Urinary retention

and Carola Felchner, science journalist

Hanna Rutkowski is a freelance writer for the medical team.

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Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Urinary retention (medical: ischuria) usually results from a blockage of the urinary tract. The bladder continues to fill up, but the person is unable to drain the urine. If this condition occurs suddenly and acutely, it is a medical emergency. But chronic urinary retention also endangers the kidneys. Read here what causes urination problems, how urinary retention manifests itself and how it is treated.

Brief overview

What is urinary retention? Doctors speak of urinary retention when the bladder is filled, but the person concerned cannot voluntarily drain the urine. There is acute and chronic urinary retention.
Symptoms: With acute urinary retention, a feeling of pressure and severe pain. With chronic urinary retention, there is often no pain, but an increased urge to urinate (without being able to drain much urine) or incontinence.
Causes: mechanical causes (e.g. enlarged prostate, uterine subsidence), neurogenic causes (such as multiple sclerosis, diabetic polyneuropathy), psychological causes (such as fear, stress), certain medications, pregnancy
What to do with urinary retention You can, among other things, do bladder training. If necessary, the cause must be treated medically (e.g. insertion of a catheter for acute urinary retention).

Urinary retention: definition

If the bladder is full to the brim, but the person concerned cannot empty the urine willingly, doctors speak of urinary retention or ischuria.

Doctors differentiate between the acute and the chronic form of urinary retention:

Acute urinary retention often affects older men. As a result of a benign enlargement of the prostate (benign prostatic hyperplasia), the urethra can suddenly narrow. Then the bladder fills steadily, but the person concerned can no longer pass urine. Kidney stones or bladder stones, tumors or nerve disorders (e.g. a herniated disc) can block the urinary tract and cause urinary retention.

Acute urinary retention is a medical emergency as the bladder can rupture. Call the emergency doctor immediately (Tel. 112)!

Men with benign prostate enlargement are also particularly affected by chronic urinary retention. However, it can also occur with weakened bladder muscles, bladder stones, a narrowing of the urinary tract or with certain medications. If left untreated, the symptoms of urinary retention can become permanent.

Urinary retention: symptoms

The symptoms depend on whether it is acute or chronic urinary retention.

Acute urinary retention: symptoms

In the case of acute urinary retention, the affected person cannot urinate. He then usually has an uncomfortable feeling of pressure up to severe pain in the lower abdomen, because the bladder continues to fill and expand. The abdomen sometimes swells up visibly.

Chronic urinary retention: symptoms

With chronic urinary retention, the sphincter muscles give way at some point due to the constantly overflowing bladder and the strong stretching of the tissue. The consequences of this so-called overflow bladder are dripping urine and incontinence (overflow incontinence).

In contrast to acute urinary retention, chronic urinary retention usually causes no pain, but in addition to the above, but among others, the following complaints:

Frequent need to urinate without really being able to urinate much
Urge to urinate even after urination

If the bladder is chronically overfilled, the urine can also back up into the kidney pelvis, which can lead to serious kidney damage. Chronic urinary retention must therefore urgently be treated and checked by a doctor!

Urinary retention: causes

Sometimes obstructed urinary tracts cause urinary retention. The urination problems can also have other causes.

Mechanical blockage of the urinary tract

Benign enlargement of the prostate: The prostate is a man's gland underneath the bladder that produces seminal fluid. It grows larger with age and narrows the surrounding structures of the bladder and urinary tract. Urinary retention can result.
Uroliths (uroliths): Urinary stones or kidney stones often manifest themselves as colic-like pain in the lower abdomen and in the kidney area.If they get stuck in the urinary tract or if they block the bladder, urinary retention can also occur.
Narrowing of the urethra (urethral stricture): A urethral narrowing is usually found in patients who have had urinary catheters placed before. But it can also be innate. Injuries and inflammation can also narrow the urethra, causing problems with urination.
Urethral valves: These small growths in the urethra only occur in boys and are often noticeable during prenatal ultrasound examinations. Urinary retention can develop in those affected even in the womb.
Malignant bladder tumor: bladder cancer (bladder carcinoma) often first manifests itself as blood in the urine. Stuck blood clots or the tumor itself can also cause urine congestion.
Uterine lowering: In older women, the cause of urinary retention is often a lowering of the uterus - due to the lack of estrogen after menopause or widely stretched pelvic ligaments after several births, the uterus can lower in the pelvis and then block the urinary tract.

Neurogenic voiding disorders

In various diseases or interventions, nerve tracts that control bladder function can be affected. Voluntary urination can be disturbed or even impossible. The consequences are incontinence or cramping of the muscles with urinary retention. Causes of a neurogenic voiding disorder are:

Diabetic polyneuropathy: A long-term poorly controlled blood sugar level in diabetes mellitus can damage nerves that control organ functions and stimulus reception. The bladder function can also be impaired, which can manifest itself in disorders of bladder emptying with urinary retention.
Spina bifida: If the spine does not close completely at one point during embryonic development, a so-called "open back" is created. The spinal cord can be partially exposed, depending on the severity. If nerve tissue is affected, this can lead to paralysis of the legs or urination disorders.
Multiple sclerosis: Here inflammatory processes destroy the nerves in the brain and spinal cord. A consequence of this can be bladder emptying disorders.
Herniated disc: In the case of an acute, severe herniated disc, problems with urination in the form of incontinence or urinary retention are not uncommon.
Paraplegic syndrome: In the case of paraplegia, nerve tracts in the spinal cord are injured - the level at which this happens affects the symptoms that occur. Paralyzed limbs and impaired bladder and bowel emptying are typical. If there is a muscle cramp (muscle spasm), this can also lead to urinary retention.
Spinal anesthesia: This type of local anesthesia numbs certain parts of the spinal cord, for example before a caesarean section. A temporary effect of this can also be urinary retention. Most of the time, however, this disappears on its own without medical intervention.

