When a person is unable to empty their bladder—either partially or completely—the condition is known as urinary retention. People with urinary retention may experience an acute (sudden) or chronic (over time) form of the condition.

Acute urinary retention arises suddenly and is associated with extreme discomfort; it may be life-threatening in some cases. Chronic urinary retention, however, may not cause noticeable symptoms because it may develop slowly over time. Some people may not realize they have chronic urinary retention until they develop complications, such as urinary tract infections (UTIs), urinary incontinence from overflow, or permanent kidney damage over time from long term obstruction.

Urinary retention becomes more common as people age, particularly after age 60. Men are more likely to experience the condition than women, as the prostate often causes blockage of the bladder as it grows larger with age. Roughly 10% of men in their 70s experience urinary retention. The number rises to 30% among men in their 80s.

Treatments are available to relieve both acute and chronic urinary retention. In both cases the goal of care is to alleviate the urinary retention and to identify and treat the underlying cause of the condition.

Urinary retention is a condition in which it is difficult for a person to (partially or completely) empty their bladder.

Typically, a person knows they need to urinate when the bladder sends a “full” signal to the brain. Then, when the person is ready to urinate, their brain sends signals to the bladder muscles to squeeze out the stored urine, which passes through the urethra to exit the body.

When a person has acute urinary retention, their brain still receives the “full” signal, but they are physically unable to release urine. Feelings of urinary urgency may be uncomfortable or painful for them. They should seek immediate medical attention—the pressure from a full bladder over time can cause irreparable kidney damage.

When a person has chronic urinary retention, however, they are usually able to urinate but unable to completely empty their bladder. Or they may have difficulty initiating a stream of urine. If this happens, an enlarged prostate or other physical barriers (more on that below) may be responsible. In other cases, people with chronic urinary retention experience a disruption in the brain–bladder connection. Feelings of urinary urgency may not fully register, so a person may not realize their bladder is still partially full after they urinate. This may lead to a UTI or other complications, such as bladder stones or kidney damage.

Urinary retention is caused by a blockage that partially or fully prevents urine from leaving the bladder or urethra, or a failure of the bladder to squeeze hard enough to expel all of the urine.

A number of conditions may cause urinary retention, including:

• An enlarged prostate (benign prostatic hyperplasia, BPH)
• Scar tissue that narrows the urethra (urethral stricture)
• Kidney stones that enter the urethra (urolithiasis)
• An inability to pull back the foreskin behind the head of the penis (phimosis)
• An inability to place the foreskin back to its usual position due to tissue constriction (paraphimosis)
• UTIs
• Injury to the bladder or urethra
• Blood in the urine accompanied by blood clots that may block the urethra
• Prostate cancer
• Cervical cancer
• Bladder cancer
• Brain tumor
• Epidural metastasis (cancer within the epidural space)
• Fibroids
• Pelvic organ prolapse
• Genital herpes
• An infection within the epidural space of the brain or spinal cord
• Constipation
• Swelling or inflammation of the urethra
• Weakened bladder muscles from aging, childbirth, and/or trauma
• Immobility

A number of neurological conditions or issues that disrupt messaging between the brain and bladder may also cause urinary retention, including:

• Multiple sclerosis
• Parkinson’s disease
• Fowler’s syndrome
• Cerebral palsy
• Spina bifida
• Heavy metal poisoning
• Guillain-Barré syndrome
  
• Spinal cord injury
• Diabetic neuropathy
• Cauda equina syndrome

Urinary retention may also be a side effect associated with the following medications:

• Opioids
• Antihistamines
• Tricyclic antidepressants
• Antipsychotic medications
• Cough suppressants
• Certain medications to treat stomach cramps or urinary incontinence

Anesthesia from surgery may also cause urinary retention temporarily.

Chronic and acute urinary retention cause different symptoms. Some people with nerve damage do not experience pain or discomfort related to urinary retention.

People with acute urinary retention may experience:

• Inability to urinate, despite a strong urge to do so
• Lower abdominal pain or discomfort
• Bloating in the lower abdomen
• Lower back pain

People who have chronic urinary retention may experience:

• Difficulty initiating a stream of urine
• A weak urine stream
• Disruptions to a urine stream (intermittent stream)
• An urgent need to urinate, followed by a light flow of urine
• Urge to urinate immediately after urinating
• Frequent bathroom visits
• Mild pain or discomfort in the lower abdomen or urinary tract
• Leakage of urine while asleep from overflow

Doctors are able to diagnose acute or chronic urinary retention after learning about a patient’s medical history, performing a physical exam, and offering diagnostic tests.

If you are unable to urinate, tell the doctor when you were last able to do so, what medications you take, and any notable changes to your medication usage, including its type and dosage. Let the doctor know if you have experienced recent constipation, blood in the urine, pelvic trauma, pelvic cancer, pelvic surgery, urologic surgery, or urologic cancer.

If you believe you may have chronic urinary retention, tell the doctor how long you have been experiencing urinary difficulty, and explain the specific problem, such as difficulty starting a stream of urine or continuing to urinate. If you have nerve damage due to diabetic neuropathy, multiple sclerosis, or another medical condition, tell your doctor.

