Do you also have difficulty completely emptying your bladder? Let's talk about Urinary Retention!

Do you sometimes feel like you can't urinate completely? Or do you only urinate a little and then feel like you have to urinate again? This is what we simply call urinary retention, or medically called ``Urinary Retention''. What happens in this is that your bladder does not empty completely. Our bladder is like a water tank. The urine that is filtered by the kidneys from the water and fluids we drink, is collected in this bladder. It then goes out through the urethra.

What is urinary retention? Are there types?

Simply put, urinary retention is when your bladder does not empty completely when you urinate. This can occur in two main ways. 1. Acute urinary retention: This is a sudden, sudden condition. You may not be able to urinate at all. This is a condition that requires emergency medical treatment. 2. Chronic urinary retention: This is a condition that develops gradually over time. Symptoms also appear slowly. This can be caused by things like urinary tract obstructions, certain medications, and nervous system problems.

Imagine this, like when something gets stuck in a water pipe, the water stops flowing.

Acute urinary retention is usually an emergency . If this happens, you should see a doctor immediately. Chronic urinary retention is most common in men between the ages of 60 and 80.

How common is this condition?

Studies show that about 10% of men over the age of 70 and about 30% of men over the age of 80 may experience this condition. Although women can also experience urinary incontinence, it is much less common than in men.

What are the symptoms of urinary retention?

These symptoms may vary depending on whether you have acute or chronic symptoms.

Symptoms of Acute Urinary Retention

In this case, the symptoms appear suddenly.

• Inability to urinate, or only passing very little urine even when the bladder is full.
• In severe cases, you may experience abdominal discomfort and lower abdominal pain . If this happens to you, you should see a doctor immediately.

Symptoms of Chronic Urinary Retention

Symptoms can vary from person to person. Some common symptoms include:

• Difficulty starting to urinate.
• Weak, slow, or uncontrollable urine stream.
• Feeling like you need to urinate again right after you finish urinating.
• Feeling like you need to urinate all the time.
• Leaking a little urine without realizing it.
• Having to get up several times at night to urinate (Nocturia).

What are the causes of urinary retention?

There can be several reasons for urinary retention. The main ones are:

• There is some kind of obstruction in the path of urine leaving the body.
• Some medications you take for other conditions.
• Nerve-related problems that interfere with the exchange of messages between the brain and the urinary system .
• Infections or swelling that obstructs the flow of urine.
• Surgery (especially after some surgeries).

1. Blockage

If something blocks the free flow of urine from the bladder to the urethra, it can cause a urinary obstruction. This obstruction is the main cause of urinary retention. Some of the possible causes of such obstructions are:

• Enlarged Prostate : In men, the prostate gland can become enlarged and press on the urethra, causing obstruction. This is also called Benign Prostatic Hyperplasia ( BPH ).
• Bladder Outlet Obstruction: A blockage at the point where urine exits the bladder (the bladder neck).
• Ureteral Obstruction: Blockage of the urethra due to urinary stones, blood clots, tumors, or other causes.
• Cystocele : A condition in which the bladder in women drops down into the vagina.
• Rectocele: A condition in which part of the rectum in women pushes into the wall of the vagina.
• Urethral Stricture: Narrowing of the urethra due to scar tissue.

2. Medications

Some medications can also cause urinary retention. For example:

• Antihistamines (e.g. Benadryl®)
• Antispasmodics (such as Detrol®)
• Opiate painkillers (e.g., Vicodin®)
• Tricyclic antidepressants (such as Elavil®)

These can change the way the bladder muscles work. Some other types of medications include:

• Some high blood pressure medications.
• Some medications for mental illness (Antipsychotics).
• Muscle relaxants.

3. Nerve Issues

You may not know, but our brain is also involved in urinating. The brain sends a signal to the muscles in the bladder to tighten, which is when urine comes out. At the same time, the brain tells the muscles around the urethra (sphincter muscles) to relax. This is when urine comes out easily. So, if there is a problem in this communication between the brain and the nerves, urination problems can occur. Possible causes of nerve-related problems:

• Stroke .
• Diabetes `(Diabetes Mellitus)`.
• Multiple Sclerosis (MS).
• Damage to the spine or pelvic area from an accident or injury.
• Compression of the spinal cord due to a tumor or herniated disc.
• Normal childbirth `(Vaginal Childbirth)`.
• Some surgeries performed in the pelvic area.

