Urinary Retention | Adult Pediatric Urology & Urogynecology Omaha

Urinary Retention

Urinary retention is when the bladder (where you store your urine) does not empty all the way or at all. It can be acute (sudden) or chronic (long-term). Acute means it comes on real quick or is very bad. Chronic means you have had it for a while.

The acute form is an emergency. You need to see a doctor right away. The chronic form occurs most of the time in older men, but it can also occur in women.

Chronic urinary retention?

There is more than one cause. It can happen when something blocks the free flow of urine through the bladder and urethra. The urethra is the tube that takes urine from the bladder out of the body. The problem can also be caused by using medications such as antihistamines (which treat allergic rhinitis and other allergies) antispasmodics (smooth muscle spasm) and tricyclic antidepressants (affect mood and emotions) that can change the way the bladder muscle works.

Passing your urine occurs when the brain tells the bladder muscle to tighten. This squeezes urine from the bladder. The brain then tells the sphincter muscles to relax. This lets the flow of urine go through the urethra and out of the body. Anything that gets in the way on the path from the brain to the nerves that go to the bladder and the urethra can also cause this problem. Urinary retention from nerve disease occurs at the same rate in men and women.

Blockage

For men, a blockage can be caused when the prostate gland gets so big that it presses on the urethra. This is the most common cause of chronic urinary retention in men. One cause in women is a bladder that drops. This is called a cystocele. It can also be caused when the rectum drops into the back wall of the vagina. This is called a rectocele.

A urethral stricture is when the urethra narrows.  This can happen in both men and women.

Infection and Swelling

In men, an infection of the prostate can cause it to swell. This causes it to press on the urethra to block the flow of urine. A urinary tract infection (UTI) can cause swelling of the urethra to cause this problem. Diseases spread by having sex (called STDs) can also cause swelling and lead to retention.

Nerve Causes

The bladder may not work right because there is a problem getting the messages from the brain to the bladder and urethra through the nerve pathway. Possible causes include stroke, diabetes, multiple sclerosis, trauma to the spine or pelvis, pressure on the spinal cord from tumors, and a herniated disk. In women, vaginal childbirth can sometimes damage nerve pathways that control going.

Drugs

Some types of drugs affect bladder muscle function as a side effect and can cause this problem. These include drugs called anticholinergics, the older drugs for depression, antihistamines, some blood pressure-lowering drugs, antipsychotics, hormonal agents, and muscle relaxants.

Surgery

Medicine given before and during surgery to make you sleepy may cause urinary retention right after surgery. Procedures such as hip replacement, rectal surgery, surgery for women’s issues, and surgery to remove hemorrhoids can cause the problem afterward.

What are the symptoms of urinary retention?

The signs can vary. Some people with chronic form have a hard time starting the flow of urine. Some have a weak flow once they start. Others may feel the need to go but can’t start. Others have to go a lot, while others still feel the need to go right after going. You may “leak” urine when you aren’t going because the bladder is full.

With the acute form, you are all of a sudden not able to go at all. This occurs even though you have a full bladder. See a doctor right away if this happens to you.

How is chronic urinary retention diagnosed?

The doctor will ask about your signs and symptoms and how long you have had them. He or she will also ask about your medical history and your drug use. A physical exam of the lower abdomen (belly) may show the cause or give the doctor clues. After this, certain tests may be needed. Men may have a rectal exam to check the size of their prostate.

Cystoscopy is a test in which a thin tube with a tiny camera on one end is put into the urethra. This lets the doctor look at pictures of the lining of your urethra and bladder. This test may show a stricture of the urethra or blockage caused by a stone or an enlarged prostate or a tumor.

Urodynamic Evaluation is testing that uses a catheter to record pressure within the bladder that may be done to tell how well the bladder empties. The rate at which urine flows can also be measured by such tests.

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