Patient education: Urinary retention (The Basics)

What is urinary retention? — Urinary retention is when you have trouble emptying your bladder. This can mean that:

●You can pass some urine, but can't empty your bladder fully.

●You can't urinate at all.

Urinary retention is caused by a problem with your urinary tract or the nerves that control it. The urinary tract is the group of organs in the body that make and store urine (figure 1). It includes the:

●Kidneys – These are 2 bean-shaped organs that filter blood to make urine.

●Ureters – These are 2 tubes that carry urine from the kidneys to the bladder.

●Bladder – This is a balloon-shaped organ that stores urine.

●Urethra – This is the tube that carries urine from the bladder to the outside of the body.

Urinary retention can be "acute" or "chronic." Acute urinary retention happens suddenly, and needs to be treated right away.

What are the symptoms of urinary retention? — The symptoms of acute and chronic urinary retention are slightly different.

●Acute urinary retention – This is when you are suddenly not able to urinate. Symptoms can include:

•Not being able urinate, even if you feel a strong urge

•Pain or discomfort – This caused by the full bladder putting pressure on the organs around it. The pain or discomfort can be severe.

Acute urinary retention is an emergency. If you think that you have acute urinary retention, get help right away.

●Chronic urinary retention – This is when you have more and more trouble urinating over time. Symptoms can include:

•Being able to pass some urine, but feeling like the bladder is not empty after

•Not having a strong urge to urinate

•Having a urine steam that is slow or irregular

•Trouble getting started urinating, such as needing to strain or push on your belly to get the urine to come out

What causes urinary retention? — Many different things can cause urinary retention. Some possible causes include:

●Something blocking the flow of urine – For example, this might be caused by:

•Kidney stones

•Benign prostatic hyperplasia – This is when the prostate gland is enlarged and pushes on the urethra.

•Pelvic floor prolapse – This can affect people with a vagina. It happens when the muscles are not strong enough to support the organs in the pelvis. These include the bladder, uterus, and rectum. This causes the organs to bulge into spaces they are not meant to be in.

•The urethra being too narrow

•Having too much muscle tone around the urethra

●Problems with the bladder muscle – These include poor muscle tone and damage to the nerves that control the muscle.

●Problems with other muscles in the pelvic floor

●Certain types of anesthesia or surgery

●Certain medicines – For example, urinary retention can be caused by medicines used to treat seizures, high blood pressure, or allergies.

●Infection

●Injury to the pelvis, urethra, or penis

●Constipation

●Giving birth

Will I need tests? — Yes. To check for acute urinary retention, tests might include:

●Ultrasound to check the bladder – An ultrasound is a type of imaging test. Imaging tests create pictures of the inside of the body. The ultrasound can show if your bladder is full.

●Inserting a catheter – A catheter is a thin, flexible tube. It can be inserted into the bladder through the urethra. Inserting a catheter allows the bladder to empty. The doctor or nurse will measure the amount of urine that was in your bladder to see if your bladder was full.

To check for chronic urinary retention, tests might include:

●Postvoid residual ("PVR") urine test – For this test, the doctor or nurse will first ask you to urinate. Then, they measure how much urine is left in your bladder. This can be done using an ultrasound or by inserting a catheter. You might need to have this test done a few times.

You might also need other tests to find out what is causing your urinary retention.

How is urinary retention treated? — Treatment includes both emptying the bladder and treating the underlying problem.

To empty the bladder, a catheter is placed. There are a few different types of catheters that can be used:

●"Indwelling" catheter – This is a thin tube that is inserted into the urethra and then left in place. Urine drains out of the bladder, through the catheter, and into a collection bag.

●"Intermittent" catheter – This type of catheter is inserted on a schedule when the bladder needs to be emptied. Then, it is removed and thrown away. When the bladder needs to be emptied again, a new catheter is used. Your doctor or nurse can teach you how to use this type of catheter yourself, if needed. This type of catheter is less likely to cause a urinary tract infection than an indwelling catheter.

●"Suprapubic" catheter – This type of catheter is placed surgically. It is usually only used if the other types can't be used. It comes out of the body above the genitals, but below the belly button.

Some people need to use a catheter for a short time, but others need it for longer.

Other treatments depend on what is causing your urinary retention. They might include:

●Pelvic floor muscle training – This involves learning exercises to strengthen and relax your pelvic muscles. These include the muscles that control the flow of urine and bowel movements.

●Stopping or changing a medicine that you take

●Taking new medicines

●A vaginal pessary – This is a device to treat pelvic organ prolapse. It fits inside the vagina to support the bladder and push it back into place. Pessaries come in different shapes and sizes. Your doctor or nurse will talk to you about your options and make sure that your pessary fits your body.

●Bladder training – This is when you urinate at scheduled times during the day. Try not to urinate until these times.

●Surgery – This is usually only needed if other treatments did not work.

More on this topic

Patient education: Kidney stones in adults (The Basics)
Patient education: Benign prostatic hyperplasia (enlarged prostate) (The Basics)
Patient education: Pelvic organ prolapse (The Basics)
Patient education: Constipation in adults (The Basics)
Patient education: Urinary incontinence in females (The Basics)
Patient education: Treatments for urgency incontinence in females (The Basics)
Patient education: Urinary incontinence in males (The Basics)
Patient education: Pelvic floor muscle exercises (The Basics)
Patient education: Suprapubic catheter placement (The Basics)
Patient education: Bladder training (The Basics)

Patient education: Kidney stones in adults (Beyond the Basics)
Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics)
Patient education: Constipation in adults (Beyond the Basics)
Patient education: Urinary incontinence in women (Beyond the Basics)
Patient education: Urinary incontinence treatments for women (Beyond the Basics)
Patient education: Pelvic floor muscle exercises (Beyond the Basics)