If you have had a catheter (urinary tube) in the past, you are at higher risk of developing nerve problems.

4. Infection or Swelling

Infections and swelling can also block the flow of urine through the urethra. Examples:

• Prostatitis: An infection or swelling of the prostate gland, causing it to swell and press on the urethra, blocking the flow of urine.
• Urinary Tract Infection (UTI): An infection in the urinary system can cause the urethra to become swollen or the bladder to become weak. Both of these can cause urinary retention.
• Sexually Transmitted Infections (STIs): These infections can also cause swelling and urinary obstruction.

5. Surgery

Urinary retention can also occur after some surgeries. For example, hip replacement or spinal surgery. Also, temporary urinary retention can occur due to general anesthesia during surgery.

What are the risk factors for urinary retention?

Although urinary retention can occur in anyone, it is most common in men . This risk is especially high in men with an enlarged prostate gland (Benign Prostatic Hyperplasia or BPH), because their prostate gland presses on the urethra and blocks the flow of urine.

What are the complications that can occur due to urinary retention?

If this condition is not recognized or treated, the following problems can occur:

• Urinary tract infections (UTIs): When urine collects in the bladder, it creates a favorable environment for bacteria to grow. This can lead to urinary tract infections, which can spread to the kidneys.
• Bladder damage: When too much urine accumulates in the bladder, the bladder muscles can become stretched and damaged.
• Kidney damage:If a urinary tract infection spreads to the kidneys, the kidneys can become swollen and inflamed. This pressure can damage the kidneys and cause kidney disease.
• Involuntary leakage of urine: When your bladder is not completely empty, you may also leak some urine without realizing it.
• Bladder Stones: Bladder stones can form when urine accumulates in the bladder.

How is urinary retention diagnosed?

Acute urinary retention is a medical emergency . If you have sudden difficulty urinating, especially if you have pain in your abdomen or lower back, you should seek medical advice immediately . If you have chronic urinary retention, you should see a urologist. He or she will:

• They will ask about your symptoms and how long you have had them.
• Your complete medical history will be obtained.
• Does a physical examination.
• A urine sample is tested to see if there is an infection.
• A digital rectal exam is performed to examine the prostate gland.

In addition, the doctor may perform other tests to find the cause of urinary retention:

• Post-void Residual Urine Test (PVR): This measures how much urine is left in your bladder after you urinate.
• Cystoscopy: This involves examining the inside of the bladder and urethra using a cystoscope, a tube about the size of a pencil, with a light and a camera or lens.
• Urodynamic Testing: This test measures nerve and muscle function, pressure in and around the bladder, and urine flow rate.
• PSA Test: This blood test checks for prostate cancer by measuring the level of Prostate-Specific Antigen (PSA).

What is the treatment for urinary retention?

The treatment for urinary retention depends on whether you have acute or chronic incontinence, and the cause.

Treatment for sudden urinary retention

Because this is a medical emergency, the doctor will insert a catheter (a tube) into your bladder to drain it. This should provide immediate relief. After that, the cause will be identified and appropriate treatment will be started.

Treatment for chronic urinary retention

Treatment depends on the cause. It may involve a combination of one or more of the following:

• Medicines.
• Surgery.
• Non-surgical options (behavioral changes).

If you have urinary retention, especially due to nerve-related problems, you may be able to temporarily use a catheter at home. If so, your doctor will teach you how to self-catheterize the catheter.

Medication

Your doctor may prescribe medication to treat the underlying cause of your urinary retention. For example:

• For an enlarged prostate: Medications such as alpha-blockers and 5-alpha reductase inhibitors shrink the prostate gland or relax the muscles around it.
• For infections: Antibiotics are given to treat infections that cause urinary retention.

