Urinary retention is the inability to empty the bladder completely. This condition can arise suddenly (acute) or develop gradually (chronic). Acute urinary retention causes severe pain and can lead to potential damage to the bladder and kidneys. It requires prompt medical attention to alleviate symptoms and prevent complications.
Immediate Steps and When to Get Help
Experiencing a sudden inability to urinate is a medical emergency. Acute urinary retention presents with a complete inability to pass urine, a painful urge, and often severe lower abdominal pain or bloating. These symptoms indicate the bladder is full but cannot empty, potentially leading to complications like kidney damage.
If you experience these symptoms, especially severe pain or no urine output for several hours, seek emergency medical attention immediately. This could involve calling emergency services or going to the nearest emergency room. Older men, particularly those over 65, should seek care promptly.
Medical professionals will prioritize draining the bladder to relieve pressure and pain. Subsequent steps will then focus on identifying the underlying cause.
Common Causes
Urinary retention in men often stems from conditions that obstruct urine flow or impair bladder function. The most frequent cause is benign prostatic hyperplasia (BPH), an enlarged prostate gland common in men over 50. As the prostate grows, it can compress the urethra, leading to difficulty emptying the bladder.
Other obstructive causes include urethral strictures (narrowings due to scar tissue) and bladder stones. Prostate cancer can also cause retention by enlarging the prostate. Infections like prostatitis or urinary tract infections can lead to swelling that impedes urine flow.
Certain medications can also induce urinary retention by affecting bladder muscle function or increasing urethral resistance. These include antihistamines, decongestants, tricyclic antidepressants, some muscle relaxants, and opioids (which reduce bladder fullness sensation and increase urethral sphincter tone).
Neurological conditions that disrupt brain-bladder signals, such as spinal cord injury, multiple sclerosis, or diabetic neuropathy, can impair bladder contraction. Severe constipation can also hinder bladder emptying by exerting pressure.
Medical Evaluation and Treatment
Upon seeking medical attention for urinary retention, a thorough evaluation begins with a detailed medical history, including current medications and any recent changes in urinary habits. A physical examination involves palpating the lower abdomen to assess bladder distension and performing a digital rectal exam to check for prostate enlargement. A neurological assessment may also be conducted to evaluate nerve function related to bladder control.
Diagnostic tests are then performed to identify the cause and extent of the retention. A urinalysis can detect infection, while blood tests may assess kidney function. A post-void residual (PVR) urine measurement, often done with an ultrasound, determines the amount of urine remaining in the bladder after an attempt to void. Imaging techniques like ultrasound or CT scans can visualize the bladder, prostate, and urinary tract to identify obstructions.
The immediate treatment for acute urinary retention involves catheterization to drain the bladder. A thin, flexible tube, typically a Foley catheter, is inserted into the urethra to relieve the accumulated urine, providing immediate relief from pain and pressure. In cases where urethral catheterization is not feasible, a suprapubic catheter may be inserted through the abdomen directly into the bladder. Once the bladder is drained, initial treatment for the underlying cause may begin, such as prescribing alpha-blockers for BPH to relax prostate and bladder neck muscles, or antibiotics for infections.
Long-Term Management
After the immediate crisis is addressed and the underlying cause identified, long-term management focuses on preventing recurrence and preserving urinary health. For benign prostatic hyperplasia (BPH), medications like alpha-blockers (e.g., tamsulosin) relax prostate and bladder neck muscles, improving urine flow. 5-alpha reductase inhibitors (e.g., finasteride) can shrink the prostate.
Lifestyle adjustments also support management. Maintaining a healthy weight and avoiding constipation through a high-fiber diet and adequate fluid intake can reduce bladder pressure. Limiting caffeine and alcohol, which irritate the bladder and increase urine production, may also help. Consistent bladder habits, such as regular urination and not holding urine, help maintain bladder muscle strength.
In some cases, medical procedures or surgery may be necessary for lasting relief. Procedures like transurethral resection of the prostate (TURP) remove obstructing prostatic tissue. For urethral strictures, dilation or surgical repair might be performed. For nerve-related issues, intermittent self-catheterization may be taught. Ongoing follow-up with a urologist or primary care physician is important to monitor the condition, adjust treatments, and ensure well-being.