Urinary retention

Definition and facts

In this section:

What is urinary retention?

Urinary retention is a condition in which a person cannot empty all of the urine from the bladder. Urinary retention is not a disease, but a disorder that can be related to other health problems , such as prostate problems  in men or cystocele  in women. Urinary retention can be acute, meaning a sudden inability to urinate, or chronic, a gradual inability to completely empty the bladder of urine.

Acute urinary retention

Acute urinary retention occurs suddenly and lasts for a short time. People with acute urinary retention cannot urinate even though they have a full bladder.

Acute urinary retention can cause severe pain and be life-threatening. If a person is suddenly unable to urinate, it is important to immediately seek emergency medical treatment.

Chronic urinary retention

Chronic urinary retention develops over time. People with chronic urinary retention are able to urinate, but cannot completely empty their bladder. Many people with chronic urinary retention do not know they have the condition because they may not have any symptoms.View full-sized image Two bladders showing normal versus restricted urine flow as a result of an enlarged prostate and a constricted urethra.(Left) During normal urine flow, the bladder fills with urine and then empties through the urethra. (Right) When the prostate enlarges, it can press against the urethra and restrict the flow of urine from the bladder.

How common is urinary retention?

Acute urinary retention is common in older men, and the likelihood of experiencing acute urinary retention increases with age. Over a five-year period, about 1 in 10 men over the age of 70 and about one in three men over the age of 80 will develop acute urinary retention. 1

Acute urinary retention is much less common in women. Each year, about 3 in 100,000 women develop acute urinary retention. 1 Acute urinary retention in children is rare.

Researchers are not sure how common chronic urinary retention is. However, they know that chronic urinary retention affects older men more than any other group.

Who is most likely to develop urinary retention?

Urinary retention affects both men and women, but occurs more often in men, especially as they age. Men who have benign prostatic hyperplasia (BPH)  , a condition in which the prostate gland becomes enlarged, are more likely to develop urinary retention. As the prostate enlarges, it presses against the urethra, blocking the flow of urine from the bladder. BPH is a common prostate problem among men over 50 years of age.

What are the complications of urinary retention?

People who have urinary retention can have complications, such as:

  • Infection of the urinary tract . When the urinary tract  is completely emptied, bacteria that normally enter the urinary tract are eliminated by urinating. With urinary retention, the urine does not come out all the way, allowing normally harmless bacteria to multiply and infect the urinary tract. If the infection spreads to the kidneys , serious problems can occur.
  • Bladder injury If urinary retention is left untreated, the bladder may overstretch or for long periods of time. When you stretch too much or for long periods of time, your bladder muscles can be injured and stop working properly.
  • Kidney injury The urinary tract is designed for urine to flow from the kidneys and through the ureters, then into the bladder and out through the urethra. When a person has urinary retention, they cannot empty urine from the bladder and urine can flow back to the kidneys. The kidneys can become so full of urine that they swell and put pressure on nearby organs. This pressure can damage the kidneys and, in some cases, cause chronic kidney disease  and kidney failure .
  • Urinary incontinence When the bladder doesn’t empty completely, it can cause urine leakage, known as overflow incontinence .

It is important for both bladder health and general health to work with a healthcare professional to prevent and treat these complications.

Symptoms and causes

What are the symptoms of urinary retention?

Acute urinary retention

Symptoms of acute urinary retention could include:

  • inability to urinate
  • pain, often severe, in the lower abdomen
  • urgent need to urinate
  • swelling in the lower abdomen

Chronic urinary retention

Chronic urinary retention develops over time and may cause few or no symptoms, making it difficult to detect. If chronic urinary retention causes symptoms, they could include:

  • inability to completely empty the bladder when urinating
  • frequent urination in small amounts
  • difficulty starting the flow of urine, known as hesitancy
  • slow urine flow
  • urgent need to urinate, but with little success
  • feeling the urge to urinate after you finish urinating
  • urine leakage without warning or urgency
  • pain or discomfort in the lower abdomen

A man in pain clutching his abdomen.Symptoms of acute urinary retention are usually severe and may include abdominal pain and inability to urinate, while chronic urinary retention may cause few or no symptoms.When should the patient consult with a healthcare professional?

