The inability to empty your own bladder is also called urinary stasis or urinary retention in medicine. Depending on the particular symptoms, a distinction is made between acute urinary retention as well as chronic urinary retention.
What is urinary retention?
Schematic diagram showing the anatomy and structure of the urinary bladder. Click to enlarge. Insofar as an obstruction occurs in the draining urinary tract, the urine of the affected person can no longer flow freely. The obstructions usually occur in the area of the kidneys or in the area of the ureters. However, depending on the severity, an obstruction can also occur in the area of the urinary bladder or in the area of the urethra. If left untreated, urinary retention can be life-threatening for the affected person. For example, transfer of bacteria from the urogenital tract into the bloodstream leads to life-threatening blood poisoning. Depending on the severity, this can lead not only to urosepsis but also to chronic kidney failure. In the case of chronic renal failure, the patient must always undergo dialysis. However, to determine an optimal therapy, the causes of urinary retention must first be identified.
Causes
Causes of urinary retention include stones in the ureters as well as in the kidneys. Not infrequently, however, tumors also favor the occurrence of urinary retention. If, for example, the body is exposed to a high level of force in the course of an accident, a so-called trauma can lead to acute urinary retention. Often, those affected are also no longer able to actively control their urine flow due to an underlying neurological disease. For example, paraplegia requires the placement of a bladder catheter. Chronic urinary retention is primarily promoted by a congenital narrowing of the urethra.
Symptoms, complaints, and signs
Urinary retention may announce itself suddenly or gradually. It is associated with severe pain and pressure in the lower abdomen. The bulging bladder can no longer empty itself and overflows. Therefore, in addition to the pain, the patient complains of constant urine dribbling. This urinary dribbling cannot be suppressed and is therefore called overflow incontinence. The flank pain is unbearable in acute urinary retention. It is a colicky pain that sometimes radiates to the groin or genitals. At times, there is blood in the urine. In some cases, there may be chills and fever. This is a particularly life-threatening emergency because it could be what is known as urosepsis. Rarely, complete urinary retention is also observed, in which even overflow incontinence is absent. The urine then backs up in the renal pelvis and ureters, leading to kidney damage in the longer term. However, acute urinary retention can heal without secondary damage if treatment is initiated in time. Chronic urinary retention leads to secondary damage, which is particularly noticeable in kidney insufficiency and even kidney failure. Chronic urinary retention can remain completely symptom-free. In some cases, however, flank pain, nausea and vomiting occur. If kidney damage is already present, blood in the urine is also observed. Other symptoms are caused by the underlying disease in each case.
Diagnosis and course
To diagnose urinary retention, the imaging technique used is called sonography. By using ultrasound, the physician can detect apparent changes in the tissue around the urethra. To concretize the initial findings, it is not uncommon for a computer tomography to be ordered. By administering a so-called contrast medium, the deeper tissue can be viewed more closely. However, computed tomography (CT) is only used if a pathological change in the surrounding tissue is suspected. As an alternative to conventional computed tomography, leading physicians use so-called excretory urography to diagnose urinary retention. A special contrast medium is administered to the affected person via the arm vein. The contrast medium is usually enriched with iodine for better visualization. Depending on the severity, the affected person complains of mild pain in the area of the kidneys. Over time, there is then an increased loss of functioning kidney tissue.Thus, in most cases, urinary retention leads to increased susceptibility to infections.
Complications
Urinary retention can lead to a variety of complications. Congestion of urine in the urinary bladder leads to painful overdistension of it. It can also cause the urinary bladder to become easily infected. In the course of time, the infection can spread throughout the entire body, leading to blood poisoning or sepsis. This is life-threatening for the affected person and must be treated immediately, otherwise it can lead to septic shock. This leads to a deficiency in the supply of blood to organs, which can die as a result. The kidneys and lungs are particularly affected. Furthermore, urinary retention can lead to an infection of the kidney, which can subsequently fail (renal insufficiency). In this case, the kidney is no longer able to adequately filter the urine, and the water remains in the body. As a result, the affected person has more blood volume, leading to increased edema. Increased blood pressure is also the result, which can lead to further impairments. In addition, the acid-base balance and the electrolyte balance are also disturbed. More acids accumulate in the body, which means that more potassium also accumulates in the blood, which promotes cardiac arrhythmias. In the worst cases, the affected person must undergo lifelong dialysis or even a kidney transplant.
When should you see a doctor?
