Not being able to urinate: causes of urinary retention in men and women

Can’t urinate, what’s going on? Urinary retention is the inability to empty your bladder, causing a buildup of urine in the bladder. With urinary retention you no longer urinate at all or you only urinate small amounts. A distinction is made between acute urinary retention and chronic urinary retention. With acute urinary retention you are suddenly no longer able to urinate and the symptoms develop within a few hours. You mainly suffer from pain because the bladder wall stretches. The acute form is a medical emergency. Chronic urinary retention, on the other hand, occurs over a longer period of time. You can still urinate, but the bladder is no longer completely emptied. This is because the bladder muscle is not strong enough. An increasing amount of urine remains in the bladder. This causes the bladder to stretch more and more. The chronic form is normally not painful because the bladder fills slowly.

  • Meaning of Urinary Retention
  • Inability to urinate or urinary retention
  • Who gets urinary retention?
  • Urinary retention symptoms
  • Complications
  • Causes of urinary retention
  • Obstruction of the urethra or urethra
  • Nerve damage
  • Medicines
  • Weakened bladder muscles
  • Urinary retention in men and women
  • Causes in men
  • Causes in women
  • Examination and diagnosis
  • Interview and physical examination
  • Visual art investigation
  • Treatment of urinary retention
  • Prevention
  • Diet and nutrition

 

Meaning of Urinary Retention

Inability to urinate or difficulty urinating is also called urinary retention. Retention is the medical word for holding up, the delayed release or retention of something. In this case it concerns the retention or delayed release of urine.

Urinary tract / Source: La Gorda/Shutterstock.com

Inability to urinate or urinary retention

Urinary retention is the inability to empty your bladder (completely). Urinary retention can be acute or chronic. Acute urinary retention is a medical emergency. Urinary retention is most common in men in their 50s or 60s due to prostate enlargement. Causes of urinary retention include urinary tract obstruction, such as an enlarged prostate or bladder stone, infections that cause swelling or irritation, nerve problems that interfere with signals between the brain and the bladder, medications, constipation, a urethral narrowing or urethral stricture, or a weak bladder muscle. Symptoms of acute urinary retention include severe discomfort and pain, an urgent need to urinate but not being able to, and a bloated abdomen. Chronic urinary retention symptoms are mild and include a constant feeling of discomfort, difficulty initiating urination, a weak urine stream, frequent urination, or a feeling of having to go after just going to the toilet. Treatment for urinary retention consists of catheterization or treatment of prostate enlargement or other underlying condition.

Who gets urinary retention?

Anyone can get urinary retention, children and adults, young people and the elderly, men and women. However, in children, urinary retention is a rare phenomenon.ยน It is most common in men in their 50s or 60s due to prostate enlargement. For example, in a woman, urinary retention may occur if her bladder has prolapsed or is out of its normal position, a condition known as ‘cystocele’. Vaginal prolapse, rectal prolapse or uterine prolapse can also lead to urinary retention. People of all ages and both sexes can have a nerve disorder or nerve damage that interferes with bladder function.

Stomachache / Source: Andrey Popov/Shutterstock.com

Urinary retention symptoms

Acute urinary retention develops within a few hours and manifests itself in abdominal pain and a painful urge to urinate without being able to do so. In contrast, the symptoms of chronic urinary retention often develop slowly and do not normally cause pain. The complaints that may occur with the chronic variant are:

  • urination is difficult to start;
  • a recurring urge to urinate;
  • having to urinate often and only small amounts at a time;
  • abdominal distension, increased abdominal pressure;
  • a weak urine stream that ends with dripping;
  • passing small amounts of urine during the day;
  • waking up more than twice a night to urinate (nocturia).

 

Complications

Urinary retention can cause damage to the kidneys if urine cannot drain from the kidneys. It can also lead to (recurrent) bladder infections and an enlarged bladder.

Causes of urinary retention

Urinary retention can be the result of:

  • Obstruction of the urethra;
  • Nerve damage;
  • Medicines;
  • Weakened bladder muscles.

 

Obstruction of the urethra or urethra

Obstruction of the urethra causes urinary retention by blocking the normal flow of urine. Conditions such as benign prostate enlargement, urethral stenosis or urethral stricture, urinary tract stones, cystocele, rectocele, constipation and certain tumors and cancers can cause an obstruction.
Benign prostatic hyperplasia
In men who are over 50 or 60 years of age, urinary retention is often caused by prostate enlargement due to benign prostatic hyperplasia. This benign condition is not a precursor to prostate cancer. The prostate gland surrounds the urethra and can therefore easily block the flow of urine. As the prostate enlarges, the gland compresses the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to urinate completely empty, leaving some urine in the bladder.
Urethral narrowing or urethral stricture
A urethral narrowing or urethral stricture is narrowing or closure of the urethra. Stricture occurs when part of the urethra narrows. Any part of the urethra can be affected. Causes include bladder infection, surgery to treat urine leakage, surgery for benign prostate enlargement and prostate cancer, scarring after an injury to the penis or perineum and prostatitis.
Urinary tract stones
Urinary tract stones form in the kidneys (kidney stones), the ureters (ureters) or the bladder (bladder stones). When a stone has formed, it can descend into the urinary system and cause an obstruction, for example blocking the opening to the urethra.
Cystocele
A cystocele indicates a prolapse of the front wall of the vagina and the bladder, whereby the bladder pushes the front wall of the vagina outward. The abnormal position of the bladder can cause it to press against the urethra and compress it closed.
Rectocele
A rectocele is a prolapse of the rectum in the vagina. The abnormal position of the rectum or rectum can cause it to press against the urethra.
Constipation
A person with constipation may have bloating or pain in the abdomen. If hard stool is present in the rectum, it can press against the bladder and surrounding structures, causing the urethra to close.
Tumors and cancers
Tumors and cancer in the bladder (bladder cancer) or urethra can gradually spread and prevent urine flow by pressing against or blocking the urethra.

