The sudden inability to urinate is a medical event known as acute urinary retention, and it demands immediate attention. This condition is characterized by the bladder filling with urine but being unable to empty, causing painful and rapid distention of the lower abdomen. Acute urinary retention requires prompt medical intervention to prevent significant complications. Delaying treatment can lead to serious health consequences, including damage to the bladder muscle and potential harm to the kidneys.
Recognizing Acute Urinary Retention and Seeking Immediate Help
Acute urinary retention presents with severe physical symptoms that signal a need for urgent care. The primary sign is the sudden and complete inability to pass any urine, despite a strong, painful urge to do so. This intense discomfort is localized in the lower abdomen, where the distended bladder can often be felt just above the pubic bone.
The pressure build-up within the bladder is the source of the severe pain, and without relief, this pressure can back up, potentially affecting kidney function. If you experience these symptoms, or if a man in your care is suddenly unable to urinate, treat the situation as an emergency. Call emergency services or go directly to the nearest hospital emergency department.
Do not attempt to wait for an appointment with a primary care doctor or urologist, as the time-sensitive nature of the obstruction is paramount. A delay in draining the bladder risks stretching the bladder wall, which can lead to permanent muscle weakness and acute kidney injury. Seeking emergency care is the only way to safely and quickly alleviate the pressure and prevent long-term damage.
Common Causes of Urinary Retention in Men
The physical blockage of the urethra, the tube through which urine exits the body, is the most frequent reason for acute urinary retention in men. The most common underlying cause, accounting for more than half of cases, is Benign Prostatic Hyperplasia (BPH), or non-cancerous prostate enlargement. Since the prostate gland surrounds the urethra, its growth compresses the urinary channel, obstructing flow.
Beyond BPH, scar tissue narrowing the urethra, known as a urethral stricture, can also create a physical barrier. Bladder stones, which are hard masses of crystallized minerals, can roll into the bladder neck and suddenly obstruct the outflow tract. These mechanical issues prevent the free passage of urine, leading to the rapid buildup of volume and pressure.
Urinary retention can also arise from problems with the nerves that control bladder function, a condition termed neurogenic bladder. Conditions like a spinal cord injury, stroke, or diabetes can damage the nerves that signal the bladder muscle (detrusor) to contract or the sphincter to relax. In these instances, the bladder may not receive the proper signal to empty, or the sphincter may fail to open.
Certain medications also contribute to acute retention by interfering with bladder muscle contraction or sphincter relaxation. Over-the-counter decongestants, which contain alpha-adrenergic agonists, can tighten the bladder neck muscles and increase obstruction. Prescription drugs, such as anticholinergics or some antidepressants, can weaken the detrusor muscle, making it unable to generate enough force to push urine out.
Emergency Medical Relief Procedures
The immediate goal of emergency treatment is to relieve the pressure and pain by draining the urine from the bladder, typically achieved through catheterization. This procedure provides rapid decompression and relief. A thin, flexible tube called a Foley catheter is inserted through the urethra and guided into the bladder.
Once inside the bladder, a small balloon at the tip is inflated with sterile water to keep the tube securely in place, allowing the retained urine to flow out. This immediate drainage resolves the severe pain and prevents the back-up of pressure toward the kidneys.
If a standard urethral catheter cannot be passed due to a severe stricture, prostate enlargement, or other obstruction, an alternative procedure is performed. This involves placing a suprapubic catheter directly into the bladder through a small incision in the lower abdominal wall. This method bypasses the urethra entirely, ensuring that bladder decompression is achieved quickly and safely.
Post-Crisis Care and Addressing Underlying Conditions
Once the immediate crisis of acute urinary retention is managed by catheterization, the focus shifts to determining the root cause of the obstruction. Follow-up evaluation often involves urine and blood tests to check for infection, kidney function, and prostate-specific antigen (PSA) levels. Imaging studies, such as a bladder ultrasound, can measure the amount of urine left in the bladder and assess the size of the prostate.
Specialized tests like urodynamics may be performed later to evaluate the bladder muscle and sphincter function. For men whose retention was due to BPH, long-term management often involves starting medications like alpha-blockers to relax the bladder neck and prostate muscles. If medications are ineffective, surgical options, such as a Transurethral Resection of the Prostate (TURP), may be required to permanently open the outflow tract and prevent future episodes.