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What is Urinary Retention? How can you treat it?

How it Works and What You can Do


Urinary retention


Urinary Retention is a condition that applies to the urinary tract. Urinary Retention makes urinating difficult, if you can urinate at all. There are two forms of Urinary Retention: acute and chronic.


If you have Acute Urinary Retention, you will suddenly lose the inability to urinate at all. This sensation lasts for a short period of time. Along with not being able to urinate, you will feel pain and the urgent need to urinate. There will be pain or discomfort in the lower abdomen, as well as bloating. Although Acute Urinary Retention comes on suddenly and lasts a short while, it can be potentially-life threatening, discomforting, and painful. If you experience Acute Urinary Retention you should seek medical treatment immediately.


If you have Chronic Urinary Retention, that means your condition is long-lasting. You can still urinate, but you cannot completely empty your bladder of urine. With Chronic Urinary Retention comes the hyper frequency of urination, meaning you may pee eight or more times a day. You may also have a hard time starting urination, have a weak stream, and the urgent need to pee but very little success when trying to pee. Sometimes you may feel the need to urinate even after urinating. Chronic Urinary Retention is also associated with mild, constant discomfort in the lower abdomen and urinary tract. Sometimes you may not even realize you have this condition until you develop Urinary Incontinence or a Urinary Tract Infection. Urinary Incontinence is the loss of bladder control. Urinary Tract Infection is an illness caused by harmful bacteria that has grown in your urinary tract due to the inability to urinate.


Common Causes of Urinary Retention


Urinary Retention is generally caused by an obstruction of the urethra, nerve issues, medications, and weakened bladder muscles.


Urinary Retention results from the obstruction of the urethra because the normal urine flow out of the body is blocked. Some conditions that can cause obstruction of the urethra are: benign prostatic hyperplasia (BPH), urethral stricture, urinary tract stones, cystocele, rectocele, constipation, and certain tumors and cancers.


Benign Prostatic Hyperplasia is a condition when the prostate gland is enlarged and not cancerous. The prostate is a major part of the male reproductive system. The prostate gland surrounds the bladder neck, where the bladder and urethra meet. This gland enlarges in two stages of a man’s life, and it is in the second stage that BPH can occur. When the prostate gets too big with this condition, it presses against and pinches the urethra. The bladder wall thickens. As a result the urethra is blocked and the bladder weakens, causing the inability to urinate properly. This is the same reason why cancerous tumors that grow in the pelvic area can also cause Urinary Retention.


Urethral Stricture is another major cause of Urinary Retention, as it is the narrowing or closure of the urethra. Inflamed scar tissues (due to surgery), disease, chronic UTIs, or injury can result in Urethral Stricture. This condition may affect men who have had prostatitis. Prostatitis is the scarring of the penis or perineum (the area between the anus and sex organs) after injury or surgery. It is painful due to inflamed tissue of the prostate and around the prostate. Men have a longer urethra than women, so urethral stricture is more common in men.


When pelvic floor muscles cannot relax urethral stricture can occur, which is what happens mostly in women regarding the urinary tract.


Pelvic Organ Prolapse Surgery like cystocele and rectocele can also cause Urethral Stricture, but generally it gets better a few weeks post-surgery. This can occur after vaginal childbirth.


Cytocele is when the bladder bulges into the vagina. This happens when the pelvic floor muscles that support the woman’s bladder and vagina weaken and stretch. This makes the bladder loosen from it’s proper position and sag into the vagina. Because the bladder is in such an unusual position, it may press against and pinch the urethra, blocking the urine flow.


Rectocele is when the rectum bulges into the vagina. This happens when the pelvic floor muscles that support the tissues between the rectum and vagina weaken and stretch. This makes the rectum loosen from it’s proper position and sag into the vagina. Because the rectum is in such an unusual position it may press against and pinch the urethra.


Constipation is when you have less than three bowel movements a week, or stool is hard, dry and small making it painful or difficult to defecate. Constipation causes Urinary Retention because the hard stools or large amount of stool in the rectum can push against the bladder and urethra. This causes the urethra to be pinched.


Urinary Tract Stones are also a major and common cause of Urinary Retention. Urinary Tract Stones are Crystals formed in urine build up along the inside of the kidneys, uterus or bladder. When the stones try to pass out of the body, they can become lodged in the bladder and may black the opening of the urethra.


