Urinary retention occurs when the bladder fails to empty completely. It can be an acute condition, which is a medical emergency, or it can be chronic. Some cases of urinary retention are caused by obstructions in the urinary tract, often due to an enlarged prostate in men or a sagging or mobile bladder in women.
Acute urinary retention is a medical emergency. One feels the need to urinate but cannot despite bloating in the lower part of the belly. The pain can be severe and may make walking difficult. If left untreated, acute urinary retention can damage the bladder, or in worst case scenarios, the bladder may rupture and need surgery.
Chronic urinary retention presents with less severe pain and bloating than acute. People with this condition often feel they still need to urinate after finishing. They may find it difficult to start a urine stream or experience a weak urine flow. The condition also manifests as a need to urinate frequently. Some people find they leak small amounts of urine during the day, never feel the urge to urinate, or wake up multiple times at night to use the bathroom.
One of the most common complications of urinary retention is the serious urinary tract infections. Severe and long-lasting urinary retention can also lead to kidney damage. In its mildest form, the pain and discomfort can reduce one's quality of life.
The development of the symptoms of urinary retention can be sudden or gradual, depending on the cause. When prostate cancer is to blame, symptoms may build up over time. In cases of illness or trauma, they may occur suddenly. Regardless of the suddenness of the onset, the longer the condition goes untreated, the more likely one is to develop serious complications such as urinary tract infections or damage to the bladder or kidneys.
There are many different causes of urinary retention. Anything that constricts or blocks a part of the urinary tract will cause some level of urinary retention. However, other conditions may contribute to the issue, such as diabetes, spinal cord problems, stroke, or heavy metal poisoning. Medications may also cause urinary retention, including some anti-inflammatories, decongestants, and antihistamines.
Several tests can diagnose urinary retention. Doctors diagnose acute urinary retention through a physical examination or ultrasound. The concern is first finding relief in the bladder and then finding the cause. After initial treatment, more extensive tests will be conducted to determine the cause of retention and facilitate a more permanent solution. For chronic urinary retention, or after the initial treatment of acute urinary retention, tests include urinalysis, blood work, and imaging studies including CT and MRI. Cytology involves inserting an instrument into the urethra to check for blockages, growths, or cancer. Urodynamic studies will measure the ability of the bladder to retain and expel urine.
The first line of treatment for acute urinary retention is the drainage of the bladder using a catheter. This may even occur before the doctor runs any tests. If a blocked urethra is the problem, the catheter will be inserted directly through the lower abdomen, just above the pubic bone. Once relief is achieved -- preventing bladder damage -- tests will be ordered to determine the cause and seek long-term solutions.
In chronic cases of urinary retention, a doctor may insert a catheter the patient is required to drain. If the problem is a restricted urethra, a doctor will perform a urethral dilation procedure. This involves inserting increasingly wider tubes into the urethra, or inserting a balloon and inflating it. Urethral stents are artificial tubes that are inserted into the urethra to help widen the space and allow urine to pass. Other interventions include medication and surgery to resolve physical abnormalities.
Preventing urinary retention involves addressing the causes before they become problematic, and a doctor may prescribe medications. Sometimes, the cause does not become apparent until urinary retention develops, such as in the case of a slow onset condition such as prostate cancer or a weakening of the pelvic muscles in women. When the issue is an infection or trauma, there is little that can be done to prevent it.
Any time you have the symptoms of urinary retention, you should see your doctor. If it is a minor infection, there is a possibility that it may go away on its own, but there is also the chance that it could develop into a more serious condition quickly. Urinary retention is a sign that something is wrong and it is wise to find out the cause as soon as possible. Severe pain may warrant a trip to the emergency room, particularly if you suspect acute urinary retention. Waiting to see if it resolves on its own can lead to bladder or kidney damage.
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