When To See A Doctor
Anyone experiencing symptoms of acute urinary retention should go to the emergency room.Chronic urinary retention is not a medical emergency, but it does usually indicate a potentially serious underlying problem.
A person should schedule an appointment with a doctor for urinary retention that lasts longer than a few days or that goes away and then returns.
People who experience temporary urinary retention due to medication or anesthesia may not need medical treatment if the symptoms disappear and do not return.
Although anyone can develop urinary retention, it is more common as a person ages. Males are also more likely than females to have urinary retention due to prostate issues and partial blockages of the urethra.
Some other risk factors include:
4 sourcescollapsed
- Carnevale, F. C., et al. . Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia.
What Are The Types Of Urinary Retention
Urinary retention can be classified as:
Acute urinary retention, which is an emergency situation where the patient presents with a sudden inability to pass urine and pain. Conditions that can trigger acute urinary retention include surgery, a urinary tract infection, excessive fluid intake or the use of certain medications. It is more common in men and often due to untreated enlargement of the prostate.
Chronic urinary retention, which is a painless condition present over a longer duration. The patient may experience dribbling of the urine once the bladder is full. Sometimes, the patient may not notice the chronic retention, and therefore, it is necessary for the doctor to suspect the condition before it can cause complications including kidney failure.
Sometimes, the patient may pass urine partially and some urine may remain in the bladder this remaining urine in the bladder due to incomplete evacuation is called post-void residual urine.
Urinary retention may also be classified as:
- Complete or partial, depending on the degree of retention
- Obstructive or non-obstructive, depending on whether an anatomical obstruction exists that stops the passage of urine
- High or low pressure, depending on the pressure generated in the bladder
Urinary retention may occur due to the following:
The causes of urinary retention include the following:
- Obstruction: The obstruction to the urinary flow may be present within the urinary tract or outside the urinary tract
Extrinsic causes include:
Grading The Strength Of Evidence For Individual Comparisons And Outcomes
The overall strength of evidence for select clinical outcomes within each comparison will be evaluated based on four required domains: study limitations directness consistency and precision .13 A fifth domain, reporting bias, will be assessed when the strength of evidence is moderate or high based on the first four domains.13 Risk of bias will be rated as low, medium, or high according to study design and conduct. Consistency will be rated as consistent, inconsistent, or unknown/not applicable . Directness will be rated as either direct or indirect. Precision will be rated as precise or imprecise. Other factors that may be considered in assessing strength of evidence include dose-response relationship, the presence of confounders, and strength of association. Based on these factors, the overall evidence for each outcome will be rated as:13
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Enhancing Healthcare Team Outcomes
The health outcomes can be enhanced by a thorough history using the questions suggested by the American Urological Association. One needs to obtain a medication review and perform a thorough physical examination to rule out a neurological disorder. Patients should receive counseling about catheter care and the importance of antisepsis. The nursing team needs to know of contraindications of catheter placement and be able to recognize them. Timely, urologic consultation for suprapubic catheterization is the recommendation in patients who have acute retention and inability to pass a urethral catheter. The clinician needs to be knowledgeable of how to do suprapubic needle drainage or temporary catheter drainage if the patient is in extreme discomfort or distress when a urologist is not immediately available.
The patient and patients support should receive training regarding clean intermittent catheterization, as well as education on medications used to treat benign prostatic hyperplasia.
Coordination between primary care clinicians, nephrologists, urologists, and emergency room clinicians is needed. Urology nurses educate patients, monitor their condition and provide update information to the interprofessional team. Pharmacists assess medications, monitor compliance, and inform patients about the side effects of medications.
What Happens After A Post
After an ultrasound, you can wipe any remaining gel off your skin, get dressed and go home.
After bladder catheterization, your provider gently removes the catheter from your urethra. You can go home after the procedure. You may feel slight discomfort as the anesthesia wears off. Drinking lots of water, and urinating several times, can help. Your provider may prescribe an antibiotic to prevent urinary tract infection.
If you have signs of urinary retention meaning high residual urine volume your provider will discuss ways to address this. Options could include a catheter , medications and/or surgery.
