"I exercised regularly and kept fit, thinking that I might otherwise suffer from a heart attack just like my uncle or grow fat and tired like my father. What I didn’t ever think would instead get me is... urine leakage.
After incontinence, there was just before and after. Life got tougher. Thank God, my doctor told me about Friends Adult Diapers. They helped a lot while I was waiting for the medicines to work. My urine issue is mostly under control now, life also is much better."
- Jagannath Parida, a retired police sub-inspector, in Maharashtra.
Jagannath suffered from urinary retention. A condition where the bladder – the organ that stores urine until you’re ready to relieve yourself – is unable to completely empty itself. Urinary retention is more common among men but can also affect women. It is especially common among people of older ages.
Now, there are two types of urinary retention: Acute and chronic. Both have different symptoms, and treatment, and can be hard to differentiate between. Read on to learn more about both these conditions.
What is acute urinary retention?
Acute urinary retention appears suddenly and can be dangerous. You may feel like you need to relieve yourself very badly, but nothing comes out when you try.
Symptoms of acute urinary retention may include severe pain in the lower abdomen, a sudden urge to urinate but being unable to, and swelling in the lower abdomen. You should immediately consult with a medical professional if you experience this.
What is chronic urinary retention?
Chronic retention, on the other hand, is gradual and occurs when you can urinate, but the bladder fails to empty itself completely.
Over time, the leftover urine in the bladder may build up and expose your body to toxins that are usually expelled out of your body through urine. Left unchecked, it can cause complications such as urinary tract infection and kidney and bladder damage.
So, it’s important that you seek medical assistance if you notice these symptoms of chronic urinary retention:
Urinating more than eight times a day.
Feeling like you must urinate urgently even though you just went.
Trouble starting urination.
Weak or interrupted flow of urine.
Leaking urine involuntarily without any warning or urge.
Pain or discomfort in the lower abdomen.
Not always sure if your bladder is full or empty.
Causes of acute and chronic retention
The seemingly simple process of releasing urine from the body is a complex and a coordinated effort from multiple organs, nerves and muscles in your body.
The kidneys produce urine which is then stored in the bladder until it’s ready to be released.
Once the bladder is full, it sends nerve signals to the brain to start the process of urination.
The bladder then contracts and shrinks in size pushing urine out of the bladder and into the urethra – a narrow tube that carries urine out of the body.
The passage to urethra from bladder is guarded by sphincter muscles that relax to let the urine through on the signal from the brain.
The muscles of the pelvic floor then help to push the urine out of the urethra in a controlled stream.
After urination, the bladder returns to its normal state of filling up again until it's time to repeat the process.
There are many possible causes of urinary retention based on issues that can affect the parts of this process:
The most common chronic and acute urinary retention cause. A blockage occurs when something gets in the way of urine leaving the bladder. If it happens suddenly, it causes acute retention. If blockage happens slowly over time and still allows some urine to come out, it results in chronic retention.
Some possible causes of blockage in the urine flow include:
Kidney stones or stones in other parts of the urinary tract
Tumor in the gut or hip area
Blood clots in the urethra
Enlarged prostate, prostate cancer, or injury to the penis in men specifically
Uterine prolapse, cystocele – a bulge of the bladder into the vagina, or rectocele – a bulge of the rectum into the vagina in women specifically
Specific medications can relax or weaken the muscles controlling the process of urination and result in urinary retention. Some of these medications include:
Specific pain relievers and muscles relaxers
Medications for Parkinson's disease
Some antidepressants and antipsychotics
Any damage to the nerves controlling the process of urination can result in urinary retention. Some possible causes of nerve problems include:
Injury to the brain or spinal cord
Surgeries such as spinal cord surgery and joint replacement surgery can also cause urinary retention.
Infections and inflammations
Infections and inflammations in the lower urinary tract from sexually transmitted infections (STIs) and urinary tract infections (UTIs) can also result in temporary urinary retention.
Diagnosis of Acute and Chronic Urinary Retention
Your doctor might record your health and medical history and perform a physical exam, which includes examination of your genitals and rectum.
Some other tests your doctor might ask you to take include:
Cystoscopy – a tube is inserted to view the bladder
Acute urinary retention treatment
Acute retention will need immediate treatment and a catheter – a hollow tube – will be inserted into the bladder to quickly drain the urine. You will be given local anesthesia to make sure the process isn’t painful or discomfortable.
