Urinary Retention is the inability to completely empty the bladder, leading to accumulation of urine. It can be caused by various factors affecting bladder function or urinary outflow obstruction. Common causes include benign prostatic hyperplasia (BPH) in men, pelvic organ prolapse in women, neurological disorders (e.g., spinal cord injury, multiple sclerosis), medications, or urinary tract infections.
Clinical Evaluation
Patient History: Review of symptoms, including difficulty urinating, frequency, urgency, and previous urinary tract infections.
Physical Examination: Assessment for signs such as distended bladder, palpable abdominal mass, or neurological deficits.
Diagnostic Tests
Urinalysis: Examination of urine to detect signs of infection (e.g., presence of white blood cells or bacteria) and assess kidney function.
Post-void Residual Volume (PVR) Measurement: Ultrasound or catheterization to measure the amount of urine left in the bladder after voiding.
Urodynamic Studies: Tests to assess bladder function and pressure during filling and voiding, evaluating for detrusor muscle dysfunction or obstruction.
Imaging Studies: MRI or CT scans to visualize the urinary tract, identifying structural abnormalities or tumors causing obstruction.
Difficulty initiating urination (hesitancy).
Weak or interrupted urinary stream.
Sensation of incomplete bladder emptying.
Frequent urination (polyuria).
Urgency to urinate.
Lower abdominal discomfort or pain.
Urinary tract infections (recurrent in some cases).
In severe cases: inability to urinate, leading to acute urinary retention.
Treatment for urinary retention depends on the underlying cause, severity of symptoms, and patient's overall health.
Catheterization: Temporary or indwelling catheter to drain urine and relieve acute retention.
Medications: Alpha-blockers (e.g., tamsulosin) to relax smooth muscle in the prostate or anticholinergics to reduce bladder muscle spasms.
Surgery: Procedures such as transurethral resection of the prostate (TURP) for BPH or surgical repair of pelvic organ prolapse.
Behavioral Therapy: Pelvic floor exercises (Kegel exercises) to improve bladder control and voiding techniques.
Lifestyle Modifications: Limiting fluid intake before bedtime, avoiding caffeine and alcohol, and managing constipation to improve bladder function.
Management of Underlying Conditions: Treating infections, adjusting medications, or addressing neurological disorders contributing to urinary retention.
Regular Follow-Up: Monitoring bladder function, adjusting treatment as needed, and addressing complications such as urinary tract infections or kidney damage.