Urinary retention is the inability to empty the bladder of urine, leaving behind a volume of urine which can lead to complications. It is important to realize that some people can still pass some urine but still be in retention as the volume left in the bladder is too high.
A bladder which does not empty may still cause incontinence as it results in overflow urinary incontinence. Urinary retention is generally treated with the following:
- bladder drainage
- urethral dilation
- urethral stents
- prostate medications
The inability to empty the bladder can have many causes, which are generally divided into acute urinary retention and chronic urinary retention.
Acute urinary retention
The sudden inability to urinate is usually symptomatic of another condition that requires treatment. It may be caused by obstructions in the bladder or urethra, by a disruption of sensory information in the nervous system (e.g. spinal cord or nerve damage), or overstretching the bladder (e.g. by delaying urination for a long period of time). Besides a clear and sudden inability to void the bladder, people with acute urinary retention usually experience a distended abdomen, and a painful desire to void.
Complications of untreated urinary retention can include bladder damage and chronic kidney failure. Treatment is draining the bladder of urine with intermittent self-catheterisation along with treatment of the underlying cause.
Chronic urinary retention
Chronic urinary retention is, like acute retention, commonly caused by a separate condition that requires treatment. It may be an obstruction in the outlet, a weak bladder muscle, a neurological problem or the side effect of medication. Symptoms can be confusing, because while you may be able to urinate, you may have trouble starting a stream or emptying your bladder completely. You may urinate frequently, you may feel an urgent need to urinate, but have little success when you get to the toilet, or you may feel you still have to go after you’ve finished urinating. At the same time, you may also dribble urine in between voiding, due to an overfull bladder (overflow incontinence).
Because of these confusing symptoms, chronic retention quite often gets diagnosed as overactive bladder or urge incontinence. This is serious, as the treatment for overactivity is basically to “calm the bladder down” with medication - which, of course, increases the level of retention. A bladder ultrasound/scan can be used or measurement residual urine after catheterisation to be certain or not of urine retention. Complications with untreated chronic retention include urinary tract infections, bladder damage, incontinence and chronic kidney failure. Treatment is similar to acute retention, treating the underlying cause and commonly draining of urine by intermittent self-catheterisation or longer-term indwelling catheter.
Intermittent catheterisation (IC)
IC is a safe and effective method which means regularly emptying the bladder with a single use urinary catheter. IC should only be performed in the presence of a residual volume of urine and symptoms or complications arising from the residual volume. Incomplete bladder emptying is generally due to one of three categories of lower urinary tract dysfunction:
- Detrusor dysfunction: an underactive or atonic detrusor which fails to contract with sufficient duration or magnitude to completely empty the bladder.
- Bladder outlet obstruction: most common causes are prostatic enlargement, high bladder neck or urethral stenosis (in women). In men, urethral strictures may obstruct bladder outflow and are often found following instrumentation such as radical prostatectomy.
- Following surgery: surgery to restore continence can impair bladder emptying, and this technique may result in acute urinary retention. Procedures for reducing stress urinary incontinence introduce a degree of obstruction to the bladder outlet, while procedures for resolving urgency urinary incontinence aim to reduce intravesical pressure and increase functional bladder capacity. Both of these can impair the ability of the bladder to empty, possibly leading to residual volume.
Alternatives to intermittent catheterisation are suprapubic and urethral indwelling catheterisation. Having an indwelling catheter is an invasive procedure. It will be placed either through the abdominal wall (suprapubic) or urethrally and continuously empties. Catheter associated urinary tract infection (UTI) is the most common complication with all catheterisation. IC is reported to reduce the risk of infection compared to indwelling catheters, for example a 20% reduction after short post-operative use.
Urethral dilation treats urethral stricture, whereby retention is caused by an obstructing or narrowing along the urethra, by inserting increasingly wider tubes into the urethra to widen the stricture. An alternative dilation method involves inflating a small balloon at the end of a catheter inside the urethra. A health care provider performs a urethral dilation during a clinic visit or in an outpatient center or a hospital. The patient will receive local anesthesia. In some cases, the patient will receive sedation and regional anesthesia.
Intermittent urethral self‐dilatation is often recommended to reduce the risk of recurrent urethral stricture. This involves passing a lubricated catheter into the urethra to stretch the area concerned and help prevent it narrowing again.
People will need to follow a regimen which will be similar to this:
Dilate as instructed once a day for two weeks then, dilate on alternate days for two weeks, then continue to dilate once a week until otherwise instructed.
Another treatment for urethral stricture involves inserting an artificial tube, called a stent, into the urethra to the area of the stricture. Once in place, the stent expands like a spring and pushes back the surrounding tissue, widening the urethra. Stents may be temporary or permanent.
Medications used in urinary retention are for the treatment of an enlarged prostate. Drugs that are used will either abate the growth of, or shrink the prostate, or relieve urinary retention symptoms associated with benign prostatic hyperplasia (BPH) by relaxation of the bladder neck muscle.
- Prostate surgery (Males only)
To treat urinary retention caused by benign prostatic hyperplasia, the prostate might be surgically destroyed or the enlarged prostate tissue is removed by using the transurethral method. The most common surgery is a trans resection of prostate (TURP).
- Internal urethrotomy
To repair a urethral stricture a special catheter is inserted into the urethra until it reaches the stricture. The urologist then uses a knife or laser to make an incision that opens the stricture.
- Cystocele or rectocele repair
This procedure is more common in females and involves surgery to lift a prolapsed bladder or rectum back into its normal position therefore relieving any obstruction causing the bladder to empty.
- Tumor and cancer surgery
Removal of tumors and cancerous tissues in the bladder or urethra may reduce urethral obstruction and urinary retention.