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Evaluation And Treatment Of Acute And Chronic Urinary Retention
Urinary retention is a condition that makes it difficult, if not impossible, to fully empty your bladder. Even after using the restroom, youll still feel like you need to urinate but youre unable to void more urine. Its a condition that often occurs due to other health or urologic problems and is more common as you get older. While men are 10 times more likely to experience urinary retention, it can and does still occur in women.2 In this article, well discuss the evaluation and treatment of acute and chronic urinary retention.
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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.
A rectocele should be treated only if your symptoms interfere with your quality of life.
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What Are The Complications Of Urinary Retention And Its Treatments
Some complications of urinary retention and its treatments may include:
- Urinary Tract Infections Because urine is normally sterile and the normal flow of urine usually prevents bacteria from infecting the urinary tract, developing urinary retention means an abnormal urine flow gives bacteria at the opening of the urethra a chance to infect the urinary tract.
- Bladder damage If your bladder is stretched too far or for extended periods, the muscles may become permanently damaged and lose their ability to properly contract.
- Kidney damage Sometime urinary retention can cause urine to flow back into the kidneys. This is called reflux and can damage or scar the kidneys.
- Urinary incontinence Transurethral surgery to treat an enlarged prostate can result in urinary incontinence in some men. Its often temporary with most men gaining bladder control in a few weeks or months after surgery. The removal of tumours or cancerous tissue in the bladder, prostate, or urethra may also result in urinary incontinence.
Treatment Of Urinary Retention
Many treatments are available for urinary retention, including medication, devices, procedures and surgery. Treatment will depend on the cause and the disease specifics.
For acute urinary retention, medical providers will use a catheter to drain the bladder. Then the doctor will seek the cause of the urinary retention and determine a course of treatment.
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Common Causes Of Urinary Retention
Examples of some of the most common causes of non-obstructive urinary retention are:
A pelvic fracture is a break that affects the structure of the pelvis, which can include the hip bones, sacrum, or coccyx, and be extremely painful. If complications occur, it may lead to internal bleeding or an injury to the bladder.
Certain medications, such as antihistamines, and antispasmodic drugs which aid digestion, can cause urinary retention. They decrease bladder muscle contraction, preventing the bladder from being completely emptied.
Antidepressant meds have anticholinergic properties at therapeutic doses that contribute to urinary problems.
The side effects of anesthetics after surgery can impair muscle or nerve function of the bladder. The pain-relieving drugs often have a disruptive impact on the neural messaging to the part of the brain, which controls the nerves and the muscles in the urinary process.
Accidents that injure the brain or the spinal cord can also impact negatively on the neurological process of the urinary system.
Fortunately, no matter what type of urinary retention you may have, there is treatment available.
Helpful Tips For Managing Urinary Retention And Incontinence
Urinary incontinence is a prevalent issue, with anywhere from 25-50 percent of women reporting an episode in the past year.
Managing urinary conditions can be frustrating and time consuming, but there are helpful tips and lifestyle changes that can reduce the burden this condition causes.
Topics in this Post
Urine retention can be uncomfortable and symptoms might include:
- Pain and bloating in the lower abdominal area.
- A frequent, urgent need to urinate but then having trouble doing it.
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When To Seek Urgent Medical Care
On its own, a weak urine stream may not be cause for concern, but if its accompanied by other symptoms, it could be an indication of a more serious medical issue. Urinary hesitancy could be an issue if you also experience:
- Chills and/or fever
- Lower back pain
If your urine stream stops entirely, a condition called urinary retention, youll need emergency medical attention, since this can become a serious problem without immediate treatment.
What Can Be Expected After Treatment For A Cystocele
In mild cases, non-surgical treatments may be all that is needed to successfully deal with a cystocele.
When surgery is performed for more serious cases, some women will eventually need another surgery because the first surgery failed, the cystocele returned or another pelvic floor problem developed. Women who are older, who smoke, have diabetes, or who have had a hysterectomy, may be at higher risk for complications.
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Complications Of Urinary Retention
Frequent urinary tract infections resulting from bacteria if the urine stays in the bladder.
Long term obstruction of the urinary tract may lead to painful bladder stones.
Serious bladder damage, such as losing the ability to contract if it becomes stretched for a lengthy period of time.
If urine backs up into the kidneys, it can lead to congestion, reducing kidney function. It can also leave you with a high risk of falling prey to chronic kidney disease.
