Urinary Retention

What is Urinary Retention?

Urinary retention is defined as the inability to void urine voluntarily. The condition may be acute or chronic. Acute retention is sudden inability to urinate and chronic retention is the gradual inability to completely empty the bladder.

The condition is more common in men with prostatic enlargement. Neurogenic causes of urinary retention occur in younger males and females.

Aetiology

Urinary retention may be caused due to a blockage that partially or fully prevents the flow of urine or when the bladder is unable to maintain a strong force to expel the urine. Causes of urinary retention are numerous and categorized as obstructive, infectious, inflammatory, pharmacologic, neurologic etc.

Males

• Obstructive causes of urinary retention: This may be due to outflow obstruction which can be mechanical such as from physical narrowing of the urethral channel. Conditions include benign prostate hyperplasia and hypertrophy, prostate cancer, urethral stricture etc.
• Infections: Prostatitis, urinary infection causing urethritis, and urethral oedema.
• Neurologic causes: This leads to the interruption of the sensory or motor innervation of the detrusor muscle. The dyssynergia occurs by interruption of the neurologic pathways such as from a stroke, spinal cord injury, infarction, demyelination along with other neurologic disorders (e.g., traumatic cord injuries, epidural abscess, epidural metastasis, Guillain-Barre syndrome, diabetic neuropathy, multiple sclerosis).
• Medications

Females

Common causes of urinary retention include nerve injury during surgery, cystotomy during operation, obstruction (vaginal hematoma, vaginal packing, sling, urethral foreign body, pelvic organ prolapse, urethral injury, constipation, failure of pelvic floor relaxation).

Sign and symptoms

The clinician should inquire about the history of prostate diseases such as cancer, trauma, surgery, kidney stones. History of the presence of haematuria, dysuria, fever, low back pain, neurologic symptoms of tremors, weakness is vital.

On physical examination of the lower quadrants of the abdomen, pelvis and genitals. Palpation can help in diagnosing distended bladder. Rectal examination can reveal an enlarged prostate or faecal impaction.

Diagnosis

After a thorough history taking and physical examination, following investigations must be carried out-

• Urine analysis
• CBC
• Kidney function test
• CT scan head
• MRI Spine

General management

Adequate pharmacological and surgical intervention depending on the underlying cause of urinary retention is recommended.

Warning: Above information provided is an overview of the disease, we strongly recommend a doctor's consultation to prevent further advancement of disease and/or development of complications.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.