Nerve Problems are also a major cause of Urinary Retention. If there is an issue with the nerves that control the bladder and the sphincter you may have a hard time urinating. If nerves are damaged, the signals to the brain that your bladder is full may not come through. Or if you know your bladder is full, when you try to push the urine out your brain may not understand the signal to push. In turn, your sphincter may not get the signal to relax. There are many causes for this type of nerve problem: vaginal childbirth, brain or spinal cord infections or injuries, diabetes, stroke, multiple sclerosis, pelvic injury or trauma, and heavy metal poisoning. Sometimes you can be born with certain disorders that cause this damaged nerve condition, like spina bifida.


While health conditions and injuries etc can cause Urinary Retention, so can the medications you are taking! Certain medications can interfere with the nerve signals to the bladder and prostate. Medications like antihistamines to treat allergies, cetirizine (Zyrtec), chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), and  fexofenadine (Allegra) can have the side effects of Urinary Retention.


Sometimes anticholinergics/antispasmodics used to treat stomach cramps, muscle spasms, and urinary incontinence can cause Urinary Rentention as well. These medications include hyoscyamine (Levbid), oxybutynin (Ditropan), and propantheline (Pro-Banthine), tolterodine (Detrol).


Medications that treat anxiety and depression (tricyclic antidepressants) may also be causing Urinary Retention. These medications include amitriptyline (Elavil), doxepin (Adapin), imipramine (Tofranil), and nortriptyline (Pamelor)


If you are taking any medications other than these and experience Urinary Retention, talk to you psychiatrist and or physician. There are many other medications that could be causing your inability to urinate.


Even over-the-counter cold and allergy medications can cause Urinary Retention. Ones that have decongestants like pseudoephedrine and antihistamines, such as diphenhydramine, can increase symptoms of urinary retention in men with prostate enlargement.


What are the Treatments for Urinary Retention?


Urinary Retention can be alleviated and or cured with the following treatments: bladder drainage, urethral dilation, urethral stents, prostate medications, and surgery.


Treatments will vary depending on why you have Urinary Retention and what cause your Urinary Retention.


Bladder Drainage is a common treatment of both Acute and Chronic Urinary Retention. With Acute, the procedure involves a catheter inserted into the urethra to drain the urine from your bladder.


For those with Chronic Urinary Retention this treatment may need to be occasionally repeated. Some patients may need long-term catheterization if other treatments prove fruitless.


Urethral Dilation is used to treat urethral stricture. It widens the urethra by increasingly inserting wider tubes, to alleviate the stricture. Sometimes, Urethral Dilation involves the method of inflating a small balloon at the end of a catheter inside the urethra. Again this widens the stricture.


Urethral Stents is another treatment for urethral stricture. An artificial tube is inserted into the urethra up until the stricture area. This tube is called a stent. Once the stent is in it’s proper place, it expands in a spring-like fashion, pushing back the surrounding tissue. This widens the urethra, allowing urine to pass through. Stents can be temporary or permanent.


Prostate Medications can help alleviate Urinary Retention in men who have symptoms due to benign prostatic hyperplasia. This medications include dutasteride (Avodart), and finasteride (Proscar). Other medications that relax the bladder muscles and prostate include: alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tadalafil (Cialis), tamsulosin (Flomax), terazosin (Hytrin). With a relaxed bladder and urethra, you are able to pass urine better.


Surgical options are also available. Prostate surgery surgically removes or destroys the enlarged prostate tissue, due to benign prostatic hyperplasia. Other forms of prostate surgery exist as well, for the different issues that come with an enlarged prostate. Internal Urethrotomy surgery is performed by a urologist who can repair the urethral stricture by inserting a special catheter into the urethra until it reaches the stricture, and makes an incision in the stricture. For women, Cystocele or rectocele repair lifts the fallen bladder from the vagina or the rectum, by tightening up the tissues that support the pelvic organs. Tumor and cancer surgery treats Urinary Retention with the removal of tumors and cancerous tissues in the bladder or urethra.


While Acute Urinary Retention can be very scary, and Chronic Urinary Retention can be discomforting, there are treatments. The majority of these treatments can be done in your physicians office, an out patient clinic, or in a hospital. It’s important to take care of your Urinary Retention because urine is a major form of alleviating your body from its toxins. Seek treatment as soon as possible and stay healthy!

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