Urinary Retention in Babies - Types, Causes, Clinical Features, and Management

Introduction

A child’s bladder can hold approximately 60 to 250 milliliter volumes of urine. The holding capacity varies with age. An increase in volume stimulates the brain signal to urinate. Therefore, the importance of retained urine is increased than bladder capacity. The child has the urge to urinate, but the child is unable to urinate. It can persist for more than twelve hours. Urinary retention can be acute and chronic based on duration and cause. In case of acute urine retention, immediate treatment is required.

What Are the Types of Pediatric Urine Retention?

There are two types of urinary bladder retention found in children.

• Acute Urinary Retention: It is of sudden onset and persists for a shorter period. The child cannot urinate even if the bladder is filled. As a result, there is severe abdominal pain. The child needs treatment immediately.

• Chronic Urinary Retention: It is of gradual onset. It occurs over a longer duration of time. The child can urinate in this condition, but the bladder is not completely emptied.

What Are the Causes of Pediatric Urinary Retention?

Infection: It is a common cause of pediatric urinary retention. Various infections, cystitis pyelonephritis, causes urinary retention. Viral infections from adenovirus also cause urinary retention.

• Neuromuscular Disorders - Urinary retention is prevalent in children suffering from neuromuscular dysfunction. Multiple sclerosis, acute disseminated encephalitis, multiple sclerosis, spina bifida, and Guillain-Barre syndrome are neuromuscular diseases that cause urinary retention in children. In addition, neuromuscular lesions such as cerebral palsy, meningocele, and arachnoiditis also cause urinary retention.

• Congenital - Congenital obstructive lesions such as posterior urethral valves and polyps are also causes of urinary retention in children.

• Constipation - Distended rectum causes elevation of bladder floor and posterior urethra resulting in urinary retention.

• Medications - Medicines such as neuroleptics, antihistamines, and alpha-adrenergic agonists cause urinary retention.

• Inflammatory Process - Abscess, meatal stenosis, and labial adhesions cause urinary retention.

• Hypermagnesemia - It is found in newborns exposed to maternal magnesium, resulting in urinary retention.

• Overdistension - If the bladder is stretched beyond its standard capacity, it impairs the elastic properties and causes voluntary overdistention.

What Are the Clinical Features of Pediatric Urinary Retention?

The signs and symptoms of urinary retention depend on the type.

1. Acute Urinary Retention - Following are the signs and symptoms of acute urinary infection.

   1. There is severe pain present in the lower part of the abdomen.

   2. The presence of bloating in children is seen.

   3. The child feels the urge to urinate but is unable to pass urine.

2. Chronic Urinary Retention - The following are the signs and symptoms of chronic urinary infection.

   1. There is the presence of abdominal pressure.

   2. The urine stream appears to be weak.

   3. There is the presence of mild abdominal pain.

   4. The child feels the urge to urinate frequently.

   5. The child faces difficulty in emptying the bladder.

What Is the Treatment Plan for Pediatric Urinary Retention?

Pediatricians treat urinary retention based on the type and cause of urinary retention.

Following are the management methods for pediatric urinary retention.

1. Draining Bladder - In case of acute urinary retention, the pediatrician drains the bladder immediately with the help of a catheter. Emptying the bladder reduces abdominal pain. In addition, it prevents kidneys from getting damaged. The catheter used is of the intermittent type, and it is removed after usage.

2. Medications - Medications help treat medical conditions in which urinary retention is found. Alpha reductase inhibitors improve the flow of urine. In addition, it helps in shrinking the growth of the prostate. Dutasteride and Finasteride have commonly used alpha-blockers. Alpha blockers such as Prazosin, Silodosin, and Terazosin relax muscles in the bladder necks. Relaxation of muscle causes urination. A combination of five alpha-reductase inhibitors and alpha-blocker blockers can be given to the child. In case of infections such as urinary tract infections, antibiotics are given.

3. Stoppage of Drugs - If any medicine is causing urinary retention in the child, parents should stop it immediately or lower the dose of medicine.

4. Cystoscopy - In this Process, a cystoscope removes the blockage from the urinary tract.

5. Laser - Laser therapy is used to remove blockage or obstruction by strong beams of the laser. It helps in treating enlarged prostate tissue and reducing the obstruction.

6. Electrovaporization - In this Process, heat vaporizes enlarged prostate tissue. It is also known as transurethral vaporization.

7. Rezum - In this Process, transurethral water vapor is used to shrink the enlarged tissue.

8. Urolift - Prostatic implants lift the prostate away from the urethra so that urine can flow freely.

9. Urethral Dilation - The size of the urethra is gradually increasing by stretching the scar tissue. It helps to treat urethral stricture.

10. Surgery - Surgery is indicated if invasive treatment is not working. Following are the surgical procedures used to treat urinary retention.

    1. Removing prostate.

    2. Repairing urethral strictures.

    3. Repairing pelvic organ prolapse.

    4. Urinary diversion procedures.

    5. Removing herniated disc.

    6. Repairing abnormal bladder and urethra.

What Should Parents Do if Their Child Is Suffering From Urinary Retention?

Parents should take the following measures if the child suffers from urinary retention.

• Parents should properly monitor and observe their children.

• Parents should give their children a warm water bath as warm water helps relax the muscles and helps drain the urethra.

• A warm towel should be kept below the baby’s navel.

• Parents should encourage the child to walk lightly.

• Parents should keep their child in the toilet for some time to create a psychological effect.

• Parents should maintain the fluid intake of the child.

• Parents should give their children a lot of fruits and vegetables to avoid constipation.

• Parents should take the child to a pediatrician timely for treatment.

Conclusion

Urinary retention causes difficulty in urination. It is commonly found in children with neuromuscular disorders. Children suffering from diseases are irritable, crying, and extremely uncomfortable. Parents are clueless and worried about this situation. Prolonged untreated urinary retention can cause distension of the bladder resulting in stagnation of urine, causing urinary tract infections. If the urine retention is acute, it requires emergency treatment. Parents should visit a pediatrician if they see signs and symptoms in a child.