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What you should know about urinary retention

Urinary retention is when the bladder cannot either empty completely or empty at all. After urinating, a healthy bladder is completely emptied (a volume of less than 50 ml is normal). The bladder muscles ensure this by contracting, while the muscles around the urethra open to empty the bladder. However, if the bladder is unable to do this due to weak bladder muscles or a blockage that inhibits the flow of urine, some residual urine will remain. This can lead to different symptoms like frequent urination, a weak urine stream and a feeling of not being able to empty the bladder.
Patient with doctor discussing TENA

What is residual urine in the bladder?

If the natural emptying process is obstructed, urine will remain in the bladder. Residual urine makes it easier for bacteria and germs to nest and multiply there. This increases the risk of urinary tract infections.

What are the symptoms of urinary retention with residual urine?

In extreme cases, urination is impossible, this is called acute urinary retention – this needs to be treated urgently. Symptoms include a sudden inability to urinate (even though the bladder is full) and severe discomfort or pain. If you can´t get timely treatment, there is a risk that residual urine may back up from the bladder to the kidneys and cause damage. Acute urinary retention may also be life-threatening. Acute urinary retention requires immediate medical attention and usually a urethral catheterisation is needed to empty the bladder. So, if you notice any of the symptoms mentioned above, consult your doctor immediately.  
 
Chronic urinary retention, however, is not usually painful.
 
The condition develops and worsens over time, with the bladder gradually becoming less efficient at completely emptying when urinating. The more residual urine that remains in the bladder, the further it expands. This could cause discomfort and other symptoms. As the bladder is filled over its capacity, it becomes distended and the closing mechanism cannot resist the pressure, which causes leakages. Dribbles or a frequent urge to urinate can be symptoms of overflow incontinence.
 
The symptoms of chronic urinary retention with residual urine vary among individuals, but can include:
  • Urinating often, more than 8 times a day
  • Urge incontinence – a sudden and urgent need to urinate and not always making it to the toilet in time
  • A sudden and urgent need to urinate, feeling like your bladder is full, then passing very little
  • Sensing the need to go to the toilet when you’ve just been
  • Waking up more than twice in the night to use the toilet
  • Difficulty starting the flow of urine
  • A weak or interrupted stream
  • Dribbling
  • A sense of discomfort or increased pressure in the lower abdomen
  • Consciously straining or pushing to empty the bladder fully
Both forms of urinary retention require medical attention. In case of an acute condition, there is little choice but to seek immediate treatment. 

What are the causes of urinary retention

Urinary retention can result from:
  • obstruction of the urethra (caused by, e.g. a prolapse or an enlarged prostate). 
  • weakened bladder muscles (caused by, e.g. nerve injury or disease or as a side-effect of medication).

Different causes in men and women – including the eldery

Urinary retention is most common among men. This is due to the fact that an enlarged prostate can cause an obstruction that restricts the flow of urine and thereby prevents the bladder from emptying completely. In women, weakened, stretched or damaged supporting tissue can cause the bladder to prolapse (cystocele) and move out of position. Severe bladder prolapse can cause a blockage in the urinary tract. During childbirth, there is a temporary risk of urinary retention. This is why the midwife will ensure the bladder empties regularly to avoid problems. 
 
Many older people suffer from weak bladder muscles. This makes urination difficult and they are unable to properly empty their bladder. Residual urine levels of less than 100 ml are usually acceptable in people older than 65 – for a younger person, these levels are abnormal. 
 
Bladder emptying difficulties can also be caused by bladder stones or kidney stones getting stuck in the urethra or bladder, which blocks the flow of urine. The migration of these stones usually leads to pain in the lower abdomen and the kidneys and can, therefore, be quickly diagnosed. A blockage can also be linked to the narrowing of the urethra (urethral stricture), which can be congenital or caused by the frequent use of a catheter.

Neurogenic bladder disorders

If the nerves that coordinate the bladder are affected by injury or disease, it may affect bladder control and lead to urinary retention. Diabetes, multiple sclerosis or a spinal cord injury are examples that may cause bladder emptying difficulties and thereby a risk of residual urine

Medication and surgery

Some medications used to treat disease may have side effects that can affect the bladder and sometime cause urinary retention. Urinary retention can also occur in conjunction with surgery. Care staff should always ensure that the bladder empties after surgery. This is because analgesics can have an effect on the bladder that causes difficulty when emptying. This type of post-operative urinary retention becomes particularly problematic when an infusion has caused a lot of fluid to enter the body and no urinary urgency is felt because of the numbing effect of the medication.

Diagnosis and treatment of urine retention

Residual urine is diagnosed by either catheterization or by using, e.g. a bladder scan or bladder ultrasonography to show an elevated residual urine volume after voiding. Further intervention may then be required to remove the blockage.  Depending on the particular cause, your doctor will find the most suitable treatment options. For example, if men suffer from an enlarged prostate, prostate reduction surgery is the best option – medication can also be prescribed. Urinary stones and similar obstacles would need to be removed, while prolapses can be corrected with surgery. Pelvic floor muscle exercise is often recommended to prevent a weak pelvic floor and thereby prolapse. Sometimes, the technique of intermittent catheterization can be an alternative – using a disposable catheter to drain the bladder artificially at regular intervals

TENA can provide the support you need

Urinary retention and residual urine in the bladder can be treated in several ways. However, completely curing or eliminating the cause and symptoms is not always possible. Your doctor will be happy to help and together you can find the right solution for all your needs. TENA products give people living with urine leakage the support they need. So even with the possibility of incontinence, people can still enjoy the same quality of life.

Audited by Josefine Grandin, District nurse, urotherapist, 2020-02-26

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