How Is Chronic Urinary Retention Diagnosed
History and physical exam: During the diagnosis process, your healthcare provider will ask about your signs and symptoms and how long you have had them. He or she will also ask about your medical history and your drug use. A physical exam of the lower abdomen may show the cause or give your provider additional clues. After this, certain tests may be needed. Men may have a rectal exam to check the size of their prostate.
Your urine may be saved and checked to look for infection.
Ultrasound of the bladder: The amount of urine that stays in your bladder after urinating may be measured by doing an ultrasound test of the bladder. This test is called a postvoid residual or bladder scan.
Cystoscopy: Cystoscopy is a test in which a thin tube with a tiny camera on one end is put into your urethra. This lets the doctor look at pictures of the lining of your urethra and bladder. This test may show a stricture of the urethra, blockage caused by a stone, an enlarged prostate or a tumor. It can also be used to remove stones, if found. A computed tomography scan may also help find stones or anything else blocking the flow of urine.
Urodynamic testing: Tests that use a catheter to record pressure within the bladder may be done to tell how well the bladder empties. The rate at which urine flows can also be measured by such tests. This is called urodynamic testing.
Bladder Retraining For Urinary Incontinence
Bladder retraining incorporates going to the bathroom at set times.
The first goal of bladder retraining for your urinary incontinence symptoms is to empty your bladder before you leak. The second goal is to begin to train your bladder to hold more urine for longer periods of time. Bladder training is usually safe, but you should see a health care provider to make sure that you dont have a bladder infection before starting bladder retraining.
There are a few different ways to retrain the bladder. One of the easiest ways is to begin by urinating every hour, on the hour. Go to the bathroom and try to empty your bladder at regular times all day while you are awake. Each week, gradually increase the time between voiding by 15 minutes. Continue to do this until you reach a length of time that is reasonable for your lifestyle and healthy for your body. Do not try to hold your bladder for more than four hours at a time.
Who Should Try Bladder Retraining?
Bladder retraining is a non-invasive treatment that can be used for many types of urinary incontinence. It works best for people with bladders that want to go all the time . It also works very well for people who have to go to the bathroom more than 6 times a day and who leak when they sneeze or cough .
Medical Reviewer: Diana Hankey-Underwood, MS, WHNP-BC
Deterrence And Patient Education
Preoperatively, patients at the most considerable risk for the development of postoperative urinary retention require education about their increased potential for developing POUR. This factor is essential to set expectations and avoid undue stress if a patient were to develop a complication which they do not envision connected to their planned surgery.
If POUR does develop, patients should be reassured that with catheterization and time, most people return to baseline voiding function and will not require longterm catheterization, medication, or urologic surgery.
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How Is Urinary Retention Treated
Treatment for urinary retention can depend on whether you have the acute form or the chronic form, as well as the cause of the condition. For the acute form, a catheter is put into the urethra to drain the bladder.
Treatment of the chronic form or the acute form that becomes chronicwill depend on the cause.
Medications for enlarged prostate: For men with an enlarged prostate, certain drugs may be used to try and open it up or shrink it. These include alpha-blockers and 5-alpha reductase inhibitors . Also, procedures or surgery to open up the prostate may be tried.
Procedures for enlarged prostate: Many procedures are available when this problem is due to an enlarged prostate. Office-based treatments can be done with just local anesthetic only. These include water vapor therapy and prostatic urethral lift .
There are also several surgeries done under general anesthesia which are available. These include shaving down the inside of the prostate and opening up the prostate with a laser . A laser can also be used to carve out the entire enlarged portion of the prostate through the urethra , or this part of the prostate can be removed through the belly . All of these procedures can be effective in opening up the blockage.
Treatment for nerve issues: If the retention is due to a nerve-related issue, you may need to use a catheter on yourself at home.
Last reviewed by a Cleveland Clinic medical professional on 01/10/2021.
References
The Bladder Retraining Technique
Before you begin bladder control training, your doctor will probably ask you to keep a diary. In your bathroom diary, you’ll write down every time you have the urge to go, as well as when you leak. Using your diary as a guide, you’ll use the following techniques to help you gain more control over urination.
