There are two types of urinary retention, acute and chronic. It can be a result of abnormalities in the genitourinary tract. Some common causes in men include benign prostatic hyperplasia or the enlargement of the prostate gland. For both men and women, common causes are neurological or muscular conditions affecting the bladder.
People who are suffering from this condition also experience leaking or mild incontinence and weak urine flow. Depending on the symptoms, there are various treatments available to address this condition.
Symptoms of Difficulty Urinating
People who experience a struggle in emptying their bladder have a medical condition called urinary retention. There are two types of this condition – acute and chronic.
Acute urinary retention is characterized by sudden and potential life-threatening difficulty in urinating. A person with this case will feel that they badly need to urinate, but can’t go. It causes pain and discomfort in the lower abdomen. Seek immediate medical care to release your buildup of urine.
Chronic urinary retention problems happen over an extended period. People with this condition can urinate; however, the bladder does not empty. Some people are not even aware that they have this condition because it has no symptoms at its early stages.
However, chronic urinary problems can lead to complications and its essential to consult your doctor as soon as you experience the following symptoms:
- The need to urinate frequently, for as often as eight or more times in one day.
- Difficulty in starting your urine stream
- A weak urine stream that starts and stop
- The need to urinate again right after your finish urinating.
- Getting up several times during the night to urinate
- Urge incontinence or the feeling that you need to urinate immediately and the incapacity to stop yourself from peeing.
- You have mild discomfort or feeling of fullness in your lower abdomen or pelvis
- You are not sure whether your bladder is full or not.
Causes Difficulty Urinating
Like any other health condition, urinary retention has various causes. Here are some of the most common.
Obstruction in the Urethra
The tube passing urine out of the bladder is called the urethra. It can become blocked by several factors. For men, a prostate gland enlargement may cause blockage of the tube. Additionally, narrowing of the urethra and constipation are other common causes of obstruction. And for women, genitourinary prolapse is one of the causes of this condition.
Problems with Nerves Supplying the Bladder
People with nerve problems may also develop urinary retention because they don’t have good control of the bladder and the valves that control urine flow. Even when the bladder is already full, the muscles around it do not receive the signal to push it out. The valves may not get the message to relax and allow the bladder to let out its content. Some of the potential causes of nerve problems in urinary retention are stroke, diabetes, and multiple sclerosis after pelvic injury.
Also, some children are born with nerve problems. For instance, spina bifida is an inborn condition that may lead to urinary retention in newborn infants.
Some people develop urinary retention after undergoing an operation. But the normal function of the bladder usually returns after the anesthetic wears off. This condition does not pose long-term problems.
Some medicines can cause urinary retention and difficulty urinating. Examples of these are muscle relaxants, antidepressant drugs, medication for nasal congestion, and drugs that are used to treat urinary incontinence or an overactive bladder.
Weak Bladder Muscles
When the muscles of the bladder weaken, it will not squeeze or contract effectively enough to empty the bladder. It will result in urinary retention, and this condition is more common with the elderly.
Diagnosis and Treatment
Difficulty urinating is often diagnosed by obtaining a detailed history of your symptoms. Your doctor may also perform a physical examination of your genitals and rectum. To confirm your condition, the doctor may order some tests or procedures to gather more information. Some of the tests that you need to undergo includes:
- Urine and blood samples
- Post-void residual
- CT scan and ultrasound
- Urodynamic tests
Treatment of Urinary Retention
If you have an acute case of difficulty urinating, it is considered a medical emergency. Your doctor will immediately place a catheter to expel urine out of your bladder. This procedure is the quickest and easiest way to ease pain, discomfort empty the bladder.
On the other hand, if this method does not work or cannot be done, your doctor may create an incision in your skin over the bladder to insert a tunnel through your bladder wall. You will have a suprapubic catheter in this method. You will be given local anesthesia for the procedures.
You will feel better soon as the bladder is emptied, and complications will be prevented. Your doctor will diagnose and treat the cause of your acute bladder condition.
If you have chronic urinary retention, there are several treatment options available for you. The symptoms in this condition develop gradually until it affects the quality of life and evolves complications. Here are some treatment options for this condition.
You may need to have a catheter to expel urine from your bladder unless your condition can be treated immediately. In most cases, doctors avoid keeping a suprapubic or urethral catheter for extended periods because it can lead to complications. Often a catheter needs to be placed several times per day. You will be instructed on how to do this to prevent the risk of getting bacteria into your bladder.
Dilation and Stents of Urethra
In this procedure, the restriction of the urethra is widened to allow more urine to pass through. Tubes to increase the width of are inserted into the urethra to open the stricture slowly. Another procedure to achieve dilation of the urethra is by inserting a tube with a balloon and inflating it.
A stent may also be used to widen the tightness of the urethra. A small tube will be inserted, and this will expand as it opens. The stent will allow a better flow of urine from the bladder. In some cases, a stent is permanently placed in the urethra to keep it open.
For this procedure, a flexible tubular scope with a light called a cystoscope will be inserted through the urethra into the bladder. This will help find and remove stones or foreign items from your bladder, outlet, and urethra.
There are several medications that doctors may prescribe for your condition. These include the following:
- Medicines to relax your urethral sphincter and prostate so that urine can pass through
- Antibiotics to treat cystitis, prostatitis or urinary tract infection
- Medication to address the enlargement of the prostate and relieve urethral obstruction in men
Changing some habits may also help in the treatment of your difficulty urinating. You can also learn to control your bladder so that you are less likely to hold in urine. Ideally, you can manage the amount and time your drinks, practice bladder retaining techniques and exercises, and strengthen your pelvic muscles.
Surgery is a last resort to this condition when therapies and medication have not worked to ease the symptoms. For men, the instrument with an attached laser to the tool will be inserted through the urethra to fix any problem. It is an outpatient procedure and invasive. Thus, it is less painful, does not require a hospital stay, and allows you to recover faster. Other treatment options include:
- Transurethral resection of the prostate to remove tissues that are constricting the urethra
- Removal of the prostate
- Urethrotomy to open a narrowed urethra
Depending on the cause of urinary retention, other surgical procedures may be done. Specific procedures may require doctors to conduct a laparoscopic or open surgical procedure for the following:
- Removal of a part or all prostate due to cancer
- Removal of cancer in the urethra or bladder
- Removal of an abnormal or enlarged uterus
- Removal of tumors or disease in the pelvic organs
- Fix the rectocele or cystocele by putting your bladder or rectum in the right place
Risk Factors for Difficulty Urinating Condition
Anybody can have urinary retention and experience difficulty urinating, and it is more prevalent as individual ages. Men are also more likely than women to have this condition due to issues with their prostate and partial blockages on the urethra. If you have this condition, you have an increased risk due to the following:
- Urinary tract infection
- Giving birth especially if it caused injury or trauma
- Use of some medications such as decongestants and anticholinergics
- Nerve damage and disorder due to diabetes or stroke
- Weakened muscles of the bladder injury or age
When to Call the Doctor?
If you experience acute urinary retention symptoms, you need urgent medical attention. But for chronic urinary retention, you can schedule an appointment with your doctor to find out any underlying problem and to address the condition early.
People who experience difficulty urinating due to medication or after surgery do not need medical treatment as the symptoms will disappear after the effects of the medicine wear off.
Table of Medications
- sulfamethoxazole / trimethoprim
- Bactrim DS