Urinary retention can be painful and have a variety of causes. A first step in combating it is to adequately diagnose the cause.
What is urinary retention?
Schematic diagram showing the anatomy and structure of the urinary bladder. Click to enlarge. In medicine, urinary retention (also known as ischuria) is when a person’s bladder is full and he also feels an urge to urinate, but he is unable to urinate. Urinary retention thus belongs to the so-called bladder emptying disorders. Depending on the person affected, urinary retention can lead to severe pain and/or a feeling of pressure in the bladder area. Both are caused, among other things, by the overstretching of the bladder wall in the case of urinary retention. If urinary retention persists over a longer period of time, the bladder sphincter may become dysfunctional; such dysfunction is manifested, for example, in urinary dribbling that cannot be influenced voluntarily.
Causes
Urinary retention can have several causes. For example, acute urinary retention in men (that is, urinary retention that is present for a short time) is often caused by benign enlargement of the prostate (prostate gland). Such an enlargement of the prostate can lead to a narrowing of the urethra and thus to urinary retention. Other possible causes of urinary retention due to a narrowed urethra include herniated discs, bladder stones or injuries to the urethra. Spinal anesthesia (anesthesia administered in the spinal cord) during surgery can also cause urinary retention lasting several hours. Urinary retention due to medication is also possible; for example, medications used to treat incontinence can provoke urinary retention. The same applies to other medications, such as certain antidepressants. Last but not least, short-term urinary retention can occur due to psychological factors; for example, situational time pressure or on outings.
Diseases with this symptom
- Prostate enlargement
- Herniated disc
- Bladder stones
- Paruresis
- Urinary stones
- Urethral stricture
- Bladder cancer
- Paraplegia
- Uterine prolapse
- Polyneuropathy
- Spina bifida
- Multiple sclerosis
Diagnosis and course
Diagnosis of urinary retention can already be frequently based on the complaint description of the affected patient. To determine the causes that are hidden behind a urinary retention, the possible procedures include, for example, a urine examination. This examination can provide information about possible pathogens underlying urinary retention. Other possible methods of investigation to determine the causes of urinary retention include blood tests or taking swabs. Occasionally, urinary retention may also require additional procedures, such as ultrasound or MRI (magnetic resonance imaging) scans. The course of urinary retention depends largely on the causative factors. If the causes can be medically eliminated relatively quickly or subside on their own, the urinary retention often recedes as a result. If urinary retention is based on longer-term causes, it can lead to a chronic course of symptoms without necessary measures, for example.
Complications
Urinary retention can lead to a number of complications. In chronic disease, the urinary tract expands over time to accommodate the increased pressure, which also places excessive stress on the kidney. This can result in what is known as water kidney (hydronephrosis): the kidney dilates, scars and eventually shrinks (shrunken kidney). In addition, infections of the urinary tract occur due to the accumulated urine, which facilitates the spread of pathogens in the body. A possible consequence is urosepsis, i.e. an acute infection of the urogenital tract, which also further weakens the kidney as the disease progresses. Kidney function continues to decline, leading to irreversible damage such as chronic renal failure, often accompanied by hypertension, edema over the entire body (dropsy), and confusion. Urinary retention in children can lead to the need for dialysis.A donor kidney is often the only way to regenerate the urinary tract. Depending on the severity of the urinary retention, further complications may occur. Almost always there is severe pain in the urinary tract and especially in the kidneys, often in combination with bacterial diseases, the formation of abscesses and in severe cases tumors in the renal and genitourinary tract. Lastly, urinary retention favors various organ diseases. In addition to the kidney, the heart, liver, and gastrointestinal tract are also excessively burdened.
When should you go to the Art?
