Acute Urinary Retention - Causes, Diagnosis, and Management

What Is Acute Urinary Retention?

The urinary bladder resembles a storage tank that stores urine temporarily. Normally, the patient urinates when the bladder becomes full. However, a problem arises when this urine fails to leave the body resulting in a condition known as acute urinary retention. This condition can affect both males and females and can be caused by medications, blockages, and nervous issues. Urinary retention can be acute or chronic. Acute urinary retention happens suddenly and lasts only for a short duration. However, the condition might turn severe at times. Patients suffering from acute urinary retention cannot pass urine even though their bladder is full. The condition can be severe or life-threatening, so the patient must seek medical attention at the earliest. Acute urinary retention is not a disease but a symptom of prostate problems and cystocele.

What Causes Acute Urinary Retention?

Urinary retention is mainly caused by a blockage that does not allow urine to exit the body through the urethra. Sometimes, urinary retention might also occur due to the inability of the bladder to maintain a strong force to expel the urine. The causes of urinary retention are listed below:

1. Blockage - Normally, if a person has to urinate properly, all parts of the urinary tract must work together. Urine flows from the kidneys to the urinary bladder through the tubes known as the ureters. Acute urinary retention occurs when one or more of the organs of the urogenital tract become blocked. As a result, the patient finds urination difficult, resulting in urinary retention. The following conditions block the urine flow:

• Enlargement of the prostate gland.

• Obstruction of the bladder outlet.

• Constipation.

• Pelvic organ prolapse.

• Urinary tract infections.

• Sexually transmitted diseases.

2. Underactive Bladder - A patient might develop urinary retention if the bladder muscles fail to contract with the required strength or do not contract long enough to allow bladder emptying. This condition is also known as an underactive bladder. The causes of the underactive bladder are mentioned below:

• Neurological Problems - Acute urinary retention usually occurs due to problems in the nervous system. Problems in the nervous system can damage the nerves that carry messages from the brain to the urinary bladder and vice versa. The following neurological problems can cause an underactive bladder:

  • Multiple sclerosis.

  • Parkinson’s disease.

  • Stroke.

  • Alzheimer’s disease.

  • Diabetes.

  • Spinal cord injury.

  • Pelvic injury.

• Medicines - The following medications interfere with bladder function and are responsible for urine retention:

  • Anticholinergics.

  • Antidepressants.

  • Antihistamines.

  • Antipsychotics.

  • Benzodiazepines.

How Is Acute Urinary Retention Diagnosed?

The doctor uses the patient’s medical history, laboratory tests, and imaging tests to diagnose urinary retention. The diagnostic methods are listed below:

1. Medical History - A doctor will thoroughly record the patient’s medical history to know about the following:

• Symptoms.

• Current medical problems or past medical problems, including the use of catheters or other operations.

• Prostate problems.

• Pregnancy.

• History of childbirth.

• Prescription medications.

• Eating or drinking habits.

• Bowel or bladder habits.

2. Physical Examination - The doctor examines the patient to evaluate the lower abdomen, rectum, and neurological examination. The doctor will examine the pelvis in the case of a female patient.

3. Post-void Residual Urine Measurement Test - Doctors use this test to measure the amount of urine that remains in the bladder after urinating. The doctor mainly uses an ultrasound or catheter to measure the amount of urine left in the bladder or post-void residual urine volume.

4. Urinalysis - Urinalysis is done to detect the exact cause of acute urinary retention, including diabetes, kidney problems, or urinary tract infections.

5. Blood Test - A blood test helps detect problems related to kidney functions or chemical imbalances in the body.

6. Ultrasound - Ultrasound is one of the most widely used imaging tests to look at the structures inside the body using sound waves.

7. Voiding Cystourethrogram - This procedure uses X-rays to show urine flow through the urethra and the bladder.

8. Computed Tomography (CT) Scan - This procedure uses computer technology and X-rays to produce images of the urinary tract. It is considered one of the most effective diagnostic methods because it provides a three-dimensional view of the urinary tract.

9. Cystoscopy - Cystoscopy is a diagnostic procedure wherein an instrument known as a cystoscope is inserted into the urethra to view the urinary tract and diagnose the exact cause of urinary retention.

10. Electromyography (EMG) - The doctor might recommend it if urinary retention is associated with neurological disorders. One such test is electromyography. It is a procedure that uses sensors to measure the electrical activity of the nerves and muscles near the urinary bladder and the urethral sphincter.

11. Prostate-Specific Antigen - It is nothing but a blood test done to screen the patient for prostate cancer. This is because prostate cancer is one of the most common causes of urinary retention.

How Is Acute Urinary Retention Treated?

The management of acute and chronic urinary retention is different. For example, in acute urinary retention, a catheter is inserted into the urethra to drain the urine from the urinary bladder. The treatment options according to the causes of urinary retention are listed below:

1. Medicines for Enlarged Prostate Gland - Males having enlarged urinary retention due to the enlargement of the prostate gland can take alpha-blockers, including Tamsulosin, Alfuzosin, and five alpha-reductase inhibitors, including Finasteride.

2. Surgery for Enlargement of the Prostate Gland - Numerous surgical procedures can be performed under general anesthesia to treat prostate problems. These procedures mainly include transurethral resection of the prostate gland or operating the gland with the help of LASER (light amplification by stimulated emission of radiation).

3. Management of Urethral Strictures - Urethral stricture or narrowing of the urethra is one of the most common causes of urinary retention. Hence, the doctor might attempt to widen the urethra with a catheter to facilitate urine drainage. Another method to treat a urethral stricture is to make an incision in the scar present in the urethra. Sometimes, a small surgery known as urethroplasty can be done to fix urethral problems.

4. Management of Urinary Retention in Females - Females suffering from cystocele, rectocele, or other mild to moderate conditions can be recommended exercises that strengthen the muscles of pelvic color. The condition can also be treated by inserting a ring known as the vaginal pessary to support the urinary bladder. The doctor might suggest estrogen therapy for females who are in the post-menopausal stage.

Conclusion

Acute urinary retention differs from chronic as the former occurs spontaneously, whereas the latter persists for prolonged periods. However, urinary retention is a severe condition, so the patients diagnosed with it must not ignore the symptoms. This is because urinary retention can give rise to several other urologic problems. Hence, the patient must seek medical attention earliest to know more about its management and prevention.