Urinary retention may also promote the formation of small pouches in the bladder wall, similar to those in the bowel which can trap bladder stones, causing pain and discomfort. Bacteria present in the pouches can multiply and are liable to cause infections.
How Is Urinary Retention Treated
- A Foley catheter is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out.
- Medicines can help decrease the size of your prostate, fight infection, and help you urinate more easily.
- Surgery may be needed to treat the condition that is causing your urinary retention.
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What Is The Food Can Help To Cure Urine Retention
If you are suffering from chronic urine retention then changing your diet can help to get rid of this problem.
- Drink more coconut water to ease the difficulty in passing urine.
- Increase the intake of water.
- It will help to flush out harmful toxins and prevent infection.
- Avoid acidic and spicy food.
- Do drink sugary soft drinks.
- Avoid drinking too much coffee.
- Stop smoking and drinking alcohol.
- Add cucumber, watermelon, muskmelon to your diet to prevent urine retention.
- Raisins also help to treat urine retention at home.
What Causes Urinary Retention
- Blockages, such as a stone, growth, or narrowing of your urethra
- A weak bladder muscle
- Nerve damage from diabetes, stroke, or spinal cord injury
- Bladder diverticula, which are pockets of urine that form in your bladder and do not empty
- Certain medicines, such as narcotics, antihistamines, or antidepressants
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Initial Management Of Urinary Retention
Acute urinary retention should be managed by immediate and complete decompression of the bladder through catheterization. Standard transurethral catheters are readily available and can usually be easily inserted. If urethral catheterization is unsuccessful or contraindicated, the patient should be referred immediately to a physician trained in advanced catheterization techniques, such as placement of a firm, angulated Coude catheter or a suprapubic catheter.5 Hematuria, hypotension, and postobstructive diuresis are potential complications of rapid decompression however, there is no evidence that gradual bladder decompression will decrease these complications. Rapid and complete emptying of the bladder is therefore recommended.34
For hospitalized patients requiring catheterization for 14 days or less, a Cochrane review found that silver alloy-impregnated urethral catheters have been associated with decreased rates of UTI versus standard catheters.41 Another Cochrane review concluded that patients requiring catheterization for up to 14 days had less discomfort, bacteriuria, and need for recatheterization when suprapubic catheters were used compared with urethral catheters.42 In a recent meta-analysis of abdominal surgery patients, suprapubic catheters were found to decrease bacteriuria and discomfort and were preferred by patients.43 Although evidence suggests short-term benefit from silver alloy-impregnated and suprapubic catheters, their use remains somewhat controversial.
Medication For Urinary Problems
Your doctor may suggest various medications to help ease your urinary problems, including:
- medications to reduce the tone of the muscles of the urethra and prostate to minimise any constriction to urine flow caused when these muscles contract
- medication to reduce the size of the prostate gland. These medications work by blocking the action of male hormones produced by the prostate gland
- medications to relax the bladder, making unwanted contractions less likely and reducing the symptoms of urgency and frequency of urination
- the over-the-counter preparation saw palmetto is sometimes used. This may help some men, especially if frequent urination at night is a problem.
However, recent reviews of the evidence for using saw palmetto as a treatment for mild or moderate urinary symptoms did not show any improvement, compared to no treatment, in men with BPH.
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Data Abstraction And Data Management
We will review bibliographic database search results for studies relevant to our PICOTS framework and study-specific criteria. The use of previous systematic reviews to replace the de novo process will be explored when relevant or partially relevant systematic reviews are identified and judged to be of fair or good quality by using modified AMSTAR criteria.9 Search dates may be altered in the presence of high-quality systematic reviews for specific populations and/or interventions.
Review of bibliographic database searches will occur in two stages. First, titles and abstracts will be reviewed by two independent investigators to identify studies meeting the criteria in the PICOTS framework and study-specific criteria. At this stage we plan to include all interventions identified in the literature. At completion of this stage, we will consult with our Technical Expert Panel to ensure that we capture only studies examining relevant interventions . All studies identified as relevant by either investigator will undergo full-text screening. Two independent investigators will screen the full text to determine if our inclusion criteria are met. Differences in screening decisions will be resolved by consultation between investigators and a third investigator if necessary. We will document the inclusion and exclusion status of citations undergoing full-text screening.
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.
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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