Surgery

Depending on the cause, surgery may be necessary to treat urinary retention. Your doctor may recommend surgery for the following conditions:

• Enlarged prostate: There are several types of surgery to treat this. For example, transurethral resection of the prostate (TURP), prostatic urethral lift, or holmium laser enucleation of the prostate (HoLEP). All of these methods (and others) can remove the blockage that is causing the blockage.
• Urethral stricture: The doctor may use a catheter or balloon to open the scar tissue that is causing the narrowing. Another option is to perform a surgery called urethroplasty, which involves opening and repairing the urethra.
• Cystocele or Rectocele: If your symptoms are caused by a prolapsed or protruding bladder or rectum, your doctor may recommend a pessary (a device that holds the bladder up) or surgery to move the organs back into place. Surgery is available for any type of pelvic organ prolapse.
• Urinary tract stones: Your doctor may use a procedure called cystolitholapaxy to break up and remove stones in the bladder or urethra.

The doctor will first try less invasive methods and treatments. However, if these don't help, more invasive methods may be considered, such as:

• Complete removal of the prostate gland (Prostatectomy).
• Spinal Cord Stimulation.
• Bladder surgery.
• Urinary Reconstruction and Diversion.

Nonsurgical Treatments

Sometimes, non-surgical methods can provide relief from symptoms. Examples:

• Kegel exercises or pelvic floor muscle therapy:Kegel exercises and physical therapy strengthen the pelvic floor muscles.
• Vaginal Pessary: ​​A ring-like device used to support the bladder if it prolapses.
• Urinary control: You can control urinary retention by controlling when you need to urinate and planning when to drink fluids.

Can urinary retention be prevented?

While this cannot be completely prevented, there are things you can do to reduce the risk:

• Go to the toilet as soon as you feel the need to urinate. Don't hold your urine in.
• Pay attention to your urination habits. Tell your doctor if you notice any changes.
• Eat a balanced diet, maintain a healthy weight, and drink plenty of water.

Can you urinate even if you have urinary retention?

Yes, some people can urinate a little. Urinary retention means that you either can't urinate at all, or your bladder doesn't empty completely when you urinate. Sometimes, the bladder is full of urine and overflows, so some urine can leak.

What should I expect if I have urinary retention?

If you are diagnosed with urinary retention, it is important to follow your doctor's treatment plan exactly. Go for follow-up tests to see if your symptoms are improving. For many people, the right treatment will help relieve symptoms.

When should I see a doctor?

See a doctor if you have any of these:

• If you feel like you need to urinate frequently, especially right after you finish urinating.
• If you have difficulty starting to urinate, or if your urine stream is weak or stops.
• If you have pain in the lower abdomen, genital area, or lower back.

What questions should I ask my doctor?

If you have urinary retention, it's normal to have questions. You can ask your doctor things like:

• What do you think is the cause of my symptoms?
• Do you recommend further testing?
• What kind of treatment do you recommend?
• How can I best manage my symptoms?
• Will my urinary retention be completely cured?

It can feel awkward to talk to family, friends, and doctors about your urinary control problems. But you're not alone. Urinary retention is a common and treatable condition. If you notice a change in your urination habits, or if you can't urinate at all, see a doctor. There are several treatments that can help manage your symptoms.

Final Take-Home Message

Urinary retention is a condition that can be a bit annoying at times, and can be serious in an emergency. The most important thing is to recognize the symptoms and seek medical advice quickly.

• Emergency symptoms: If you experience sudden symptoms such as the inability to urinate or lower abdominal pain , go to the hospital immediately .
• If you have persistent symptoms such as difficulty starting to urinate, a weak urine stream, or a frequent need to urinate, don't be shy and see a doctor for a checkup.
• There can be many causes: prostate problems, medications, nerve problems, infections, etc. Only by finding the exact cause can the right treatment be given.
• There are treatments: Depending on the cause, this condition can be treated with medication, surgery, or lifestyle changes.
• Don't ignore it: If left untreated, complications such as kidney damage and infection can occur.

So, if you have this kind of discomfort, don't be afraid to talk to a doctor. You can get relief with quick treatment.