Overview
Urinary retention is expressed as the state of a failure to empty the bladder. It comes with voiding problems. It normally comes in two forms: either acute or chronic. Acute urinary retention entails severe discomfort and can be life-threatening if not promptly managed. Chronic urinary retention develops more slowly, and in most cases, there will be no signs of its existence until complications set in, such as UTIs, urinary incontinence, or permanent damage of the kidneys.
This condition becomes more common with increasing age, especially in men above the age of 60, in whom prostate enlargement—a very common cause of obstruction to the bladder—starts becoming more likely. About 10 percent of men in their 70s and 30 percent of men in their 80s suffer from urinary retention, most of the time due to BPH.
What is Urinary Retention?
Urinary retention is a condition in which a person is unable to fully or partially completely empty their bladder. Normal Process: The literal filling of the bladder signifies to the brain, which in turn gives a message of urination in a person. At urination, the brain sends a signal that contracts the bladder muscles and opens up the passage of the urethra, allowing the passage of urine.
While the brain is sending the message the the bladder is "full," acute urinary retention refers to the inability to void the bladder, which is usually painful and an emergency that should be treated without delay to prevent kidney damage.
Chronic urinary retention can, in turn, lead to difficulty at the onset of urination, poor flow of urine, and incomplete emptying of the bladder. This may be due to an increased growth of the prostate or a different type of blockage or malfunction in the connections between the nerves in the brain and the bladder. In some cases, the patients are unable to feel the urge to empty their bladders, which means the bladder is always active and can lead to collateral damage—frequently UTIs and bladder stones.
In most cases, the obstruction prevents the passage of urine out of the bladder or urethra. Then again, it can result from the inability of the bladder wall to contract appropriately. These can be caused by:
• Enlarged prostate, BPH
• Urethral stricture due to scarring
• Kidney stones obstructing the urethra (urolithiasis)
• Phimosis or paraphimosis, or other problems with the foreskin
• Infections, such as urinary tract infections (UTIs)
• Bladder or urethral injury
• Blood clots in the urine
• Cancer of prostate, cervix, or the bladder
Fibroids or pelvic organ prolapse
Neurological disorders affecting the communication between the brain and the bladder
Constipation, causing urethral blockage
Infections within the epidural space of the brain or spinal cord
Aging, childbirth, or trauma that damages the bladder muscles
Immobility
Medications– The below medications can cause this condition:
· Opioids
· Antihistamines
· Tricyclic antidepressants
· Antipsychotics
· Cough suppressants
· Medications employed for the treatment of the stomach cramps
· Medications employed for urinary incontinence
· The anesthetic used in.
Symptoms of Urinary Retention
· Symptoms of urinary retention may differ between chronic and acute cases. The following are the most common symptoms of acute urinary retention:
· Painful lower abdomen with the inability to pass urine in spite of a strong urge
· Lower abdominal soreness
· Abdominal bloating due to a distended bladder
· Lower back pain
The symptoms of chronic retention of urine could be:
· Difficulty to begin urinating
· Weak, dribbling, or intermittent flow of urine
· Frequent urination with recurring pressure to urinate again shortly after emptying the bladder
· Pain or aching in the lower abdomen
· Increased frequency or urgency, especially at night
· Nocturia with overflow incontinence
Diagnosis of Urinary Retention
-Urinary retention is diagnosed based on the patient's medical history, physical examination, and diagnostic studies. The patient should provide information about the duration of changes in urination habits, new medications, or other symptoms such as constipation, hematuria, pelvic trauma, etc.
-During the physical examination, physicians will scan the abdomen for bladder distension, perform pelvic examination that may identify anatomical malformations, or performing a digital rectal examination in men to check for an enlarged prostate. A neurological examination could also be carried out to check the presence of any emerging nerve damage.
Laboratory tests may include:
Blood tests that could detect the cause of the urinary blockage as well as establish the health of the kidney
Urinalysis that could reveal infections among other urinary disorders
Measuring post-void residual to see how much urine is left in the bladder after urination
Cystoscopy, examination of the passage from the vulva to the urethra and the inside of the bladder, to check for any abnormalities; for example, blockage of the urethra or failure of bladder function
Electromyography to record the electrical activity of muscles and nerves related to the bladder
Bladder imaging tests, including ultrasounds, CT scans, or MRIs, to capture the image of the bladder and related structures
Urinary Retention Treatment
Treatment depends on the etiology causing urinary retention and includes the following:
Bladder Drainage: In patients with acute retention, a drainage catheter is inserted for bladder decompression to relieve the situation.
Medication:
· 5-alpha reductase inhibitors (e.g., finasteride, dutasteride) acting to shrink the prostate gland
· Alpha blockers (e.g, terazosin, tamsulosin) acting to relax the muscles in the bladder neck and prostate with the enhanced urine flow
· Antibiotics for UTIs or prostatitis
· Modifications or weaning off medications that cause UR
· Surgical Management
· Laser therapy, in the form of Holmium Laser Enucleation of the Prostate (HoLEP) is an effective procedure in enlarged prostate treatment.
· Prostatic urethral lift where implants are used to hold the prostate transurethrally and away from the urethra, which enhances urine flow.
· Transurethral water vapor therapy. In this procedure, water vapour or steam is passed to the prostate and makes it shrink.
· Urethral dilatation in case of an urethral stricture
· Vaginal pessary, where the ring of the pess
· Physicians may recommend a patient to a type of pelvic floor physical therapy to enhance muscles which are responsible for the holding and urine control. Treatment options may, therefore, consist of the following
· Pelvic floor strengthening exercises in enhancing control
· Bladder training techniques such as timed urination, double-voiding, and relaxation
Conclusion; Urinary Retention
Most of the time, patients with this disorder can resolve the conditions and return to his normal daily activities after following the recommended treatment. The feeling and treatment is strongly advised to prevent other complications which might arise from diseases like urinary infections and the impairment of the kidneys.
