Evaluation and Treatment of Acute and Chronic Urinary Retention

September 10,2020 |

Urinary retention is a condition that makes it difficult, if not impossible, to fully empty your bladder. Even after using the restroom, you’ll still feel like you need to urinate but you’re unable to void more urine. It’s a condition that often occurs due to other health or urologic problems and is more common as you get older. While men are 10 times more likely to experience urinary retention, it can and does still occur in women.2 In this article, we’ll discuss the evaluation and treatment of acute and chronic urinary retention.

What is Acute Urinary Retention?

As we mentioned, urinary retention is when your bladder doesn’t fully empty while using the restroom, even if it’s still full. Although you will still feel the need to urinate, you can’t empty your bladder. Urinary retention comes in two forms, acute and chronic.

Acute urinary retention (AUR) is when it happens suddenly. You’re unable to urinate, even though your bladder is completely full. Acute urinary retention often only lasts a short time, but it can cause severe pain and even be life threatening.1 Due to the severity of acute urinary retention, it’s considered a urologic emergency and requires immediate medical care. The primary symptom that you’ll experience with AUR is a feeling like you need to use the bathroom but can’t accompanied by high levels of pain or discomfort in your lower abdomen.2

What is Chronic Urinary Retention?

Chronic urinary retention (CUR) happens over a long period of time and slowly presents itself. Because of this, many people don’t even realize they have chronic urinary retention because its unaccompanied by other symptoms at first or they are so minor that you don’t notice them. However, over time, chronic urinary retention can also become dangerous and can result in serious complications.

Since chronic urinary retention happens gradually, the symptoms are often less intense and can easily be mistaken for other urologic conditions. Symptoms of chronic urinary retention include:2

  • Feeling like you need to urinate frequently, often eight or more times a day
  • Difficulty starting your urine stream
  • Weak urine stream
  • Urine stream that starts and stops frequently
  • Feeling the need to urinate right after you finish urinating
  • Getting up multiple times throughout the need to urinate
  • Urine leakage or incontinence
  • Urge incontinence—the strong feeling you have to urinate immediately followed by the inability to stop yourself from urinating2
  • Inability to tell when your bladder is full
  • Ongoing mild discomfort
  • Feeling of fullness in pelvis/lower abdomen

Causes of Urinary Retention

Since urinary retention is often exasperated by other urologic conditions, there can be a number of different underlying causes. To better understand urinary retention, you need to understand how the urinary tract system works. The bladder is part of the lower urinary tract and is where your urine is stored. The urethra is a tube that carries urine from the bladder out of your body. You have two sets of muscles called sphincters that help your bladder contract and expand to control the voluntary output of urine. Your internal sphincters are involuntary muscles located where your urethra connects to the bladder and the external sphincter is voluntary and works as a valve that opens and closes to control when urine can leave the bladder.2 In males, the prostate is also closely interconnected with the lower urinary tract system.

Whenever you have to urinate, your bladder works with your sphincter to push urine out and open the valves so that urine can leave your body. You have control of the external sphincter, which is why using the bathroom is a voluntary action. However, when there is a problem with any of these structures, or the connected nerves, you can experience urologic problems such as urinary retention. Some problems that can cause urinary retention include obstructions, medication, nerve problems, or surgery. There are also a few male specific and female specific causes of urinary retention, which we’ll discuss.

Obstruction

In general, any obstruction that disrupts your flow of urine can lead to either acute or chronic urinary retention. If the obstruction is sudden, AUR occurs. If the obstruction slowly grows to create a progressive blockage, CUR occurs. Either can occur from urinary tract stones, urethral strictures, mass or cancer in the pelvis or intestine, severe constipation, blood clot from bleeding in your bladder, a foreign object in the urethra, severe urethral inflammation.2

In men, one of the most common causes of obstruction related urinary retention is from benign prostatic hyperplasia. If you have BPH, talk to your doctor about what you can do to reduce the likelihood of it causing urinary retention problems. Men can also experience obstructions from prostate cancer, penile constriction bands, paraphimosis, meatal stenosis, or phimosis.2

In women, an obstruction can be caused from a mass or cancer in your uterus. Cystocele or rectocele also often lead to urinary retention along with a condition known as prolapse.

Medication

Certain medications make it more difficult for your bladder muscles to work properly or disrupt the function of your internal urinary sphincter.2 Talk to your doctor if you’ve just started a new medication and notice any signs or symptoms of urinary retention.

Nerve Problems

There are many nerves that work together to send signals to and from your brain triggering the need to urinate. If one or more of the nerve signals aren’t working properly, it can lead to urinary retention.2 There are many things that can cause nerve problems, such as stroke, diabetes, delivering a baby, or injury, so talk to your doctor to get a better understanding of what’s going on.

Surgery

Depending on the type of surgery you undergo, urinary retention may be a temporary condition that occurs during recovery. This is most common in people who undergo some sort of spinal surgery.

Male Specific Causes

Men can also suffer from urinary retention due to prostate infection or inflammation or a condition called balanitis, which is the inflammation or swelling of the foreskin in uncircumcised men.2 If you experience trauma on your penis, this can also lead to urinary retention due to swelling and subsequent urethral obstruction.

Female Specific Causes

Female specific causes of urinary retention include vulvovaginitis, which is an infection in the other part of the vagina, or bladder infections.2

Treating Acute and Chronic Urinary Retention

Your doctor will be able to diagnose urinary retention through administering a physical exam. In certain instances, further testing will be done to better understand the underlying cause. After diagnostics, your doctor will work with you to create a treatment plan based on your certain circumstances.

Acute urinary retention needs to be treated as a medical emergency using catheterization. If for some reason catheterization cannot be performed, a suprapubic catheter can be inserted using local anesthesia.2

Depending on the severity, some cases of chronic urinary retention can be treated with behavior modification and lifestyle changes. Catheterization is still commonly used to help relieve pain associated with a full bladder and for the duration of your treatment plan. Some other treatment options for chronic urinary retention include:

  • Urethral Dilation and Stents – this is done to help widen the urethra so that urine can flow easily from the bladder outside of the body.2 To do this, your doctor will insert tubes of increasing width into your urethra to slowly open and stretch the stricture.2 This procedure can also be done using a balloon or a stent.

     

  • Cystoscope – a cystoscope is a lighted, flexible tubular scope that can be inserted through the urethra up into the bladder to find or remove any stones or objects that may be causing urinary retention.2

     

  • Medication – there are a number of different medications that can help relieve urinary retention and increase muscle relaxation.2 If medications are causing your urinary retention, your doctor will work with you to find an alternative that won’t cause retention issues.

     

  • Surgery – in severe cases that don’t respond to other treatment, your doctor may recommend surgery. Many urinary retention surgeries are outpatient procedures and non-invasive, so you’ll have a fast recover with minimal down time.2

Conclusion

Urinary retention can cause severe disruptions to your daily life. If you notice any signs or symptoms of urinary retention, see your doctor immediately. If you experience AUR, go to the emergency room as soon as possible to avoid any further complications.

Byram Healthcare is proud to offer full-service urological care and urological supplies provider. All orders can be discreetly delivered to your home. If you’re looking for personalized, confidential services, our teams of knowledgeable urological customer service specialists are here to help. 

Sources:

1 https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention/all-content

2 https://www.healthline.com/health/urinary-retention

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