Urine retention

Urine retention, when acute, is a harrowing experience. The patient has an extreme urge and cannot urinate. His bladder is overfull, and the lower abdomen is painful and tender. Bladder catheter insertion may seem aggressive but leads to immediate relief. Afterwards, a proper diagnostic workup allows us to find the cause and treat it before removing it and returning to everyday life.

Chronic urinary retention is when the bladder empties partially after urination. In this case, pain is not common, but the patient passes just little amounts of urine frequently.

Urine retention is uncommon in young and adults, while it is more frequent while ageing.

Why does it happen?

Urine retention occurs because the bladder wall muscles do not contract enough to empty the bladder. In acute retention, the bladder outlet obstruction makes urination impossible, and the urine pressure increases in the bladder. This high pressure may overcome the muscle strength in the bladder walls, and the bladder can no longer empty. In chronic retention, the muscle damage of the bladder is progressive and subtle. Over time, the fibrous, not contractile tissue does substitute the damaged muscle. This change in the bladder wall composition leads to permanent lower contractility until the atonic status.

Causes

These are the most common causes of lower urinary tract obstruction and weak bladder contractility:

• Urethral stricture;
• Prostate enlargement;
• Bladder neck obstruction;
• Urethral stone;
• Neurologic bladder.

Symptoms of urine retention

When acute, retention causes rapidly progressive tension pain in the lower abdomen and the penis. The patient fills an intense and painful urge to urinate without being able to do it. Sometimes there is some urine leakage insufficient to relieve the pain. In chronic retention, the progression is subtle. The pain is low or absent. The patient has a full feeling in the lower abdomen. Sometimes the bladder is so filled that urine drips from overflowing (false incontinence or paradoxical iscuria). Chronic retention may cause a complicated Urinary Tract Infection like cystitis and prostatitis with a high fever.

The main sign of urine retention is a bulge in the lower abdomen. The patient may feel acute, moderate pain or discomfort depending on whether the retention is acute or chronic.

Complications of urine retention

Complicated urinary tract infection with high fever may have a worsening and unpredictable progression to sepsis and shock. The condition requires immediate bladder catheterization (or suprapubic transcutaneous catheter insertion to bypass an infected prostate) and aggressive antibiotic treatment. The overfull bladder causes progressive back-pressure through the kidneys and impaired renal function. Acute and chronic renal failure are possible severe complications of urine retention and require immediate treatment.

Treatment

A proper diagnostic workup allows us to detect the cause of urine retention and recommend the appropriate treatment.

Chronic urine retention damages the bladder, losing strength and becoming less contractile. This condition is not reversible, and we need to leave a catheter in the bladder permanently. The catheter must substitute it every 3-4 weeks, but the patient must be catheterized for life. The lack of bladder contractility in acute urine retention is mainly reversible, and the patient can resume his spontaneous micturition after treating the causes.

External resources

Bladder catheterization (video)