Urine Retention – Symptoms and Causes of Urine Retention

Urine retention is also known as ischuria. The inability to empty the bladder or urinate is termed as Ischuria. You may be able to urinate but the rouble is felt during the starting of the flow or stream. Difficulty may be felt with emptying the bladder completely. In general urinary retention is a complication associated with benign prostatic hypertrophy. But few medications may also cause the same.

You might feel an urgent urge to urinate but after getting into the toilet, a little succes might be achieved to empty the bladder completely. You might feel like going again even after finishing urinating. This is a typical sign of urine retention in chronic cases. This can be life-threatening, leading to serious problems. But in acute cases, you cannot urinate at all eventhough, your bladder is completely filled. Such a case requires medical emergency and prompt action.

Any man and woman may experience the defect while urination, but the condition is more common in men after 50s. Men are more prone because after 50 years of age, their protrate gland enlarges. But in woman, when their bladder sags or moves out of the normal alignment or position, leads to Cystocele. When the sagging bladder is pulled out of position by the sagging colon, it causes Rectocele. Both Cystocele and Rectocele can cause urine retenetion in women. Even disease or damage in the nerve affecting the bladder function can cause Urine retention. This can be seen in men and women of all ages.

Symptoms Of Urine Retention
Typical charactersitics of ischuria include –

  • poor urinary stream
  • straining during urinating
  • intermittent flow
  • constant feeling of incomplete voiding
  • delay between making efforts to urinate and the initiation of the actual flow (hesitancy)
  • great discomfort
  • pain
  • bloated lower belly

As the bladder remains full due to hindrance during urinating, the following symptoms may be observed –

  • incontinence
  • need to urinate at night nocturia)
  • high frequency of urination

When a patient feels a painfully full bladder immediate medical assistance must be taken up. It is an emergency situation. urine retention may cause in excessive enlargement of the bladder leading to tearing. This can cause severe pain and must be dealt as soon as possible. The increase in pressure may also prevent urine entering from the ureters. The urine may flow pass back the ureters, entering the kidney. This can cause hydronephrosis and possibly kidney failure (pyonephrosis) and sepsis. Obstructions of the urinary tract can also cause the following condition in the long run –

  • Bladder stones
  • Diverticula in bladder wall (leading to stones and infection)
  • Congestion of the kidneys (Hydronephrosis)
  • Loss of detrusor muscle tone
  • Hypertrophy of detrusor muscle

Causes of Urine Retention

  • Nerve damage or nerve disease –
    Nerve problems is the common and most explainable cause of the retention of urine. Urinary retention is basically caused by an obstruction in the urinary tract. This obstruction does not allow to pass the signals between the brain and the bladder. The brain then fails to get the message when the bladder is full and needs to be emptied.
    Hence the bladder muscle is not given any signals to squeeze to push the urine out. It may also happen that the sphincter muscles may not receive the signal to relax. Besides nerve problem, even weak bladder muscle can cause retention.
    Events that can cause damage to the nerves and the Spinal Cord –

    • Accidents causing injury to the head (brain) and spines
    • Diabetes
    • Infections in the head (brain) or spinal cord
    • Stroke
    • Multiple sclerosis
    • Heavy metal poisoning
    • Vaginal childbirth
    • Pelvic injury or trauma
    • Born nerve problems
  • Prostate Enlargement (Benign Prostatic Hyperplasia) –
    This is very common problem in men. With age, the prostrate gland enlarges. This is also named as BPH or benign prostatic hypertrophy. With the enlarging prostrate gland, the layer of tissue which prevents its expansion, causes the gland to press against the urethra. This makes the walls of the bladder thick more thick and irritable. The bladder gradually begins to contract. This ultimately results in frequent urination even if there is a little urine. Over time, the bladder muscles weakens and loses its ability to empty itself.
  • Infection –
    The urinary tract infection cause swelling and irritation due to inflammation. When the urethra gets inflammed and swells, it leads to urine retention.
  • Surgery –
    When anesthesia is given during the surgery, it blocks the pain signals. And simultaneously fluid is also given intravenously to compensate for the blood loss. This combination mostly results in filled bladder with impaired nerve function. So majority of patients suffer from a urinary retention after surgery.
  • Medication –
    Some medicines are used to calm the overacting nerve signals. These may cause urianry retention. A few of such classes of drugs are mentioned below –

    • Allergy treatment by antihistamines
      • fexofenadine
      • diphenhydramine
      • chlorpheniramine
      • cetirizine
    • Treatment of Stomach cramps, urinary incontinence and muscle spasms by anticholinergics/antispasmodics
      • hyoscyamine
      • oxybutynin
      • tolterodine
      • propantheline
    • Treatment of anxiety and depression by tricyclic antidepressants
      • imipramine
      • amitriptyline
      • nortriptyline
      • doxepin
  • Bladder Stone –
    A stone formed in the urinary tract can log the bladder. And if the stone is excessively large, it can even block the urethra.
  • Cystocele and Rectocele –
    The sagging of the bladder due to any of the above condition can cause urinary problems.
  • Constipation –
    When a hard stool is present in the rectum, it may push against the urethra and bladder. This may also cause the urethra to pinched shut.
  • Urethral Stricture –
    Stricture is defined as the the narrowing down of a tube or a closure. A stricture is observed in men following a scarring occurred after a trauma or injury to the penis.
    • Other possible causes include –
    • In the bladder –
      • Detrusor sphincter dyssynergia
      • Neurogenic bladder
      • Iatrogenic scarring of the bladder neck
      • Damage to the bladder
    • In the prostate –
      • Benign prostatic hyperplasia
      • Prostate cancer and other pelvic malignancies
      • Prostatitis
    • Penile urethra –
      • Congenital urethral valves
      • Phimosis or pinhole meatus
      • Circumcision
      • Obstruction in the urethra
      • STD lesions
    • Others –
      • Paruresis
      • Consumption of some psychoactive substances
      • Use of NSAIDs or drugs with anticholinergic properties
      • Stones or metastases

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