Urinary retention is the inability to empty the bladder. With chronic urinary retention, you may be able to urinate, but you 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. With acute urinary retention, you can’t urinate at all, even though you have a full bladder. Acute urinary retention is a medical emergency requiring prompt action. Chronic urinary retention may not seem life-threatening, but it can lead to serious problems and should also receive attention from a health professional.
Male and female urinary tracts
Anyone can experience urinary retention, but it is most common in men in their fifties and sixties because of prostate enlargement. A woman may experience urinary retention if her bladder sags or moves out of the normal position, a condition called cystocele. The bladder can also sag or be pulled out of position by a sagging of the lower part of the colon, a condition called rectocele. Some people have urinary retention from rectoceles. People of all ages and both sexes can have nerve disease or nerve damage that interferes with bladder function.
What is the urinary tract?
The urinary tract consists of the organs, tubes, and muscles that work together to make, move, store, and release urine. The upper urinary tract includes the kidneys, which filter wastes and extra fluid from the blood, and the ureters, which carry urine from the kidneys to the bladder. The lower urinary tract includes the bladder, a balloon-shaped muscle that stores urine, and the urethra, a tube that carries urine from the bladder to the outside of the body during urination. If the urinary system is healthy, the bladder can hold up to 16 ounces (2 cups) of urine comfortably for 2 to 5 hours.
Muscles called sphincters squeeze shut the tubes from the bladder to help keep urine from leaking. The sphincter muscles close tightly like a rubber band around the opening of the bladder, which leads into the urethra.
Nerves in the bladder tell you when it is time to urinate. As the bladder first fills with urine, you may notice a feeling that you need to go. The sensation to urinate becomes stronger as the bladder continues to fill. As it reaches its limit, nerves from the bladder send a message to the brain that the bladder is full and the urge to empty your bladder intensifies.
When you urinate, the brain signals the bladder muscle to tighten, squeezing urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax. As these muscles relax, urine exits the bladder through the urethra. When all the signals occur in the correct order, normal urination occurs.
What causes urinary retention?
Urinary retention can be caused by an obstruction in the urinary tract or by nerve problems that interfere with signals between the brain and the bladder. If the nerves aren’t working properly, the brain may not get the message that the bladder is full. Even if you know that your bladder is full, the bladder muscle that squeezes urine out may not get the signal that it is time to push, or the sphincter muscles may not get the signal that it is time to relax. A weak bladder muscle can also cause retention.
Nerve Disease or Spinal Cord Injury
Many events or conditions can damage nerves and nerve pathways. Some of the most common causes are vaginal childbirth, infections of the brain or spinal cord, diabetes, stroke, accidents that injure the brain or spinal cord, multiple sclerosis, heavy metal poisoning, and pelvic injury or trauma. In addition, some children are born with nerve problems that can keep the bladder from releasing urine.
Infection
Infections cause swelling and irritation, or inflammation. A urinary tract infection (UTI) may cause retention if the urethra becomes inflamed and swells shut.
Surgery
During surgery, anesthesia is often administered to block pain signals, and fluid is given intravenously to compensate for possible blood loss. The combination may result in a full bladder with impaired nerve function. Consequently, many patients have urinary retention after surgery.
Medication
Many medicines work by calming overactive nerve signals. Drugs that may cause urinary retention include antihistamines such as fexofenadine, diphenhydramine, chlorpheniramine, and cetirizine; anticholinergics and antispasmodics such as hyoscyamine, oxybutynin, tolterodine, and propantheline; and tricyclic antidepressants including imipramine, amitriptyline, nortriptyline, and doxepin.
Bladder Stone
A stone formed anywhere in the urinary tract may become lodged in the bladder. If the stone is large enough, it can block the opening to the urethra like a bathtub plug.
Cystocele and Rectocele
A cystocele occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. The abnormal position of the bladder may cause urine to remain trapped. In a rectocele, the rectum droops into the back wall of the vagina. These conditions can pull the bladder out of position and cause urinary problems such as urinary retention.
Constipation
A hard stool in the rectum may push against the bladder and urethra, causing the urethra to be pinched shut, especially if a rectocele is present.
Urethral Stricture
A stricture is a narrowing or closure of a tube. Men may have a narrowing of the urethra, usually caused by scarring after trauma to the penis. Infection is a less common cause.
What are the symptoms of urinary retention?
Acute urinary retention causes great discomfort and pain. You feel an urgent need to urinate but cannot do so. The lower abdomen may become bloated. Chronic urinary retention causes mild but constant discomfort, difficulty starting urination, weak urine flow, frequent urination, and the feeling that the bladder is never fully empty. Dribbling may occur due to overflow incontinence.
How is urinary retention diagnosed?
Diagnosis involves several tests.
A physical examination may reveal a distended bladder. A urine sample is examined for signs of infection.
A bladder scan uses a portable ultrasound device to determine how much urine is in the bladder. After urinating, a doctor or nurse measures the post-void residual (PVR). If the PVR is consistently 100 milliliters or more, chronic urinary retention is diagnosed. Accurate measurement with a modern bladder scanner helps clinicians assess bladder emptying quickly, safely, and without discomfort.
Cystoscopy allows the doctor to look inside the bladder and urethra to detect stones, narrowing, or blockage. X-rays or CT scans may identify obstruction or abnormal bladder position. Urodynamic tests measure bladder pressure and muscle coordination, especially when nerve damage is suspected.
How is urinary retention treated?
With acute urinary retention, treatment begins with catheterization to drain the bladder and relieve discomfort. Long-term treatment depends on the cause. Temporary retention, such as after surgery, may resolve once anesthesia effects wear off. Chronic cases may require continued catheter use or clean intermittent self-catheterization with sterile technique.
Women with cystocele or rectocele may require surgery to repair weakened pelvic tissue and restore proper bladder support.
What are the complications of urinary retention?
Urinary retention can lead to urinary tract infections because stagnant urine allows bacteria to grow easily. Over time, continuous stretching of the bladder may cause permanent bladder muscle damage, reducing its ability to contract normally. In severe or untreated cases, urine may back up into the kidneys, leading to hydronephrosis and eventually chronic kidney disease, which can seriously affect overall health.
What are the complications of treatments for urinary retention?
Catheter use increases the risk of urinary tract infection, especially if sterile technique is not strictly followed. Prolonged or improper catheterization can also cause urethral irritation or injury. Maintaining proper hygiene, using sterile equipment, and following medical guidance carefully are essential to reduce these risks and ensure safe treatment.
Conclusion
Urinary retention is a serious condition that can affect anyone, though it is more common in older men and women with pelvic floor issues. Understanding the causes, symptoms, and risks is essential for timely diagnosis and treatment. Modern diagnostic tools, such as a bladder scanner, make it easier to detect urinary retention accurately and non-invasively. Early intervention, proper medical management, and lifestyle adjustments can prevent complications like infections, bladder damage, and kidney problems, improving overall urinary health and quality of life.
