Causes of Urinary Retention and Treatments

Total urinary retention requires a trip to the ER. Partial retention still requires medical consultation as soon as possible.
Causes of Urinary Retention and Treatments

Last update: 27 September, 2021

In general terms, urinary retention is the inability to empty the bladder in spite of the desire to do so. This condition is a medical emergency and, thus, requires immediate attention.

Urinary retention can arise from a variety of causes, usually due to obstructive conditions. However, it’s also caused by infections, inflammation, neurological problems, and drugs.

According to available data, urinary retention is the most frequent urological emergency at the primary care level in hospitals. One can correct it by using a temporary catheter that facilitates bladder emptying.

What’s urinary retention?

Urinary retention is an inability to pee despite having a full bladder. This anomaly can appear at any point in life but is more frequent in people over 60. In fact, the incidence increases with age.

This disorder afflicts 10% of men over 70 and 30% of those over 80. There’s insufficient documentation, but estimates indicate it’s more frequent in males than in females.

Retention can be total or partial. The latter leads to an increase in urinary frequency or even incontinence.

It’s important to differentiate it from anuria, the complete absence of urine production. There’s a production of urine when there’s retention, it just fails to exit the body and accumulates in the bladder.

A person on the toilet.
There’s no urine output in urinary retention even when there’s an urge to pee.


The causes that give rise to urinary retention are classified into four groups: obstructive, infectious and inflammatory, neurological, and pharmacological. Let’s review each one of them:

  • Obstructive retention happens when there’s an anatomical condition that prevents the passage of urine. It’s usually due to enlargement of the prostate or benign prostatic hyperplasia, in the case of men. In women, it’s a gynecological disease, most likely.
  • Infections and inflammations in men are related to conditions such as acute prostatitis, urethritis, sexually transmitted diseases, and genital herpes. In women, it’s usually vulvovaginal lesions or vulvovaginitis.
  • Neurological retention is due to lesions in the autonomic peripheral nerve, brain, or spinal cord. It can equally affect both men and women.
  • Pharmacological retention is a side effect of certain drugs, usually anticholinergics, tricyclic antidepressants, and nonsteroidal anti-inflammatory drugs.

Symptoms and diagnosis of urinary retention

The main symptom of urinary retention is difficulty peeing — be it a weak stream of urine, dribbling, small leaks during the day, increased abdominal pressure, straining to pass urine, frequent urination, and nocturia (the desire to pee at night).

The retention isn’t total most of the time but there’s difficulty emptying the bladder entirely. As a consequence, the bladder of a person who can’t pee soon becomes inflamed and leads to unbearable pain.

Furthermore, retained urine is a breeding ground for bacteria and a risk factor for urinary tract infections. The still fluid promotes the proliferation of infection-causing microorganisms.

The diagnosis of a person who’s unable to urinate is obvious. A test can determine how much urine remains in the bladder after urination if the retention is partial. To establish this, a doctor will perform a bladder ultrasound or insert a catheter into it.

Treatment of urinary retention

The procedure to follow in the case of a person with urinary retention is to immediately insert a urinary catheter so as to extract the retained urine. There must be a decompression to promote the outflow of the accumulated fluid.

There are two types of catheterization: intermittent and permanent. The first consists of a catheter being inserted and removed and any person can learn to do with proper training if it’s a recurrent disorder. As for the second, the catheter must remain in place for a period longer than the interval between two micturitions.

Finally, the physician will attempt to determine the cause of the urinary retention. Estimates indicate that this problem recurs in 30% of patients in whom the initial cause isn’t efficiently established.

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