What Is The Treatment For Urinary Retention

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

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

How Long Does It Take To Recover

Since urinary retention is treated using various different methods, each method has separate post-treatment guidelines. In case of bladder drainage and urethral dilation, post-operative treatment generally includes the patient being instructed on how to self-catheterize to drain urine as necessary. For treatment via prostate surgery, the patient has to stay in hospital for a couple of weeks. For the first week the patient urinates via the catheter, following which he can urinate on his own. Physical activities requiring wide range of motion are prohibited for up to a few months after the surgery.

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Symptoms Of Urine Retention

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.

It’s important to be checked if you have symptoms because urine that stays in your bladder for longer than it’s supposed to could grow bacteria .

If your cancer care team thinks you might have urinary retention, they will order tests. Some of these tests include bladder ultrasound, cystoscopy, CT scans, urodynamic tests , or electromyography .

Symptoms Of Urinary Retention

Sometimes, people cannot urinate at all. In such cases, the bladder stretches very painfully over a few hours as it fills with urine and people have swelling in the lower abdomen.

• Measurement of urine remaining in the bladder after urination

If a person is unable to pass any urine, the diagnosis is clear.

In other cases, doctors try to see how much urine remains in the bladder after the person has urinated as much as they can. Immediately after the person urinates, doctors either insert a catheter into the bladder to see how much urine comes out or do ultrasonography of the bladder to measure the amount of urine present. The amount of urine left after urinating is called postvoid residual volume. If this volume is more than about half a cup , urinary retention is diagnosed.

Doctors do a physical examination, usually including a rectal examination. In men, the rectal examination can indicate whether the prostate is enlarged. In men and women, the rectal examination helps identify a fecal impaction. Doctors may take a sample of urine to test for infection. Blood tests and imaging tests may be needed to determine the cause of urinary retention.

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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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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.

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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.

Diagnosis For Urinary Incontinence

Only a licensed healthcare professional can diagnose urinary incontinence. The best treatment for urinary incontinence depends on the underlying cause and the type of urinary incontinence you have. To determine a diagnosis, your doctor may have you undergo a physical exam and complete other tests.

Your doctor will check your urine for an infection or other potential abnormalities, like hematuria, proteinuria, and glycosuria.

Bladder diary

You will record how much you drink and urinate each day and whether you experienced bladder leakage or a strong desire to urinate.

Post-void residual measurement

Your doctor will ask you to urinate into a container. The doctor checks the amount of urine left in your bladder using ultrasound . The doctor can help determine if you have an obstruction in your bladder or a problem with your bladder or nerves.

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How Is The Treatment Done

Urinary retention is the inability to empty the bladder completely. Urinary retention can be acute or chronic. Acute urinary retention happens suddenly and lasts only a short time. People with acute urinary retention cannot urinate at all, even though they have a full bladder. Acute urinary retention, a potentially life-threatening medical condition, requires immediate emergency treatment. Acute urinary retention can cause great discomfort or pain. Chronic urinary retention can be a long-lasting medical condition. People with chronic urinary retention can urinate. However, they do not completely empty all of the urine from their bladders.

How Is A Cystocele Treated

If it is not bothersome, a mild cystocele may not require any treatment other than avoiding heavy lifting or straining that could cause the problem to get worse.

Other potential treatment options include the following:

• Weight loss.
• Estrogen replacement therapy.
• Kegel exercises to strengthen the openings of the urethra, vagina and rectum. These exercises involve tightening the muscles that are used to stop the flow of urine, holding for 10 seconds, and then releasing.
• If symptoms are modest, a device called a pessary may be placed in the vagina to hold the bladder in place. Pessaries are available in a number of shapes and sizes to ensure a proper fit. A pessary has to be removed and cleaned on a regular basis in order to avoid infection or ulcers.

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What The Patient Can Do

Here are some things that may help make urine retention less of a problem:

• Empty your bladder at least every 4 hours, even if you don’t feel the urge to do so.
• Empty your bowels regularly.
• If tolerated, drink 6 to 8 glasses of fluid daily, preferably water.
• Talk to your doctor about all medicines, vitamins, herbs, and supplements youre taking.
• Avoid drinks with caffeine or alcohol and citrus juices, which can irritate the bladder.
• Avoid hygiene products and chlorinated pools and hot tubs that may irritate the bladder
• Avoid smoking.

What Are The Signs And Symptoms Of Urinary Retention

• Frequent urination, or the urge to urinate right after you finish
• An urge to urinate, but your urine does not come out or dribbles out slowly and weakly
• Frequent urine leaks that happen during the day or while you sleep
• Pain or pressure when you urinate
• Pain or stiffness in your abdomen, lower back, hips, or upper thighs
• Blood in your urine

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Pelvic Floor Muscle Training

Your pelvic floor muscles surround the bladder and urethra and control the flow of urine as you pee.

Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.

A GP may refer you to a specialist to start a programme of pelvic floor muscle training.

The specialist will assess whether you’re able to squeeze your pelvic floor muscles and by how much.

If you can contract your pelvic floor muscles, you’ll be given an exercise programme based on your assessment.

Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.

Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.

Find out more about pelvic floor exercises.

The Main Causes Of Urinary Retention In Women

Your bladder and your urethra make up your lower urinary tract. Your bladder stores urine and your urethra is a tube that connects your bladder to the outside of your body. The prostate is an additional part of this system for men.

When its time to urinate, the muscles that are in your bladder squeeze in order to push urine out of your body. Simultaneously, your nervous system is communicating to your sphincters that they should open. When all is going well, the urine will then travel through your urethra and leave your body.

You have two different sphincters, an internal sphincter and an external sphincter. While you do have control over the external sphincter, you cant control the internal sphincter.

If there are issues with any of these structures it can lead to urinary retention. Additionally, if there are problems with the nerves that make them work it can also lead to this disorder.

Click here for a more thorough look at the urinary system and how it works.

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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.

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.

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What Is The Treatment For Urinary Hesitancy

The treatment for urinary hesitancy will depend on your specific condition and whether you have any other diseases. Some treatment options include:

Urinary hesitancy can be uncomfortable and may lead to other problems. If you experience any symptoms of urinary hesitancy, talk with your doctor to decide the next steps.

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What Is A Rectocele

A rectocele is a bulging of the front wall of the rectum into the back of the vagina. The bulge occurs as a result of thinning and weakening of the band of tissue that separates the vagina from the rectum. This thinning has a number of causes, including:

• Advanced age.
• Multiple vaginal childbirths or trauma during childbirth .
• Repeated surgeries in the area of the pelvic floor or rectum.
• Chronic straining during bowel movements due to long-term constipation.

Normal anatomy of rectum

Rectum with rectocele

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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.

How Can Urinary Retention Be Prevented

People can prevent urinary retention before it occurs by treating some of the potential causes. For example, men with benign prostatic hyperplasia should take prostate medications as prescribed by their health care provider. Men with benign prostatic hyperplasia should avoid medications associated with urinary retention, such as over-the-counter cold and allergy medications that contain decongestants. Women with mild cystocele or rectocele may prevent urinary retention by doing exercises to strengthen the pelvic muscles. In most cases, dietary and lifestyle changes will help prevent urinary retention caused by constipation. People whose constipation continues should see a health care provider.

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