Best Treatment For Urinary Retention

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 arent 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.

What Is A Post

The amount of urine that remains in your bladder after you urinate is called post-void residual . A post-void residual urine test measures the amount of urine left in your bladder.

Ideally, when you go to the bathroom, your bladder should empty completely. But sometimes, urine stays in the bladder even after you think youve emptied it. The PVR test can tell your healthcare provider if youve completely emptied your bladder. A small amount of residual urine is generally ok, but large amounts can be concerning for urinary retention.

Problems With The Nerves Supplying The Bladder

Urinary retention can result from problems with the nerves that control the bladder and the valves that control the flow of urine from the bladder.

Even when the bladder is full, the bladder muscles that squeeze urine out may not receive the signal to push. The sphincters may not receive the signal to relax and allow the bladder to empty. Possible causes of nerve problems that may cause urinary retention include diabetes, a stroke, multiple sclerosis or after an injury to the pelvis.

Some children are born with conditions that may affect the nerve signals to the bladder. For example spina bifida may cause urinary retention in newborn babies.

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How Is A Cystocele Diagnosed

A Grade 2 or Grade 3 cystocele can be diagnosed from a description of symptoms and from an examination of the vagina.

The doctor may also perform certain tests, including the following:

• Urodynamics: Measures the bladders ability to hold and release urine.
• Cystoscopy : A long tube-like instrument is passed through the urethra to examine the bladder and urinary tract for malformations, blockages, tumors, or stones.

What Symptoms Would I Have With A Rectocele

Many women with a rectocele have no symptoms, and the condition is only seen in a pelvic examination. In general, if a rectocele isnt causing you symptoms or discomfort, it can be left alone.

When symptoms are present, you may have:

• Difficulty having bowel movements.
• The need to manually reduce the bulge in your vagina to have a bowel movement.

A rectocele should be treated only if your symptoms interfere with your quality of life.

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What Are Risk Factors And Causes Of An Inability To Urinate

There are a number of medical conditions and medications that may cause urinary retention. These medical conditions and medications may affect the function of the bladder itself, the function of the outlet of the bladder, and/or the urethra. Obstruction may be fixed or dynamic . There are also infectious causes and surgical causes of urinary retention.

Common Causes/Risk Factors

Medication-Related Causes

Certain medications can cause urinary retention, especially in men with prostate enlargement. Many of these medications are found in over-the-counter cold and allergy preparations. These drugs include the following:

• Drugs that act to tighten the urinary channel and block the flow of urine include ephedrine , pseudoephedrine , phenylpropanolamine , phenyleprhine , and amphetamines.
• Antihistamines such as diphenhydramine and chlorpheniramine , as well as some older antidepressants, can relax the bladder too much and cause urination problems.
• Beta-adrenergic sympathomimetics, including isoproterenol , terbutaline , and metaproterenol
• Opioid-containing medications

Urinary Retention in Children

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:

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Medical Procedures And Devices

Your health care professional may recommend a medical procedure or device to treat your urinary retention, depending on the cause of the retention. Examples of these procedures and devices include

• cystoscopyusing a cystoscope to look inside the urethra and bladder to find and remove blockages such as urinary tract stones
• laser therapytherapy that uses a strong beam of light to treat an area of enlarged prostate tissue by breaking up the blockage and reducing the obstruction
• prostatic urethral lift, or UroLiftusing tiny implants to lift and hold the prostate away from the urethra so urine can flow more freely
• transurethral electrovaporizationa procedure that uses heat to vaporize an area of enlarged prostate tissue
• transurethral water vapor therapy, or Rezumtherapy that uses water vapor, or steam, to shrink an enlarged prostate
• urethral dilationgradually increasing the size of the urethral opening by stretching the scar tissue, to help treat urethral stricture
• vaginal pessarya stiff ring that is inserted into the vagina to help stop urine leakage, such as with cases of a cystocele or rectocele

What Is The Outcome

The outcome will depend on the underlying cause of urinary retention and whether the urinary retention has caused any damage to your kidneys:

• Some causes of urinary retention resolve quickly without any long-term problems – eg, urinary retention after a general anaesthetic.
• In other cases, urinary retention will resolve once the underlying cause has been treated – eg, prostate gland enlargement.
• Occasionally the cause of urinary retention cannot be cured and a long-term small, flexible tube is needed. Sometimes this can be done by regularly inserting a catheter into the bladder and then removing the catheter once the bladder is emptied.

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Enhancing Healthcare Team Outcomes

Postoperative urinary retention is not an uncommon problem, and it should have management from an interprofessional healthcare team. Its diagnosis and treatment rely on an interprofessional approach through all perioperative stages. Surgeons should identify patients preoperatively who are at the highest risk of developing POUR, educate them on their increased potential of developing POUR, and consider prescribing a prophylactic alpha-blocker . Intraoperatively, the anesthesia team should keep in mind that POUR correlates with the volume of intravenous fluids given, and the surgeon should keep in mind that the length of operation has a link to the development of POUR.