Urinary retention and pain when urinating indicate urinary retention. A doctor should be consulted if symptoms persist for more than one to two days or if other symptoms appear. Cramping pain indicates that urine is already pressing on the urinary tract and should be clarified quickly. An acute feeling of illness indicates an infection. Medical advice is needed at the latest when fever symptoms appear. Signs of renal colic or other serious sequelae should also be clarified by a doctor immediately. The affected person should have urinary retention diagnosed and treated before sepsis develops. Sepsis can lead to septic shock, which requires intensive medical care. If signs of such shock are noticed in the affected person, first responders should alert emergency medical services. In the best case, urinary retention is detected early and treated directly by the primary care physician. An early clarification allows a symptom-free and quick treatment. Other contacts are the urologist and specialists in internal medicine.
Treatment and therapy
In the case of urinary retention, the choice of therapy depends primarily on the symptomatology as well as the localization of the symptoms. If urinary retention is associated with a bacterial infection, therapy with antibiotics is recommended. However, the administration of antibiotics can only alleviate the acute symptoms. Despite the administration of antibiotics, the underlying primary disease should always be treated. Thus, as part of the treatment of urinary retention, a catheter is placed in those affected. This is the only way that urine can continuously drain from the bladder. Often, the further formation of bacteria can be prevented by placing a catheter. For the treatment of urinary retention, the so-called nephrostomy is also becoming increasingly popular. In this new form of therapy, the accumulated urine is drained through the skin. For this purpose, a so-called nephrostomy catheter is placed through the skin of the affected person under local anesthesia.
Outlook and prognosis
With early and extensive medical care, the prognosis for urinary retention is good. Urinary retention can be treated with medication. Within a few days or weeks, improvement usually occurs, and urine can be fully excreted as usual. Nevertheless, it is essential to clarify the underlying cause in order to achieve lasting freedom from symptoms. Otherwise, urinary retention will recur after a short time. If infections or inflammations are present, they are usually treated together with the urinary retention. Often, the patient can be discharged from the treatment as recovered after a short time. If no therapy is initiated, germs and pathogens develop and multiply. These trigger secondary diseases that can take an unfavorable course. For a favorable prognosis, the cause of the disorder must be identified and treated.In some patients, a catheter is placed temporarily or permanently to ensure the removal of urine. Pregnant women are subject to a risk group. They endanger the health of the unborn child if they consult a doctor late or refuse treatment of the urinary retention. The growth of the child may be the cause of the discomfort and must be clarified by a doctor for relief to occur.
Prevention
To prevent urinary retention, it is recommended to have regular examinations regarding kidney stones. Appropriate therapy can be initiated at the first sign of kidney stones. In addition, a regular trip to the toilet is recommended. This is the only way to thoroughly flush out dangerous bacteria. However, a doctor should always be consulted at the first signs of urinary retention.
Aftercare
In the case of urinary retention, there are few measures of aftercare available to the patient. First and foremost, the underlying disease must be identified and treated so that this unpleasant complaint does not recur and further complications can be prevented. The earlier the urinary retention is detected and treated, the better the further course of this disease usually is. Since the early detection of the disease is in the foreground, the patient should see a doctor at the first symptoms and signs of the disease. The treatment itself depends on the exact cause of the symptoms, but is usually accomplished by taking medication. The affected person should ensure that the medication is taken correctly and in the prescribed dosage, and should also follow the doctor’s instructions. If there are any questions or uncertainties, a doctor should always be consulted first. Since urinary retention is usually treated by taking antibiotics, the affected person should not drink alcohol during this process. During treatment, many patients are dependent on the help and support of their own family. In this context, intensive discussions can also prevent psychological upsets or depression.
Here’s what you can do yourself
In the case of urinary retention, the choice of treatment depends predominantly on the symptoms. If urinary retention is the result of a bacterial infection, a doctor must be consulted in any case. He will prescribe appropriate antibiotics and recommend that the patient drink plenty of water or unsweetened herbal or fruit tea. In case of urinary retention as a result of cystitis, a hot water bottle on the lower abdomen will help. In addition, warm underwear should be worn and cold sitting surfaces should be avoided. Baths and sauna visits can drain the fluid on the skin and intestines, often improving symptoms. Naturopathy recommends preparing a decoction from a fresh couch grass and drinking it in small sips. Regular consumption of horseradish, corn tea and calcium-containing foods has also proven beneficial. However, in case of urinary retention as a result of bladder stones or a serious illness, medical treatment is always necessary. Supporting the therapy with home remedies is sometimes possible, but should always be done in consultation with the responsible physician. If the above measures do not show any effect, the family doctor or a urologist should therefore be consulted in any case.
