Acute urinary retention is the sudden inability to urinate along with lower abdominal pain. About one-third of men will experience acute urinary by the age of 80.
Non-neurological chronic urinary retention is defined as having over 300 cc left in your bladder after voiding and represents a different problem than acute urinary retention. If left untreated, urinary retention can risk serious infections as well as permanent loss of kidney function.
Causes and Risk Factors
Both acute and chronic urinary retention are caused by either a weak bladder, a blocked bladder outlet (due to urethral narrowing or prostate growth in men; or, pelvic organ prolapse in women), or both. Factors that predispose to urinary retention include neurologic disease, diabetes, certain medications (such as anticholinergics, antihistamines, narcotics), constipation, urinary tract infection, large fluid intake, bladder overdistension, and anesthesia.
When to Speak with a Urologist about Urinary Retention
You should speak to a Urologist if you are requiring catheters to empty your bladder, you feel (or have been told) that you empty your bladder poorly, or imaging shows signs that urine is backing up to both kidneys.
What to Expect when Seeking Treatment
In addition to a history and physical examination, initial assessment includes checking ultrasound evaluation of bladder fullness, obtaining a urine sample for urinalysis and urine culture, blood work to assess kidney function, and abdominal imaging to check for urine backing up to the kidneys. Further testing to plan possible treatments can include ultrasound to obtain prostate size, pressure flow studies to understand how well the bladder is squeezing, and cystoscopy with a flexible camera inserted into the urethra to examine the anatomic configuration of the prostate.
Treatment Options
The first goal is to make sure you are safe. This often involves placing a catheter in the bladder to drain the urine and prevent kidney damage or serious infection.
The treatment plan will be based on the likely cause of your retention. All patients should avoid constipation as well as anticholinergic and narcotic medications that limit bladder contractility. Further techniques to aid bladder emptying include timed voiding (voiding every 4 hours by the clock regardless of urge) and double voiding (returning to the toilet 5 minutes after initial attempt to void).
For men, management is much like the treatment of lower urinary tract symptoms / enlarged prostate with various medications or procedures to open the prostate. For women with pelvic organ prolapse, sometimes surgical intervention can restore appropriate anatomy and function.
A void trial with catheter removal in the office should be conducted in about 3-5 days to check for return of ability to urinate after a period of bladder rest. If you are still not able to urinate, instruction will be provided on self clean intermittent catheterization. For patients unable to perform intermittent catheterization, indwelling catheters may be left in place and exchanged once monthly though have increased risk of urinary tract infection relative to intermittent catheterization. Further testing will be completed to determine if a procedure may be beneficial to aid in bladder emptying and likelihood of eliminating the need for regular catheterization.