The patient should see a healthcare professional immediately if they are unable to urinate or have severe pain in their abdomen. Acute urinary retention can be life threatening.

If you have any of the other symptoms of urinary retention, such as difficulty urinating, frequent urination, or urine leakage, you should consult with your healthcare professional about your symptoms and possible treatments. Chronic urinary retention can cause serious health problems.A healthcare professional sits with a patient, filling out a medical form.It is important to consult a healthcare professional if the patient has symptoms of urinary retention.What Causes Urinary Retention?

The causes of urinary retention are related both to a blockage that partially or totally prevents the flow of urine from the bladder or urethra, and to the fact that the bladder cannot maintain a force strong enough to expel all the urine.

Blockage or narrowing of the urethra or bladder neck

In order for you to urinate normally, all parts of the urinary tract  must work together in the correct order. Urine normally flows from the kidneys to the bladder through the ureters and out through the urethra. If a blockage or narrowing occurs somewhere along the urinary tract, the person may have difficulty urinating and, if the blockage is severe, may not be able to urinate at all.

Medical problems that could narrow the urethra and block the flow of urine include:

Ineffective bladder contraction (underactive bladder)

The patient can develop urinary retention when the bladder muscles cannot contract with enough force or do not contract enough to empty the bladder completely, which is also known as an underactive bladder. Causes of underactive bladder include:

Neurological problems Urinary retention can occur when there is a problem in the nervous system that prevents messages from traveling from the brain to the bladder and urethra. Neurological problems have many causes, including:

Medicines. Urinary retention can be caused by certain medications that interfere with nerve signals going to the bladder, urethra, or prostate. Examples of these drugs include:

  • alpha adrenergic agonists
  • anticholinergics and antispasmodics
  • antidepressants
  • antihistamines and decongestants
  • antipsychotics
  • benzodiazepines
  • calcium channel blockers
  • serotonin and norepinephrine reuptake inhibitors
  • nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen
  • Parkinson’s medications
  • opioids

Surgery. It is common to develop temporary urinary retention immediately after surgery. During surgery, the patient is often given fluid through a vein (IV), which can cause a full bladder. You are also given anesthesia , which can keep you from feeling the need to urinate despite a full bladder. Additionally, pelvic surgery can cause inflammation, scar tissue, and trauma that can partially or completely block the flow of urine out of the bladder or urethra.

Weak bladder muscles. Weak bladder muscles may not contract with enough power or force to empty the bladder completely. Causes of weakness can include:

  • pregnancy and childbirth
  • age-related loss of bladder muscle power
  • overdistention or a bladder that has been stretched in such a way that the muscles are injured
  • trauma

Diagnosis

How do healthcare professionals diagnose urinary retention?

Healthcare professionals use a patient’s medical history, a physical exam, and a postvoid residual urine measurement  to diagnose urinary retention. The healthcare professional may also order laboratory and other diagnostic tests  to help find the cause of urinary retention.

Clinic history

A healthcare professional will take the patient’s medical history and may ask about:

Physical exam

The health care professional will do a physical exam, which will include a review of the lower abdomen, a rectal exam, and a neurological evaluation. If you are a woman, you will also have a pelvic exam.

Measurement of post-void residual urine

Health care professionals use a postvoid residual measurement to determine how much urine is left in the bladder after urinating. The remaining urine is known as post-void residue. The healthcare professional will use a catheter or ultrasound equipment to measure post-void residual urine.A healthcare professional talking to an older patient.Health care professionals may use information from the patient’s medical history, a physical exam, and tests to help find the cause of urinary retention.Lab tests

Your healthcare professional may order the following lab tests to look for signs of certain diseases and conditions that could be causing urinary retention.

  • Urinalysis , which is used to find medical conditions that may be causing urinary retention, such as a urinary tract infection , kidney problem, or diabetes .
  • Blood test , which is used to show problems with kidney function or a chemical imbalance in the body.

