Chronic Urinary Retention: Causes, Symptoms, Diagnosis, Complications & Treatment

Introduction:

The bladder acts as a storage tank for urine waste products. When the bladder is full, the person will urinate, and the waste will leave the body. However, if the person has urinary retention, the bladder will not empty the urine, resulting in retention. This can happen to both men and women, and many things like medications, blockages, and nerve issues can cause it. Chronic urinary retention generally develops slowly over months to years. It is not painful, which is asymptomatic or may be associated with lower urinary tract symptoms such as urinary frequency, incontinence, or urgency.

What Is Urinary Retention?

Urinary retention is a condition where the individual is unable to empty the urine from the bladder. It is a condition that is related to other health problems, such as prostate problems in men and a cystocele (bladder bulges into the vagina) in women. Urinary retention can be acute (a sudden inability to urinate) and chronic (a gradual inability to empty the bladder).

Urinary retention is common in men and increases as they grow older. Throughout five years, approximately one in 10 men of 70 years and almost one in three men of 80 years will develop urinary retention. Whereas urinary retention is less common in women and rare in children. Every year, about three in 100,000 women develop urinary retention.

What Is Chronic Urinary Retention?

Chronic urinary retention, as the name indicates, develops over a longer period. The individual with chronic urinary retention can urinate but cannot empty the bladder. Many people with chronic urinary retention do recognize the condition since they may not experience any symptoms.

What Are the Causes of Chronic Urinary Retention?

The causes of chronic urinary retention are as follows:

• Aging causes changes in the urinary tract, resulting in the inability to empty the bladder.

• Urethral blockage can cause urinary retention. This includes a full bladder, constipation, an enlarged prostate gland (in males), urinary tract stones, vaginal prolapse (in females), tumors, and narrowing of the urethra.

• Nerve damage may cause urinary retention. This includes spinal injuries and health conditions affecting the nervous system, diabetes, multiple sclerosis (a chronic disease of the central nervous system), stroke, and Parkinson's disease (a brain disorder affecting mental health and movement).

Other causes of chronic urinary retention include:

• Recent surgery pain.

• Medications.

• A urinary tract infection

• Recent delivery.

Who Is More Likely to Develop Urinary Retention?

Urinary retention is common in both men and women, but men of older age groups are commonly affected. Men with benign prostatic hyperplasia (the prostate gland is enlarged) are more likely to develop urinary retention. In this condition, the prostate enlarges and pushes against the urethra, resulting in urine blockage out of the bladder.

What Is the Pathophysiology of Chronic Urinary Retention?

When the bladder fails to empty partially or fully, it means that the urine is unable to leave the urinary bladder or urethra due to any blockage or medications. The most common factors include prostate enlargement, urethral stricture, spinal cord injuries, neuropathy, increased urethral sphincter tone, and medications.

What Are the Symptoms of Chronic Urinary Retention?

Urinary retention usually takes longer to notice the symptoms. The symptoms include:

• Strain while passing urine.

• Weaker urine flows with a slow start.

• Feeling full bladder even after passing the urine.

• Overflow incontinence (leakage of urine without control).

• Difficulty in controlling urine during cough and sneeze.

• Frequent urination at night.

• Abdominal swelling.

• Pain in the abdomen.

How to Diagnose Chronic Urinary Retention?

The diagnostic tests for chronic urinary retention are as follows:

• Urinalysis helps identify urinary problems, such as kidney issues, urinary tract infections, and diabetes.

• Urine culture.

• A renal function test is performed to assess overall kidney function.

• A prostate-specific antigen test is a test that is not directly used to diagnose chronic urinary retention. However, it is performed to assess prostate health.

• Urodynamic testing is done to check the work of the urethra and bladder.

• Renal, bladder, and transrectal prostate ultrasound.

• Cystoscopy is done to diagnose urinary tract issues.

• Retrograde cystourethrography is performed to identify urinary tract issues and to guide treatment options.

When Should the Individual See a Doctor?

The individual should consult the physician in case of:

• Unable to pass urine.

• Pain and burning sensation, along with an inability to pass urine.

• Blood in the urine.

• Once the symptoms do not regress with treatment.

• Feeling unwell.

• Fever.

• Abdominal pain.

• Urine has a bad smell.

• No urination for four hours.

What Is the Treatment for Chronic Urinary Retention?

Based on the etiology, the physician suggests a treatment plan. Therefore, it is important to perform tests to identify the etiology. Many treatments are available for chronic urinary retention:

• Catheterization: For chronic urinary retention, occasional or long-term catheterization is required. The physician will teach the individual how to self-catheterize if necessary.

• Urethral Dilation: Urethral strictures are treated using urethral dilation.

• Urethral Stents: An artificial tube called a stent is inserted into the urethra to relieve the stricture. Once placed, the stents expand like a spring and push the surrounding tissues, thereby widening the urethra.

• Surgery: Surgical interventions include prostate surgeries for men and pelvic organ prolapse repair for females will be required.

• Pharmacological Interventions: The following medications can reduce urinary retention but should be taken under the physician's advice.

• Alpha Blockers: Doxazosin, Prazosin, Tamsulosin, Terazosin, Alfuzosin, and Silodosin.

• 5-Alpha Reductase Inhibitors: Dutasteride and Finasteride.

• Combination Therapy: Tamsulosin and Dutasteride.

What Are the Complications of Urinary Retention?

• Urinary Tract Infection: When the urinary tract is emptying, bacteria that normally enter the urinary tract are flushed out during urination. With urinary retention, the urine does not completely drain out, which allows the harmless bacteria a chance to multiply and infect the urinary tract. Serious problems can occur if the infection spreads to the kidneys.

• Bladder Damage: If urinary retention is not treated, the bladder may become stretched too far. When stretched too far, the muscles in the bladder may become damaged and no longer perform their normal function.

• Kidney Damage: The urinary tract is designed to have the urine flow from the kidneys, through the ureters, to the bladder, and out the urethra. If the individual has urinary retention, it becomes difficult for them to empty the urine from the bladder, and the urine may back up into the kidneys. This makes the kidneys full of urine so that they swell and ultimately press the nearby organs. This pressure can damage the kidneys and, in some cases, may lead to kidney failure and chronic kidney disease.

• Urinary Incontinence: When the bladder does not empty fully, urine leakage occurs, which is called urine overflow incontinence.

Conclusion:

Working with a healthcare professional to prevent and treat these complications is important for both the health of the urinary tract and overall wellness. In men, it is important to determine whether the retention is due to high-pressure or low-pressure retention, as this sometimes affects the treatment decisions. The prognosis of chronic urinary retention is good with proper treatment. Otherwise, it may lead to complications without treatment.