Urinary retention is a bladder emptying disorder that absolutely requires immediate medical attention. People affected by urinary retention will try to see a doctor as soon as possible anyway. If they are still unable to empty their bladder, which is obviously full and they have a corresponding urge to urinate, or if they can do so only very slowly, and if they also experience severe pain, this is extremely worrying and quickly leads to a high level of suffering. The causes of urinary retention are manifold. A classic cause of urinary retention in men is benign prostatic enlargement, in which urinary retention occurs due to a narrowing of the urethra. In both sexes, urinary retention can also occur due to bladder stones, urethral injuries, herniated discs, uterine prolapse and bladder cancer, as well as certain medications. Impaired bladder emptying in diabetes mellitus and multiple sclerosis should also be considered. In addition, urinary retention can be psychological. Acute urinary retention, in which no urine can be passed at all, is considered a medical emergency. In this case, the bladder must be emptied immediately via a catheter to prevent the bladder from rupturing. This is followed by therapy for the underlying condition. However, chronic urinary retention, which is not always painful, also requires medical treatment because it damages the kidneys in the long term. In addition, the pressure of a constantly overfilled bladder weakens the sphincter muscle and incontinence threatens.
Treatment and therapy
In order to successfully treat medically relevant urinary retention, a thorough diagnosis of the cause is first necessary. According to the identified causes, the individual therapy for urinary retention is then designed. In order to initially relieve the acute pressure on the bladder wall and possible pain in cases of urinary retention, a symptomatic intervention is often the emptying of the bladder with the aid of a urethral catheter. Such a catheter is inserted into the urethra in case of urinary retention and allows urine stagnated in the bladder to drain. The length of time that a urinary catheter remains in the urethra of an individual patient depends on the cause of the urinary retention. This can be followed by treatment of the cause of urinary retention: For example, if the urinary retention is bacterial, antibiotics may be administered to combat the underlying infection. If urinary retention is due to bladder stones in the affected person, the corresponding bladder stones are usually removed; this is possible, for example, by means of minor surgical procedures. If urinary retention is due to malignant or neurologic diseases, for example, an important aspect is treatment of the corresponding underlying disease.
Outlook and prognosis
The prognosis depends on the underlying disease. If urinary retention is recognized and treated in a timely manner, there are usually no complications. With controlled emptying of the overfilled bladder through a urethral catheter, injury to the bladder may occur in rare cases. If left untreated, urinary retention can become chronic. Acute urinary retention threatens to rupture the bladder. Urinary retention kidney is also possible. As urinary retention progresses, incontinence may occur because the stagnant urine increases the pressure in the bladder until overflow incontinence develops. Men are more frequently affected by acute urinary retention than women. To enable a comprehensive diagnosis and prognosis for recovery, female patients undergo a different clinical examination than male patients because of different anatomical conditions. Gender-specific underlying diseases such as prostate enlargement in men and cervical cancer in women may also be the cause. The course of the disease is more protracted if a herniated disc or multiple sclerosis is the trigger for urinary retention, as these underlying diseases are themselves associated with different complications.In most cases, urinary retention is due to bladder stones, cystitis, urethritis, urinary tract infection or stress. In these underlying conditions, the prognosis is positive because these symptoms can be treated specifically and promptly with medication within a period of two to three weeks.
Prevention
The possibility of preventing urinary retention depends on its causes. For example, bacterial urinary retention can be prevented by taking adequate hygienic measures in the intimate area. If there is evidence of a possible physical illness that may lead to urinary retention, other options for prevention include seeing a doctor early and starting treatment early (if necessary).
Here’s what you can do yourself
In the case of acute urinary retention, in which the bladder is constantly filling with urine but the affected person can no longer empty it voluntarily, a doctor must be consulted immediately. Self-treatment in this case poses the risk of a ruptured bladder. If there is a blockage of flow due to bladder stones, this problem must also not be treated by the patient himself. However, the affected person can do a lot to prevent bladder stones from forming again. Patients prone to bladder stones should drink at least two liters of fluid daily, preferably water or unsweetened herbal or fruit tea. In naturopathy, patients are also advised to use a number of home remedies. It is said to help to pour hot water over a fresh couch grass and let it steep for ten minutes. The decoction is drunk in small sips after cooling. Regular consumption of horseradish, corn tea and calcium-containing foods, which are supposed to bind the stone-forming oxalate in the intestine, is also considered helpful. If the urinary retention is due to an acute inflammation of the urinary tract, there are also some home remedies that can help improve the situation. In the case of cystitis, a hot water bottle on the lower abdomen often helps. The patient can also help the inflammation heal as quickly as possible by wearing warm underwear and avoiding cold sitting surfaces.