A laboratory technician compares a urinalysis strip to a table of results.The patient may be asked for a urine sample to check for certain medical conditions that could be causing urinary retention.Imaging tests

Your healthcare professional may use the following urinary tract imaging tests  to diagnose other conditions that may be causing urinary retention.

  • Ultrasound , which is a type of imaging that uses sound waves to look at structures inside the body without exposing it to radiation .
  • Voiding cystourethrogram, which uses x-rays to show how urine flows through the bladder and urethra.
  • Magnetic resonance imaging (MRI) , which uses magnets and radio waves to take pictures of the urinary tract  and spine.
  • CT scan , which uses a combination of x-rays and computer technology to create images of the urinary tract.

A patient coming out of a CT scan.A healthcare professional may use imaging tests of the urinary tract, such as an ultrasound, voiding cystourethrogram, MRI, or CT scan to determine what is causing urinary retention.

Urodynamic tests

Urodynamic tests are a group of tests that look at how well the bladder, sphincters, and urethra store and release urine. The health care professional may use the following urodynamic tests to help diagnose urinary retention.

  • Uroflowmetry , which measures the amount of urine released from the body and how quickly it passes.
  • Pressure-flow studies , which measure pressure in the bladder and the speed of flow when urinating.
  • Urodynamic video (in English), which takes pictures and videos of the bladder as it fills and empties.
  • Cystometry , which measures how much urine the bladder can hold, how much pressure builds up in the bladder as it stores urine, and how full the bladder is when the patient begins to feel the urge to urinate.
  • Electromyography , which measures how well muscles respond to nerves in and around the bladder and sphincters.

Cystoscopy

cystoscopy  is a procedure that uses a cystoscope  , a long, thin instrument, to look inside the urethra and bladder. The healthcare professional will watch the patient for swelling, redness, signs of infection, cancer, or structural problems.

Treatment

How do healthcare professionals diagnose urinary retention?

Health care professionals treat urinary retention based on the type of urinary retention, acute or severe, and the cause.

Drainage of the bladder

In the case of acute urinary retention , a healthcare professional will immediately drain urine from the bladder using a catheter. Removing urine from the bladder relieves pain and helps prevent injury to the bladder and kidneys.

If the patient has chronic urinary retention , the healthcare professional will first attempt to diagnose and treat the cause of the retention. However, the healthcare professional may need to use a catheter to drain urine from the bladder if the retention continues or worsens.

In some cases, people with urinary retention must continue to use a catheter to drain urine from the bladder until their urinary retention can be resolved. The catheter may remain in the bladder (for a short or long time, or intermittently) as it is inserted to drain it when needed and then withdrawn. If the patient has to use an intermittent catheter, a healthcare professional can teach him how to use it.A bladder filled with urine with a catheter inserted through the urethra, with arrows showing the flow of urine leaving the bladder through the catheter.If the bladder becomes too full, a healthcare professional may use a catheter to drain urine.

Medicines

The healthcare professional may suggest that the patient take medication to help treat the medical condition that is causing the urinary retention.

In some people, certain medications may cause urinary retention . If the healthcare professional believes that a drug is causing urinary retention, they may tell the patient to reduce the dose or stop using the drug.

All medications, even over-the-counter ones, have side effects. The patient should always consult with a healthcare professional before using any medication for more than a couple of days.

Medical Devices and Procedures

A healthcare professional may recommend a medical device or procedure to treat urinary retention, depending on the cause of the retention. Examples of these procedures and devices include:

  • cystoscopy (in English) : a cystoscope to look inside the urethra and bladder to find and remove blockages as urinary tract stones used
  • laser therapy : therapy that uses a strong beam of light to treat an area of ​​enlarged prostate tissue, breaking the blockage and reducing the obstruction
  • lifting of the prostatic urethra or UroLift – small implants are used to lift and hold the prostate away from the urethra so urine can flow more freely
  • transurethral electrovaporization: a procedure that uses heat to vaporize an area of ​​enlarged prostate tissue
  • transurethral steam therapy, or Rezum: therapy that uses steam to shrink an enlarged prostate
  • urethral dilation: the size of the urethral opening is gradually increased by stretching the scar tissue, to help treat urethral stricture
  • vaginal pessary – a rigid ring that is inserted into the vagina to help stop urine leakage, as in cystocele or rectocele

Surgery

The healthcare professional may consider surgery to help treat the cause of urinary retention if other less invasive treatments don’t work. Some of these treatments could include:

  • remove part of the prostate
  • repair urethral stricture or scar tissue of the bladder neck
  • repair pelvic organ prolapse
  • remove a tumor, abnormal uterus, or injured part of a herniated disc
  • repair an abnormal bladder
  • doing a urinary diversion  , a procedure that diverts the flow that urine normally leaves the body

How can the patient treat his urinary retention?