If a catheter doesn’t work due to one or the other reasons like medical conditions, your doctor may insert a suprapubic catheter is inserted just above your pubic bone, directly into your bladder. These two treatments will ease your pain from acute retention and prevent your bladder and kidneys from being damaged.
Chronic urinary retention treatment
With chronic retention, however, your doctor will first try to diagnose the cause behind the condition and then will work together with you to come up with a treatment plan.
A catheter is used to drain the urine until a treatment proves effective. This isn’t a long-term solution and can cause complications such as infections by allowing bacteria to enter your body through the catheter. Catheters may also be used as a long-term treatment in cases of nerve problems.
Bladder training and lifestyle changes
Gradually increasing the time between urination to regain control over your bladder is called bladder training.
Lifestyle changes may include performing pelvic floor exercises, limiting fluid intake before bedtime, avoiding bladder irritants like caffeine and alcohol, practicing scheduled voiding, etc.
Medications for urinary retention work towards improving the cause behind urinary retention. For example, antibiotics are given in case of infections, and medications to reduce the size of the prostate are given in cases of enlarged prostate.
Medical procedures and devices
A flexible tube with a light and a camera is inserted into the bladder to view the insidesof the bladder, helping your doctor to find and remove any visible blockages.
A strong beam of light is used to break up the blockage or treat an enlarged prostate.
Small tubes are inserted through the urethra to widen the urethra enough to release urine.
Prostatic urethral lift:
Small implants are used to hold the prostate away from the urethra to allow for free flow of urine.
A stiff ring is inserted into the vagina to prevent urine leakage.
Surgery may be considered if the other treatments prove ineffective. Some of the surgical procedures may include:
Removal of parts of the enlarged prostate or prostate removal
Repairing cystocele, rectocele or uterine prolapse
Removal of any tumor or stones causing the blockage
Removal of cancerous tissues
Performing a urinary diversion procedure that creates a new way for urine to be released from your body
Ways to prevent urinary retention
You can’t always prevent urinary retention, but you sure can take steps to lower your chances of developing urinary retention.
Never hold your urine for too long.
Practice pelvic floor exercises.
Take medications as prescribed.
Eat a high-fibre diet, drink plenty of fluids, and exercise regularly to prevent constipation-led urinary retention.
Watch out for the symptoms of urinary retention.
Be aware of any changes in your body after a spinal cord or joint replacement surgery. It’s common for urinary retention to develop – either immediately or gradually over time – due to these surgeries. Also watch out for the other causes that might cause urinary retention such as stroke, constipation, injury to the spinal cord or brain, etc.
It’s typically easy to diagnose acute and chronic retention, especially if you see your doctor immediately after noticing the symptoms. Treatments can often prove effective and prevent any complications in future.
Whatever the treatment, your life will still be better than the period before the treatments, so reach out to your doctor at the first sign of changes in the way you urinate.
What causes acute retention of urine?
Acute retention of urine is caused by a sudden inability to pass urine, which can be due to a blockage in the urethra or a dysfunction of the bladder muscles. It can be caused by various factors such as urinary tract infections, prostate enlargement, medications, nerve damage, or constipation.
Is acute urinary retention temporary?
Acute urinary retention can be temporary or chronic. If the underlying cause is treated promptly, it may be temporary. However, if left untreated or if the underlying condition is chronic, acute urinary retention can become a long-term problem.
Is urinary retention serious?
Urinary retention can be a serious condition as it can lead to kidney damage and other complications if left untreated. It can also cause discomfort and pain and impact a person's quality of life.
What does chronic urinary retention feel like?
Chronic urinary retention may not have any symptoms in the early stages. However, as the condition progresses, a person may experience a frequent urge to urinate, difficulty starting urination, a weak or interrupted urine stream, leaking after urination, and a feeling of incomplete bladder emptying.
What is the most common treatment for urinary retention?
The treatment for urinary retention depends on the underlying cause. For example, medication, surgery, or catheterization may be used to treat prostate enlargement, while antibiotics may be prescribed for urinary tract infections. In some cases, lifestyle changes such as pelvic floor exercises and fluid management may also be recommended. The most common treatment for urinary retention is the use of a catheter to drain the bladder.