Bladder health

Urinary retention

What it is, what causes it, what complications it can lead to, and how it is treated.

What is the pelvic floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. Three openings run through it: the urethra, the vagina, and the rectum. Its functions include:

• Supporting the pelvic organs, specifically the uterus, the bladder, and the rectum
• Helping provide sphincter control for the bladder and bowel
• Withstanding increases in abdominal pressure such as coughing, sneezing, laughing, straining, and lifting
• Enhancing the sexual response

What is urinary retention?

Urinary retention is the inability to urinate completely, or at all.

Urine is composed of water, electrolytes, and other waste material filtered out of the blood by your kidneys. It travels through the ureters to your bladder, where it is stored. Once the bladder is full, the muscles in its wall contract, forcing urine through the urethra and out of your body. Sphincter muscles and pelvic floor muscles keep the urethra closed to avoid leakage, and they relax at the same time the bladder contracts so urine can exit.

Symptoms depend on whether the condition is acute or chronic.

Acute urinary retention

• A strong urge to urinate but being unable to when you try
• Discomfort or pain in the lower abdomen
• A bloated belly

Chronic urinary retention

You may not always have symptoms. If you do, they include:

• Mild constant discomfort in the lower abdomen
• Difficulty starting the urinary stream
• A weak urinary stream
• Increased frequency of needing to urinate
• Your bladder still feels full after urinating
• Overflow incontinence, when a small amount of urine leaks because your bladder is full

What causes urinary retention?

Medications

Many medicines work by lowering nerve signals, which can also result in urinary retention. Common examples are antihistamines (used for allergies), anticholinergics and antispasmodics (used for stomach cramps, muscle spasms, and urinary incontinence), and tricyclic antidepressants (used for anxiety and depression).

Surgery

Urinary retention is common after surgery because anesthesia, used to block pain signals, can interfere with bladder function. Some surgical procedures in the pelvic area may also cause swelling of the urinary tract that interferes with normal urination.

Nerve damage

Damage to the nerves between your bladder and brain, or to the nerves that supply the muscles of the bladder wall, urinary sphincter, or pelvic floor, can result in retention. Some children are born with nerves that do not function properly. Other causes include spinal cord injury, vaginal delivery, multiple sclerosis, heavy metal poisoning, pelvic injury, infections of the brain or spinal cord, stroke, and diabetes.

Obstruction

A blockage anywhere along the urinary tract. Common causes include bladder stones, constipation leading to hard stools pushing into the urethra, and urethral stricture, which is scarring that causes the urethra to close off.

Infection

A urinary tract infection may cause retention if the urethra becomes inflamed and swells shut. Herpes infections in the pelvic area can interfere with nerve signals. Infection at the spinal cord may press on the spinal cord and block nerve signals.

Weak bladder

If the bladder muscle is weak, it may have difficulty squeezing urine out.

Cystocele

A cystocele, or prolapsed bladder, may result in retention. When the bladder falls into the vagina, the abnormal position makes it difficult for all of the urine to leave.

What are the complications?

Urinary tract infection

Your urine is normally sterile, but if it stays in the bladder too long, bacteria may grow and cause an infection.

Bladder damage

If your bladder is stretched out too much, its muscular walls can be damaged, causing it to lose its ability to contract.

Kidney damage

If urine backs up to your kidneys, permanent damage can result.

How is it treated?

Treatment consists of draining a full bladder to prevent permanent damage.

Catheterization

A catheter is a small flexible tube inserted into the urethra and up to the bladder, where it drains urine into a bag. It can be placed for short periods or remain in for continuous drainage. If urinary retention is a chronic problem, you may be taught to catheterize yourself.

If the catheter cannot reach your bladder through the urethra because of an obstruction, other methods may be used:

• Urethral sounds and dilators are small instruments inserted into the urethra to widen it by stretching or by removing extra tissue. Once the urethra is wide enough, a catheter is inserted to drain the bladder.
• Suprapubic catheterization. A catheter is placed through the skin and abdominal wall into the bladder. This drains the bladder until a procedure can be done to open the urethra.

For chronic problems, the cause must also be addressed:

Surgery

If a cystocele or prolapsed bladder is the cause, surgery to correct the position of the bladder will help.

Procedures to correct urethral stricture

Sounds, dilators, and catheters with small balloons on the tip can be used to open strictures by widening the urethra. Wire stents can be placed to keep it open. Another method is a urethrotomy, in which a surgeon uses a catheter to find the stricture and then uses a laser or small knife through the catheter to open it.

Addressing constipation

If the cause is an obstruction by impacted stool, dietary changes with more fiber-rich foods and plenty of fluids may help.