During a physical exam, the doctor will feel your abdomen to see if the bladder is distended or if pressing on the bladder causes discomfort. The doctor will possibly perform a pelvic exam to check for constipation or look for anatomical causes of urinary retention. In male patients, the digital rectal exam may be used to check for an enlarged prostate. The doctor may also perform a neurological exam to check for nerve damage.

Doctors may order the following diagnostic tests:

• Blood tests, to help determine the cause of urinary retention and assess kidney function
• Urine analysis (based on a sample removed by catheter, if needed), to check for infection or other causes of urinary retention
• Post-voiding catheterization, during which a doctor places a urinary catheter to see how much urine remains in the bladder immediately after a person urinates
• Cystoscopy, during which a thin tube with a camera attached is inserted into the urethra so the doctor can view any abnormalities present in the urethra or bladder, such as a stricture or kidney stone
• Electromyography, which measures the electrical activity of muscles and nerves in and around the bladder; it may be offered when neurological conditions or nerve problems are suspected.
• Imaging tests, such as:
  • An ultrasound of the bladder (or bladder scan), to see how much urine is left in the bladder after a person urinates
  • A computed tomography (CT) scan of the abdomen, to view the bladder or rule out other conditions
  • A magnetic resonance imaging (MRI) scan, to view the bladder and the spinal cord, if a neurological condition is suspected

Treatments vary, depending on the cause of urinary retention.

• Draining the bladder. When a person has acute urinary retention and cannot urinate at all, doctors place a urinary catheter to empty the bladder, providing immediate relief. A urinary catheter may only be needed once, or it may be used on an ongoing basis until the condition resolves.

• Medication. One or more of the following medications may be prescribed to ease symptoms of urinary retention:
  • 5-alpha reductase inhibitors, such as finasteride or dutasteride, which can shrink the size of the prostate.
  • Alpha blockers, such as terazosin or tamsulosin, help to relax muscles in the bladder neck (a group of muscles near the bottom of the bladder) and the prostate, which can make it easier to urinate.
  • A combination of a 5-alpha reductase inhibitor and an alpha blocker, which may have a more significant impact than one drug alone.
  • Antibiotics, if the urinary retention has been caused by a UTI or prostate inflammation (prostatitis).

In some cases, doctors may switch or reduce the dosage of medication that causes urinary retention as a side effect.

• Surgical Procedures: If medications alone are not effective, one or more of the following procedures may be offered, depending on the cause of urinary retention:
  • Laser therapy, which delivers a narrow, strong beam of light to an area within an enlarged prostate that is obstructing the flow of urine, helping to eliminate the blockage. Holmium laser enucleation of the prostate (HoLEP) is an extremely effective way to treat an enlarged prostate with greater durability of benefits, shorter catheter duration, shorter hospital stay, and lower bleeding risk compared to other procedures used to remove tissue from the prostate.
  • Prostatic urethral lift, a procedure during which small implants are placed around the prostate to hold it back from the urethra. This helps urine flow more freely through the urethra.
  • Transurethral water vapor therapy, a procedure during which an instrument is inserted through the urethra to the prostate. It delivers short bursts of steam, which helps to shrink enlarged prostate tissue, thereby enabling urine to flow more freely through the urethra.
  • Urethral dilation, a procedure that helps to widen a urethra constricted by scar tissue. Often, a small balloon may be inserted into the urethra, inflated to widen the space, and then removed. Other times, doctors may place a series of increasingly wider instruments into the urethra to expand the area.

• A vaginal pessary. This medical device can be inserted into a woman’s vagina to help stop urine leakage.

• Surgery. Different surgical procedures may be offered to treat urinary retention if other methods aren’t successful. Options include:
  • Removing part of the prostate
  • Repairing a urethral stricture
  • Repairing or removing scar tissue from the bladder neck
  • Repairing pelvic organ prolapse
  • Removing a tumor that obstructs urine flow
  • Removing part of a herniated disk that impacts urine flow
  • Removing an abnormal uterus that causes urinary retention
  • Repairing bladder abnormalities that impact urine flow
  • Rerouting urine flow out of the body with a urinary diversion

• Physical Therapy. Doctors may also recommend the following exercises to strengthen the pelvic floor muscles:
  • Physical therapy that focuses on pelvic floor muscles, which are responsible for starting and stopping urine flow.
  • Bladder training, which helps a patient learn to empty their bladder more fully. Options include timed voiding (urinating on a set schedule), double voiding (urinating again a short while after using the bathroom), and relaxing in the bathroom, rather than rushing through the actions.

Treatments for acute and chronic urinary retention are effective, leading to symptom relief in most cases. People who receive treatment for urinary retention are able to return to their normal lives and daily activities.

“In males, BPH is one of the most common causes of urinary retention,” says Yale Medicine urologist Daniel Kellner, MD. “Yale Urology has become a destination center for the treatment of BPH. We offer a tailored approach to the treatment of BPH in order to maximize outcomes of treatment while minimizing risks and side effects. Yale Urology was the first in Connecticut to offer Holmium Laser Enucleation of the Prostate [HoLEP] which is a minimally invasive treatment of BPH. HoLEP is effective in treating prostate of all sizes, with more durable benefits and minimal bleeding and pain, and is usually performed as outpatient surgery.”