BPH:
- Alpha-blockers (e.g., tamsulosin)
- 5-alpha-reductase inhibitors
- TURP (Transurethral Resection of the Prostate)
For Urethral Strictures:
- Dilation or urethrotomy
- Surgical reconstruction
For Tumors:
- Resection, chemotherapy, or radiotherapy
For Neurological Causes:
- Intermittent self-catheterization
- Neuromodulation
- Treat underlying neurological condition
Lifestyle Changes and Prevention Tips
- Stay hydrated to avoid stone formation
- Limit caffeine and alcohol
- Practice timed voiding for neurological bladder
- Avoid long-term use of anticholinergic drugs without supervision
- Monitor prostate health with regular checkups
Complications of Untreated Urinary Retention
- Recurrent UTIs
- Bladder damage or rupture
- Kidney damage (hydronephrosis)
- Overflow incontinence
- Sepsis (in severe infections)
FAQs on Urinary Retention
Q. What is the most common cause of urinary retention in elderly men?
A. Benign Prostatic Hyperplasia (BPH) is the most common cause.
Q. Can women get urinary retention?
A. Yes, especially during pregnancy, due to pelvic masses, or neurological issues.
Q. Is urinary retention an emergency?
A. Acute urinary retention is a medical emergency and requires immediate catheterization.
Q. How is chronic urinary retention diagnosed?
A. Through symptoms, bladder scan, urodynamic testing, and cystoscopy.
Q. Can diabetes cause urinary retention?
A. Yes, due to diabetic neuropathy affecting bladder control.
Final Thoughts
Urinary retention can severely impact quality of life, whether it’s acute or chronic. Prompt recognition, thorough evaluation, and targeted management can restore normal bladder function and prevent complications. With aging populations and lifestyle-related conditions like diabetes on the rise, awareness and early intervention have never been more important.