Medication

Various drugs affect bladder function, such as:

Anticholinergics (e.g. for COPD)
Diazepam (a sedative)
Antidepressants
Neuroleptics such as haloperidol or fluspirils (given, among other things, for states of excitement, hallucinations or schizophrenic psychoses)

pregnancy

When the uterus dilates and gets bigger, acute urinary retention can occur in the first few months of pregnancy. Most of the time it is a one-time event. However, you should urgently consult your gynecologist if the urinary retention does not go away on its own.

psyche

A certain form of anxiety disorder causes the bladder muscles to become so tight that urinary retention occurs. Doctors then speak of paruresis, a mentally caused bladder emptying disorder. A trigger for this mental disorder can be anxiety, stress, or simply the shame of urinating in public toilets.

Urinary retention: you can do it yourself

Occasional urination problems, e.g. B. During pregnancy or with a benign enlarged prostate, the following techniques can reduce or prevent urinary retention:

No dehydrating drinks: If you have a constant urge to urinate anyway (even after urinating), you should avoid coffee and cola.
What to do if the urge to urinate constantly: Men with enlarged prostates in particular suffer from a constant urge to urinate. Develop strategies to keep you from going to the bathroom, such as: B. sit on a chair, bend forward and down like tying shoes and wait until the urge to urinate subsides.
Bladder training: Also useful if you have a constant urge to urinate as a result of an enlarged prostate: Try not to give in to going to the toilet. Avoid going to the toilet "as a precaution" and try to gradually increase the time between toilet visits. This is how you train your bladder to hold more urine.
Relaxation bath for pregnant women: If you have urinary retention during pregnancy, you can first try to relax the bladder muscles yourself with a warm bath. If the bath does not help, you have to see a doctor!

First aid for acute urinary retention

Acute urinary retention is dangerous: if the bladder is constantly filling with urine and if it is no longer possible to empty it at will, the bladder may rupture. Therefore, acute urinary retention is considered a medical emergency for which you must provide first aid:

Emergency call: In the event of acute urinary retention, call the emergency doctor (Tel. 112) immediately!
Correct positioning: Position the affected person as he / she tolerates. A lying position with knees drawn up is often the best option.
Check vital functions: check the blood pressure, pulse and breathing of the person concerned!
calm down: Talk to the patient calmly and gently until the ambulance arrives.

Urinary retention: what does the doctor do?

In the case of urinary retention, the doctor must find the cause as soon as possible. In an initial consultation to collect the medical history (anamnesis), the doctor collects important background information. Possible questions are, for example:

How long have you had urination problems?
Have there been any surgical interventions in this area in the past?
Do you suffer from a condition such as diabetes mellitus, COPD or kidney disease?
Do you take any medications?

During the following physical examination, the doctor palpates the abdomen and abdomen. A full bladder is easy to feel. For men, the unpopular digital rectal examination is inevitable. The doctor feels the rectum and surrounding structures such as the prostate with a finger that he inserts into the patient's anus. An enlarged prostate can be felt in this way.

Urine and blood tests are also important to clarify urinary retention. The urine sample may provide information about bacterial infections, blood and proteins in the urine. The blood sample provides information about kidney function and the level of prostate PSA. Sometimes more kidney function tests are needed.

The most important method to quickly find the cause of urinary retention is nowadays an ultrasound examination (sonography). The kidneys, the pelvis and the filling level of the bladder can be viewed painlessly and without surgery. Tumors or stones in the urinary tract can also usually be seen on ultrasound.

Depending on the cause, further imaging examinations such as x-rays, computed tomography (CT) or magnetic resonance imaging (magnetic resonance imaging, MRI) are sometimes necessary. This way, for example, possible tumors can be represented well.

In cytoscopy (bladder speculation), the doctor inserts a tiny camera attached to a thin tube through the urinary tract into the bladder. For example, he can detect changes in tissue or narrowing of the urethra. Pathological processes in the urinary bladder can also be made visible in this way.

Before the cystoscopy, however, the bladder must be emptied using a urinary catheter. To do this, the doctor pushes a thin plastic tube over the urethra to the bladder and collects the draining urine in a bag.

The doctor can also insert fine instruments for minor surgical interventions through the thin tube that is pushed into the urinary tract during the urinary tract.

Emergency acute urinary retention - that's what the doctor does

In the case of acute urinary retention, the bladder continues to fill. A bladder rupture threatens. Inserting a catheter is the only solution to then relieve the bladder. There are two options:

Urinary catheter: The doctor pushes a thin tube through the urethra to the bladder (as in the run-up to a cystoscopy). This will allow the pent-up urine to drain and the severe pain will subside immediately. Depending on your needs, this catheter can be left for a short time or for a longer period of time.
Suprapubic catheter: If the catheter is to remain in place for a longer period of time, the doctor can insert the tube directly into the bladder through a skin incision above the pubic bone. However, this method is associated with greater effort and is therefore used less often.

Urinary retention: when should you see a doctor?

If you suddenly cannot pass urine despite the urge to urinate (acute urinary retention), you should call an emergency doctor immediately! Otherwise there is a risk of a rupture of the bladder and long-term damage to the kidney. Most of those affected see a doctor anyway because of the severe pain.

With chronic urinary retention, the symptoms often come on late. But the consequences for the kidneys can be devastating. This is why you should see a urologist if you have any of the following urination problems: