What Causes Urinary Retention?

If you are often unable to urinate or experience frequent urges but can only urinate in small amounts, you may be experiencing urinary retention. Though chronic urinary retention creates discomfort and obstacles for patients, fortunately, it is treatable. Keep reading to learn what urinary retention is, what causes urinary retention, and the treatment options that can bring you relief.

What is urinary retention?

Urinary retention is the inability to completely or partially empty the bladder. Common symptoms include:

Hesitancy (difficulty starting urination)
Frequent small voids (emptying)
Slow or weak urine stream
Post-void fullness (bloating or discomfort in the pelvic or abdominal region)
Small urinary leaks throughout the day
Inability to feel bladder fullness
Nocturia (waking up more than one time per night to urinate)

Though urinary retention affects both men and women, it is more common in men - up to 10 times more common according to some estimates.

Acute vs. chronic urinary retention

The information in this article focuses on chronic urinary retention. Acute urinary retention, on the other hand, is a medical emergency and should be addressed by a medical professional right away.

Seek medical help immediately if you experience a sudden, strong, painful urge to urinate but can’t.

What causes urinary retention?

Chronic urinary retention can result from a range of possible sources, including obstructions, infections, cancers, injuries, neurological disorders, and more. To determine the best treatment for you, your doctor or urologist will take you through a diagnostic process - including a review of your symptoms, a physical exam, and possibly tests - to uncover the causes of your urinary retention symptoms.

Obstructive urinary retention

This condition is the result of something blocking the urinary tract and preventing urine from flowing freely. Examples of obstructions include kidney stones, urinary tract stones, an enlarged prostate, or cancerous growths.

Non-obstructive urinary retention

In the absence of something physically blocking the urinary tract, there may be a problem with the communication between the brain and bladder. Weak muscles or nerve problems can block the signals that tell the brain that the bladder is full and needs to be emptied.

Causes of this condition include:

Stroke
Vaginal childbirth
Pelvic injury/trauma
Impaired muscle or nerve function due to medications, anesthesia, brain or spinal cord injuries, neurological diseases such as Parkinson’s, Multiple Sclerosis, or long-term diabetes

Men vs. women

There are also some differences in what causes urinary retention between men and women. In men, more than 50% of urinary retention cases are caused by problems with the prostate, according to Healthline. Because the prostate surrounds the urethra, an enlarged prostate can constrict the urinary tract in men and obstruct the flow of urine.

Urinary retention in women, on the other hand, may be caused by uterine masses or cancers, cystoceles or rectoceles, uterine prolapse (“fallen uterus”), or infections of the vulva or bladder.

Infections

Healthline notes that the following infections can contribute to urinary retention symptoms:

Cystitis - infection or inflammation of the bladder
Urethritis - infection or inflammation of the urethra
Prostatitis - infection of the prostate
Balanitis - Inflammation or swelling of the foreskin (this can cause obstructive urinary retention)

Medications

There are several medications that can cause urinary retention, including medications used to treat urinary incontinence (frequent urges to urinate that may cause leaks). Medications to treat Parkinson’s disease may also cause urinary retention.

Other medications that may decrease the ability to urinate or fully empty the bladder include antihistamines (allergy medications), amphetamines (such as those used to treat ADHD), muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs, such as Ibuprofen), pseudoephedrine, some antipsychotics, cyclic antidepressants, and some opioid painkillers.

Surgeries

Surgeries - especially joint or hip replacements - can also cause urinary retention.

Possible complications of urinary retention

Chronic urinary retention can lead to other medical problems, including high blood pressure, leg swelling, and kidney damage, due to the increased pressure in the urinary tract which affects the kidneys.

Complications can also arise with some urinary retention treatments, namely clean intermittent self-catheterization. Catheters can cause UTIs, urethral injury or breakdown, or urethral strictures. Catheters can also lead to dangerously low blood pressure because of the excess urine produced after suddenly emptying a full bladder through a catheter.

This is one of many reasons that, as with other bladder and bowel problems, doctors recommend conservative treatments such as behavioral therapies or medications before trying catheters or surgeries.

Patient care pathway for urinary retention

Doctors treating patients with chronic urinary retention will first recommend conservative treatments that target the patient’s behavior and/or diet. Therapies like bladder training and pelvic floor exercises may improve the communication between the bladder and brain to restore the patient’s ability to fully empty the bladder. If behavioral interventions fail, medications may be prescribed - particularly alpha-blockers for men with enlarged prostate.

Finally, advanced therapies such as clean intermittent self-catheterization or surgery may be required to treat urinary retention that is not resolved through behavioral therapies or medication. Keep reading to learn about the advanced therapy offered by Axonics.

The Axonics System

Sacral Neuromodulation is a guideline-recommended therapy used to treat bladder and bowel problems, including urinary retention. The therapy works by stimulating the sacral nerve, which is instrumental in sending sensory information from the bladder to the brain to communicate bladder fullness and allow the pelvic muscles to facilitate the release of urine at the appropriate time.

Axonics Therapy starts with a minimally invasive surgical procedure in which a small lead wire is implanted near the back of the pelvis. From there, the device delivers mild electrical impulses to the sacral nerves to help restore normal communication between the bladder/bowels and brain.

If you’ve been unable to find relief from more conservative treatments, find out if Sacral Neuromodulation for urinary retention is right for you.

Disclaimer: Axonics does not provide medical advice, diagnosis or treatment. The contents of this website are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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