A trial without a catheter can then follow in 1 to 3 days by the floor nurse at the order of the surgeon/hospitalist. It is essential after removal of a foley to closely monitor the patient’s ability to void to avoid a second episode of extreme bladder retention and confirm a low postvoid residual bladder scan before considering the trial without catheter a success. If a patient does fail a trial without a catheter, the patient should receive an outpatient urology consultation. These interprofessional measures can ensure the best possible patient outcomes with POUR.

Searching For The Evidence: Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions

We will utilize bibliographic database searching to identify previous systematic reviews, randomized controlled trials, and observational studies published from 1946 to the present for studies enrolling adults based on a diagnosis of CUR. Relevant bibliographic databases for this topic include MEDLINE® and the Cochrane Central Register of Controlled Trials . Our preliminary search strategy appears in Appendix A. This search strategy searches on only one concept, CUR, and employs relevant Medical Subject Headings and natural language terms to find studies on the topic. The concept search is supplemented with filters designed to select experimental designs. Bibliographic database searches will be supplemented with backward citation searches of highly relevant systematic reviews. We will update searches while the draft report is under public/peer review.

We will conduct additional grey literature searching to identify relevant completed and ongoing studies. Relevant grey literature resources include trial registries and U.S. Food and Drug Administration databases. We will search ClinicalTrials.gov and the International Controlled Trials Registry Platform . We will also review Scientific Information Packets sent by manufacturers of relevant interventions. Grey literature search results will be used to identify studies, outcomes, and analyses not reported in the published literature to assess publication and reporting bias.

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What Specialists Treat Urinary Retention

Urologists are most often involved in the care of patients with urinary retention. However, urogynecologists also treat women with urinary retention. Internists, family physicians, and emergency-room physicians also frequently treat urinary retention and will refer you to a urologist or urogynecologist if it is not improving.

What Causes Chronic Urinary Retention

Urinary retention can happen for several different reasons. These causes can include:

• A blockage to the way urine leaves your body.
• Medications youre taking for other conditions.
• Nerve issues that interrupt the way your brain and urinary system communicate.
• Infections and swelling that prevent urine from leaving your body.
• Complications and side effects of medications given to you for a surgical procedure.

Blockage

When something blocks the free flow of urine through the bladder and urethra, you might experience urinary retention. The urethra is the tube that carries urine from the bladder to the outside of your body. In 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 sags. This is called cystocele. It can also be caused when the rectum sags into the back wall of the vagina a condition called rectocele. Some causes can happen to both men and women. The urethra can get narrow due to scar tissue. This is called a stricture. Urinary stones can also block the flow of urine out of your body.

Medications

Nerve issues

• Trauma to the spine or pelvis.
• Pressure on the spinal cord from tumors and a herniated disk.
• Vaginal childbirth.

Urinary retention from nerve disease occurs at the same rate in men and women.

Infections and swelling

Surgery

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How Do I Know If I Have Obstructive Or Non

The only way to find out if a patient has obstructive or non-obstructive urinary retention is for the patient to undergo testing, typically done by urologists to determine the cause of urinary retention. Tests such as pelvic/bladder ultrasound, uroflow, urodynamics study, and cystoscopy can help to determine whether you have an obstructive or non-obstructive type of urinary retention.

What Types Of Surgical Repairs Are Available For A Rectocele

If non-surgical methods do not help control rectocele symptoms, surgery may be needed. Talking with a reconstructive surgeon who specializes in pelvic floor conditions can help women decide upon the best approach. In most cases, surgery is done under general anesthesia and takes about one hour.

• The most common surgical repair is a transvaginal rectocele repair, also called a posterior repair. The rectocele is reached through the vagina. It offers the chance to correct not only the rectocele but a thinned perineum and widened vaginal opening. It also has the advantage of not disturbing any tissue in the rectal area. This is the traditional approach to rectocele repair by urologists and gynecologists.
• A rectocele can also be repaired by a colorectal surgeon through a transanal repair. The rectocele is reached through the anus. This method is preferred by many colorectal surgeons because it allows for correction of problems in the anal or rectal area, in addition to repairing the rectocele.

Other types of repairs or approaches may be used when additional procedures are required, such as for uterine or bladder prolapse or rectal prolapse through the anus.

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How Is It Treated

Acute urinary retention is treated by catheterisation. This is usually done in accident and emergency departments and followed by hospital admission. In some places, catheterisation is done by general practitioners or community nurses and is followed by an outpatient referral to a urologist. The catheter is usually placed urethrally, although some favour the suprapubic approach, particularly if the catheter is going to be in place for some time.