Schedule bathroom visits. Determine how often you’re going to the bathroom based on your diary entries. Then add about 15 minutes to that time. For example, if you’re going to the bathroom every hour, schedule bathroom visits at every one hour, 15 minutes. Use the bathroom at each scheduled visit, regardless of whether you actually feel the urge to go. Gradually increase the amount of time between bathroom breaks.
Delay urination. When you feel the urge to urinate, hold it for another five minutes or so. Then gradually increase the amount of time by 10 minutes, until you can last for at least three to four hours without having to go to the bathroom. If you’re feeling a strong need to go, try distracting yourself by counting backwards from 100 to one or practicing relaxation techniques such as deep breathing. When you just can’t hold it any longer, use the bathroom, but go again at your next scheduled void time to stay on your bladder retraining schedule.
To improve your success with bladder retraining, you can also try these tips:
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Is Bladder Training Right For Me
The decision to try bladder training depends on what’s causing the problem. Bladder control training is typically used to treat urinary incontinence, the involuntary loss of urine. Incontinence is most common in women, especially after childbirth and menopause. Different types of urinary incontinence exist, including:
- Stress incontinence: Sudden pressure on your abdomen causes you to accidentally lose urine.
- Urge incontinence: You feel a sudden, strong urge to go to the bathroom because your bladder contracts even when it’s not full. You may not always be able to reach the toilet in time.
- Mixed incontinence: A combination of stress and urge incontinence.
- Overflow incontinence: A problem emptying the bladder completely that leads to urine leakage.
Bladder retraining may also be used to treat bed-wetting in children.
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 to help stop urine leakage, such as with cases of a cystocele or rectocele
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How Bladder Training Can Help
After going through bladder training, you should be able to:
- Go longer periods of time between bathroom visits
- Hold more liquid in your bladder
- Have more control over the urge to go
Although you probably want to see results right away, be patient. Bladder retraining can take six to 12 weeks to be successful.
If you’ve been trying bladder training for several weeks and it still isn’t working, check back in with your doctor. You might need to try other approaches, like medication or surgery.
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What Are The Symptoms Of Urinary Retention
The signs can vary. Some people with the chronic form have a hard time starting the flow of urine. Some have a weak flow once they start. Others may feel the need to go but cant start. Others have to go a lot, while others still feel the need to go right after going. You may leak urine when you arent going because the bladder is full.
With the acute form, youre all of a sudden not able to go at all, or only able to go very small amounts. This occurs even though you have a full bladder. See a healthcare provider right away if this happens to you.
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When Should I See A Health Care Professional
See a health care professional right away if you are unable to urinate or have severe pain in your abdomen. Acute urinary retention can be life threatening.
If you have any of the other symptoms of urinary retention, such as trouble urinating, frequent urination, or leaking urine, talk with your health care professional about your symptoms and possible treatments. Chronic urinary retention can cause serious health problems.
Blockage Or Narrowing In The Urethra Or Bladder Neck
For you to be able to urinate normally, all parts of your urinary tract need to work together in the correct order. Urine normally flows from your kidneys, through the ureters to your bladder, and out the urethra. If a blockage or narrowing occurs somewhere along the urinary tract, you may have difficulty urinating, and if the blockage is severe, you may not be able to urinate at all.
Medical problems that may narrow the urethra and block urine flow include
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How Is It Diagnosed
To diagnose urinary retention, a doctor will first ask about the history of your symptoms and perform a physical exam. The physical will include an examination of your genitals and rectum to look for any symptoms affecting those areas that may also affect the urinary tract.
Some other tests that may be used to confirm a diagnosis
likely be inserted to help quickly drain the urine. Local anesthesia will be used to make sure you dont feel pain or discomfort from the catheter.
If a catheter doesnt work or cant be used because of an injury or other condition, a doctor may insert a suprapubic catheter into the skin above your bladder to drain the urine.
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.
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