Nerve damage

Urinary retention can be the result of problems with the nerves of the bladder and sphincters. Many events or conditions can interfere with nerve signals between the brain and the bladder and sphincter muscles. If the nerves are damaged (nerve damage), the brain cannot receive the signal that the bladder is full. Even when a person has a full bladder, the signal cannot get through. People of all ages can develop nerve problems that interfere with bladder function. Some of the most common causes of nerve problems include:

  • Vaginal delivery;
  • Brain or spinal cord infections such as encephalitis (inflammation of the brain) and meningitis (inflammation of the meninges with headache, fever and stiff neck), or injuries;
  • Diabetes;
  • Stroke;
  • Multiple sclerosis;
  • Pelvic injury or trauma;
  • Heavy metal poisoning;
  • Spina bifida and other birth defects that affect the spinal cord can lead to urinary retention in newborns.

 

Medicines

Several types of medications can cause urinary retention by interfering with nerve signals to the bladder and prostate. These medications include:

  • Antihistamines to treat allergies;
  • Anticholinergics for treating stomach cramps, muscle cramps and urinary incontinence;
  • Tricyclic antidepressants to treat anxiety and depression;
  • Various other medications involved in pain management and seizure prevention.

 

Weakened bladder muscles

Aging is a common cause of weakened bladder muscles. Deteriorated bladder muscles may not be strong enough or squeeze long enough to empty the bladder completely, resulting in urinary retention.

Urinary retention in men and women

Causes in men

The main causes of urinary retention in men are:

  • an enlarged prostate;
  • a prostate abscess;
  • a narrowing of the urethra (urethral stricture);
  • a narrowing of the bladder outlet (as a result of a benign prostate enlargement);
  • reduced muscle strength in the bladder wall, for example as a result of nerve damage.

 

Causes in women

The following causes are often seen in women:

  • vaginal prolapse, bladder prolapse, rectal prolapse or uterine prolapse;
  • abnormalities of the urethra;
  • as a result of operations for urine loss;
  • gynecological tumors;
  • Fowler Syndrome (bladder spasm), is mainly seen in young women.

 

Examination and diagnosis

Interview and physical examination

With acute urinary retention, the symptoms are often obvious. For example, you may have a swollen and painful lower abdomen, a painful, urgent need to urinate, and an inability to urinate. In the case of chronic urinary retention, the diagnosis can only be made after the doctor has performed a series of tests. This is because some of the symptoms may also apply to conditions related to the bladder and urinary tract.
The doctor will perform a physical examination and ask you all kinds of questions about the complaints you are experiencing. He will also take your medical history into account. In general, in case of acute or chronic urinary retention, the doctor will lightly tap your abdomen during the physical examination to determine whether you have a full bladder.

Cystoscopy / Source: Alexilusmedical/Shutterstock

Visual art investigation

In addition, the following examinations can be performed to determine the cause of urinary retention:

  • In the case of an ultrasound residue, an ultrasound of the bladder is made. This measures the amount of residue (residual urine) left in the bladder after you have urinated.
  • A cystoscopy is an internal examination of the urethra and bladder and is performed with a flexible cystoscope. Any deviations are examined.
  • CT scan, which can make images of the urinary tract and reveal urinary tract infections, urinary stones, tumors, traumatic injuries and scars and cysts.
  • Urodynamic studies, including uroflowmetry (a study to record the force and pattern of your urine stream), video urodynamics (a combination of urodynamic studies with real-time X-ray or ultrasound images of the lower urinary tract during the filling and voiding phase) , and electromyography (measuring the muscle tension of, among other things, the bladder and pelvic floor muscles).

 

Treatment of urinary retention

First of all, you will empty the bladder. The urine will be allowed to flow away by placing a catheter. Further research will then have to reveal the cause and consequences of the observed urinary retention. Appropriate treatment will then be proposed. Examples include self-catheterization, peeling of the prostate (for a benign enlarged prostate) or sacral neuromodulation, a form of treatment for bladder function disorders in which the sacral nerves in the lower back are stimulated with weak electrical impulses. A urethral stricture can be stretched or incised. Only a short stricture in a specific part of the urethra qualifies for this. All other strictures must be repaired surgically (urethroplasty).

Drink enough to prevent constipation / Source: Luminast/Shutterstock.com

Prevention

You can prevent urinary retention before it occurs by treating a number of possible causes. For example, men with benign prostatic hyperplasia should take prostate medications as prescribed by their doctor. Men with benign prostatic hyperplasia should avoid medications associated with urinary retention, such as over-the-counter decongestants (an agent that shrinks swollen mucous membranes) and allergy medications. Women with mild cystocele or rectocele can prevent urinary retention by performing exercises to strengthen the pelvic muscles.
In most cases, diet and lifestyle changes will help prevent urinary retention caused by constipation. The most common causes of constipation are the triad: too little exercise, too little drinking and too little fiber in the diet. By tackling these (lifestyle) factors, you can remedy and prevent constipation.

Diet and nutrition

Diet and nutrition are not known to play a role in causing or preventing urinary retention.
Note:

  1. J Urol. 2001 Mar;165(3):918-21.

 

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