Urinary Retention


Urinary Retention

Description, Causes and Risk Factors:

ICD-9-CM: 788.20.

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.

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.

Acute urinary retention causes great discomfort, and even pain. You feel an urgent need to urinate but you simply can't. The lower belly is bloated.

Chronic urinary retention, by comparison, causes mild but constant discomfort. You have difficulty starting a stream of urine. Once started, the flow is weak. You may need to go frequently, and once you finish, you still feel the need to urinate. You may dribble between trips to the toilet because your bladder is constantly full, a condition called overflow incontinence.

There are two general causes of urinary retention: obstruction and non-obstruction. If there is an obstruction (for example, kidney stones), urine cannot flow freely through the urinary track. Non-obstructive causes include a weak bladder muscle and 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.

Symptoms:

Symptoms of urinary retention may include:

    Difficulty starting to urinate.

  • Weak dribble or stream of urine.

  • Loss of small amounts of urine during the day.

  • Inability to feel when bladder is full.

  • Increased abdominal pressure.

  • Lack of urge to urinate.

  • Strained efforts to push urine out of the bladder.

  • Frequent urination.

  • Nocturia (waking up more than two times at night to urinate).

Diagnosis:

Diagnosis is obvious in patients who cannot void. In those who can void, diagnosis is by postvoid catheterization showing a residual urine volume > 100 mL. Other tests (eg, urinalysis, blood tests, ultrasonography, urodynamic testing, cystoscopy, cystography) are done based on clinical findings.

Treatment Options:

Relief of acute urinary retention requires urethral catheterization. Subsequent treatment depends on cause. In men with benign prostatic hypertrophy, drugs (usually ?-adrenergic blockers or 5?-reductase inhibitors) or surgery may help decrease bladder outlet resistance. No treatment is effective for impaired bladder contractility or a neurogenic bladder; intermittent self-catheterization or indwelling catheterization is usually required. Urinary diversion is a last resort.

Some people can reduce their symptoms of urinary retention with lifestyle changes, fluid and diet modification, bladder retraining, Kegel exercises or other kinds of physical therapy.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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