Once a man is catheterised a decision is made whether to undertake a trial without catheter. Again the proportion of men having a trial without catheter depends largely on local practice. Some urologists regard acute urinary retention and previous lower urinary tract symptoms as an absolute indication for prostatectomy. Others tend to allow most men a trial of voiding.

Predicting who will successfully void is not easy. Half of men who initially void successfully will experience recurrent acute urinary retention within a week, and 68% will experience a second episode within a year. Recurrence is 90% for men with an initial peak urinary flow rate less than 5ml/s. Factors that make failure more likely include age greater than 75 years and drained volume of urine greater than 1 litre. Though a measurement is not readily available, the inability of the bladder to mount a strong detrusor contraction strongly predicts failure.

Urinary Retention In Adults: Evaluation And Initial Management

DAVID C. SERLIN, MD JOEL J. HEIDELBAUGH, MD and JOHN T. STOFFEL, MD, University of Michigan Medical School, Ann Arbor, Michigan

Am Fam Physician. 2018 Oct 15 98:496-503.

• References

Urinary retention is the inability to voluntarily pass an adequate amount of urine and can be attributable to acute and chronic etiologies. Acute urinary retention is a urologic emergency characterized by the sudden inability to urinate combined with suprapubic pain, bloating, urgency, distress, or, occasionally, mild incontinence.1 Chronic urinary retention is usually associated with non-neurogenic causes, is often asymptomatic, and lacks consensus on defining criteria. The overall incidence of urinary retention is much higher in men than women and increases dramatically as men age. Estimates for men range from 4.5 to 6.8 per 1,000 person-years, increasing up to 300 per 1,000 person-years for men in their 80s, whereas the incidence in women is only seven per 100,000 per year.24

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Initial evaluation of the patient with suspected urinary retention should involve a detailed history, including current use of prescription and over-the-counter medications and herbal supplements.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Initial evaluation of the patient with suspected urinary retention should involve a detailed history, including current use of prescription and over-the-counter medications and herbal supplements.

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Examples Of Case Reports Describing Unusual Presentations Of Acute Urinary Retention

Cases which suggest a mechanical obstruction to bladder emptying

Severe urethral inflammation after exposure to a nonoxynol-9 based vaginal contraceptive pessary during unprotected intercourse

Chronic lymphocytic leukaemia infiltrating the prostate

Staphylococcal prostatic abscess

Diabetic cystopathy

Transverse myelitis attributed to Lyme disease

2 days after herpes zoster lesions in the sacral dermatomes resulting in reversible bladder dysfunction

After intense anal intercourse

Overdistension is probably the cause of one of the most common forms of acute urinary retention: that following surgery under general anaesthesia., In these circumstances the bladder, unless catheterised, fills to a high volume. In the postoperative period opiates or opioids, which are often given as part of a general anaesthetic, decrease the sensation of bladder fullness. Loss of sensation might be further complicated by anticholinergic drugs and the high adrenergic tone after surgery . When bladder and sphincter pressures are measured in men with acute urinary retention the findings are variable. Men who on urodynamic testing were unable to contract their bladder required catheters for longer than men whose bladder motor function was preserved. Retention was invariably associated with abnormally high urethral pressures and bladder volumes. Both returned to normal during catheterisation.

Your Urology Specialist Can Help

Having difficulty urinating is an uncomfortable and inconvenient experience. While urinary retention remedies are good practice in preventing future health concerns, not being able to urinate is a medical emergency that requires immediate attention.

Managing mild urinary retention symptoms is possible, but it is always best to see a urology specialist for a professional opinion to learn about traditional treatment options. Schedule an appointment with us, or visit your local emergency room, if you start showing symptoms of urinary retention.

This content was originally published in March 2019 and was refreshed in January 2021.

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Current Management For Cur

Once the threshold for intervention for CUR has been met , multiple options are available for treatment. After treatment, the clinical indication metric that triggered the intervention should be followed to ensure that it improves or at least does not progress. Medications, self-catheterization, indwelling catheters, and surgical interventions are all possible options for treatment of CUR with varying degrees of efficacy.

Medication

Medications used to treat outlet obstruction caused by the prostate in men, particularly alpha-blockers and 5-alpha-reductase inhibitors,37 are generally indicated for older men with CUR and benign prostates. These are well described in the AUA BPH guidelines, but it is important to note that patients with acute urinary retention are more likely to pass a trial of void if started on alpha-blockers.38 Primary bladder neck obstruction associated with CUR can be treated in both genders with alpha-blockers however, the use of alpha-blockers in women with more global CUR without defined BOO appears to have marginal or no benefit.39

Catheterization