The healthcare professional may recommend that the patient try self-care treatments, either alone or in addition to other treatments, to control urinary retention.

Physiotherapy

The healthcare professional might suggest that the patient work with a physical therapist who specializes in pelvic floor problems. The physical therapist will try to stretch the tight pelvic floor muscles and will teach the patient to keep them relaxed. Pelvic floor muscle exercises, also known as Kegel exercises , help the nerves and muscles used to empty the bladder work better.An older woman stretching with the guidance of a physical therapist.Physical therapy can help control urinary retention symptoms

Bladder training

Your healthcare professional may suggest timed urination (urinating at set times) to help prevent your bladder from becoming too full. Another bladder training technique that your healthcare professional might recommend is double urination (wait a bit after urinating and try again) to help ensure that your bladder is completely empty after urinating.

The patient must take longer to bathe in order to relax and empty the bladder completely. Women should try to relax the muscles around the bladder when urinating to facilitate urination. It is better to sit on the toilet seat or squat. Leaning over the toilet seat to avoid touching it and urinating practically while standing does not allow the muscles to fully relax and can cause urine to stay in the bladder.

Prevention

Can urinary retention be prevented?

Urinary retention cannot always be prevented, but steps can be taken to reduce the likelihood of developing the condition.

Change urination habits

The patient should go to the bathroom whenever they feel like it. People often hold their urine because it is not a good time to go to the bathroom. However, holding urine regularly can wear down the bladder muscles and make a urinary tract infection more likely. UTIs can cause urinary retention.Men and women restroom sign.You should go to the bathroom whenever there is a need to avoid injury to the bladder muscles

Staying in tune with the body

The patient should pay attention to how often he feels the need to urinate. If urination becomes easier to hold and the time between urinations lengthens, the bladder may gradually stretch. In addition, the patient should consider if it is more difficult for him to start urinating or if he cannot completely empty his bladder. Both cases can be early signs of urinary retention.

The patient should be aware of any changes in urination habits after surgery or a serious back injury. It is common for urinary retention to develop, either immediately or over time, after surgery or a back injury.

Consult your healthcare professional if any of the signs of urinary retention are present. It is possible to prevent the condition from getting worse if the patient receives help in time.

Take medications as directed by the doctor

Men with prostate problems , such as benign prostatic hyperplasia  , should take medications prescribed by their healthcare professional and avoid medications that can cause urinary retention , such as decongestants and non-steroidal anti-inflammatory drugs.

Exercising the pelvic floor muscles

Pelvic floor exercises, also known as Kegel exercises , can strengthen the pelvic floor muscles and improve bladder and bowel function. Both men and women can benefit from pelvic floor muscle exercises.

Modify diet and lifestyle

The patient can help prevent urinary retention caused by constipation by  making diet and lifestyle changes. To help prevent constipation, you should get enough fiber in your diet, drink plenty of water and other fluids, and get regular physical activity.A table covered with healthy foods like broccoli, almonds, apples, salmon, tomatoes, and rice.Eating a diet rich in fiber can help prevent urinary retention caused by constipation.

Clinical trials

The NIDDK conducts and supports clinical trials for many diseases and conditions, including urologic diseases. Clinical trials look for new ways to prevent, detect or treat diseases and to improve the quality of life.

What are clinical trials for urinary retention?

Clinical trials and other types of clinical studies are part of medical research and involve people like you. When a person volunteers to participate in a clinical trial, they are helping doctors and researchers learn more about diseases and improve health care for people in the future.

Researchers are studying many aspects of urinary retention, such as: