Urinary retention, also known as ischuria, is the inability to completely empty the bladder. It is a common medical condition that can happen to anyone at any age, but is more common in older adults. Urinary retention causes the bladder to become distended, which can lead to multiple medical complications if left untreated. However, in some mild cases, urinary retention may resolve on its own without requiring medical intervention.
What causes urinary retention?
There are several potential causes of urinary retention including:
- Neurological disorders such as stroke, multiple sclerosis, Parkinson’s disease, or spinal cord injuries
- Nerve damage from diabetes, vitamin B12 deficiency, alcoholism, or autoimmune disorders
- Side effect of medications like anticholinergics, antihistamines, antidepressants, or opiates
- Enlarged prostate in men (benign prostatic hyperplasia)
- Urethral strictures or bladder stones blocking urine flow
- Pelvic organ prolapse in women
- Pregnancy and childbirth
- Constipation or impacted stool
- Injuries, surgery, or radiation near the urinary tract
- Psychological causes like anxiety or fear of using public bathrooms
In many cases, urinary retention is caused by an obstruction or nerve problem that interferes with signals between the bladder and brain. This prevents the bladder from fully contracting to push out urine.
Signs and symptoms
Common signs and symptoms of urinary retention include:
- Inability to urinate at all
- Difficulty starting a urine stream
- Weak urine stream
- Dribbling urine
- Feeling like the bladder does not fully empty
- Needing to urinate again shortly after using the bathroom
- Frequent urination, especially at night
- Sudden urge to urinate
- Leakage or dribbling between bathroom visits
- Lower abdominal pain
- Bloated feeling in the lower abdomen
In acute urinary retention, the onset of symptoms is sudden and severe. The patient is unable to urinate at all. In chronic urinary retention, symptoms come on more gradually over weeks or months as the bladder capacity expands to hold larger volumes.
When to see a doctor
It’s important to see a doctor right away if you experience any inability to urinate or empty the bladder. Seek emergency care for acute urinary retention when the bladder becomes extremely full and painful. Some signs that require urgent medical care include:
- No urine output for over 4 hours
- Difficulty breathing
- Severe lower abdominal pain
- Vomiting and nausea
- Fever and chills
- Weak, rapid pulse
- Confusion
Left untreated, urinary retention can increase the risk of potentially serious complications like:
- Urinary tract infections
- Bladder or kidney damage
- Bladder stones
- Blood infections (sepsis)
Schedule an appointment with your doctor even for mild symptoms of incomplete bladder emptying. Timely evaluation is important to determine the underlying cause and prevent the problem from worsening.
Diagnosing urinary retention
To evaluate urinary retention, the doctor will begin with a physical exam, including an abdominal palpation to feel for a distended bladder. Diagnostic tests may include:
- Post-void residual urine test – Measures how much urine stays in the bladder after you try to empty it by urinating into a container. Residual volumes greater than 50-100 mL generally indicate urinary retention.
- Urinalysis – Checks a urine sample for signs of infection.
- Blood tests – May help reveal related conditions like diabetes or neurological disorders.
- Prostate exam – Enlarged prostate may obstruct urine flow in men.
- Imaging tests – Ultrasound, CT, or MRI scans reveal anatomy and identify blockages.
- Urodynamic tests – Measure bladder pressure and function during urination.
- Cystoscopy – Uses a tiny camera inside the urethra and bladder to visualize blockages.
Identifying the underlying cause of urinary retention is key to determining the best treatment options.
Can urinary retention resolve on its own?
In some mild, temporary cases, urinary retention may resolve on its own without treatment. Potential scenarios where it could improve spontaneously include:
- Side effect of a medication – Symptoms may disappear after stopping or changing the medication.
- UTI – Retention caused by a urinary tract infection can resolve with antibiotic treatment.
- Constipation – Hard stool compressing the bladder may improve with laxatives, enemas, or dietary changes.
- Anxiety – Retention related to a fear of using bathrooms away from home could get better with relaxation techniques, counselling, or exposure therapy.
- Post-surgery swelling – Inflammation blocking urine flow after a procedure may subside during recovery.
However, urinary retention should never be ignored. Without treatment, it is likely to worsen over time. Even mild cases not fully resolved have a high likelihood of recurring. Seeking medical advice is important.
Treatments for urinary retention
Most cases of acute or chronic urinary retention require active treatment to prevent complications. Some options may include:
- Catheterization – A catheter inserted through the urethra into the bladder drains urine out. This provides immediate relief but is not a long-term solution.
- Medications – Alpha blockers, anticholinergics, or other drugs may help relax the urinary sphincter and improve bladder emptying in some cases.
- Prostate surgery – Removing enlarged prostate tissue can improve urine flow in men with benign prostatic hyperplasia.
- Bladder stones removal – Cystolitholapaxy surgery eliminates bladder stones so they no longer obstruct urination.
- Urethral stents – A special tube inserted into the urethra can widen strictures.
- Neuromodulation – Electrical stimulation of nerves that control urination may enable bladder emptying for certain neurological causes.
- Intermittent self-catheterization – People catheterize themselves several times per day to empty the bladder when natural urination is not possible.
The best treatment approach depends on the underlying reason for urinary retention, so identifying the cause is imperative.
Home remedies and lifestyle changes
While medical treatment is usually necessary for urinary retention, some complementary remedies and lifestyle changes may also provide relief in mild cases:
- Avoid any medications that can worsen urinary retention, like antihistamines or decongestants.
- Increase fluid intake to dilute urine and make it easier to pass.
- Reduce caffeine and alcohol which can irritate the bladder.
- Do pelvic floor exercises like Kegels to strengthen bladder muscles.
- Use the bathroom as soon as you feel the urge and take your time completely emptying the bladder.
- Try urinating in a warm sitz bath to relax pelvic muscles.
- Avoid constipation by eating high fiber foods, drinking fluids, and exercising.
- Manage anxiety and stress through relaxation techniques.
- Ask your doctor about prescription medications that may improve urination.
However, home treatments should not take the place of medical care for a confirmed case of urinary retention.
Preventing urinary retention
It is not always possible to prevent urinary retention, but the following lifestyle measures can reduce your risk:
- Control conditions like diabetes and neurological disorders with medications.
- Get regular physical activity to avoid constipation.
- Manage enlarged prostate with medications or surgery if needed.
- Do pelvic floor exercises to strengthen bladder muscles.
- Avoid unnecessary medications that impact urination.
- Stay hydrated and avoid holding urine for long periods.
- Get annual physical exams to assess prostate health in men.
- Treat UTIs quickly to prevent spread to bladder.
- Improve toilet posture by elevating feet and leaning forward to fully empty.
Seek prompt medical care if you experience any symptoms of urinary retention. Identifying and treating the underlying cause early can help prevent complications.
When to see a urologist
It is advised to see a urologist if you experience recurring or persistent urinary retention. A urologist specializes in treating conditions of the urinary tract and can thoroughly evaluate your symptoms.
Make an appointment with a urologist if you have:
- Repeated episodes of inability to fully empty the bladder
- Chronic urinary retention with progressive symptoms
- Underlying neurological, prostate, or urinary tract abnormalities
- Post-void residual urine volumes greater than 100-200 mL
- Recurrent urinary tract infections related to retention
- Failure of medications or home treatments to improve urination
- Need for intermittent catheterization to empty the bladder
A urologist has specialized training to diagnose the wide range of potential causes of urinary retention. They can perform or order specific tests such as cystoscopy, urodynamic studies, bladder ultrasounds, and prostate exams as needed.
Based on the test results, the urologist can recommend appropriate therapies. These may include medications, minimally invasive procedures, prostate surgery, or specialty care with pelvic floor physical therapists if needed.
If urinary retention symptoms are significantly impacting your quality of life, do not hesitate to see a urology specialist.
Key points
- Mild urinary retention may resolve with time, but severe or chronic cases usually require medical treatment.
- See a doctor promptly for inability to urinate or empty the bladder.
- Underlying conditions like UTI, constipation, enlarged prostate, or nerve dysfunction need to be addressed.
- Home remedies can provide symptom relief but are not an adequate substitute for medical care.
- A urologist should evaluate persistent or recurrent urinary retention to check for underlying problems.
- Early treatment can improve outcomes and prevent complications like kidney damage.
- Urinary retention tends to worsen over time without proper management.
Conclusion
Urinary retention can sometimes resolve temporarily on its own, but the condition typically requires medical treatment. Getting an accurate diagnosis and appropriate care is essential to relieve symptoms and prevent potential complications. Mild, short-term retention may resolve with rest, medications, or home treatments in some cases. But recurring or persistent inability to fully empty the bladder warrants evaluation and management by a urologist or healthcare provider. Left untreated, retention can lead to infections, bladder damage, kidney problems, and other risks.