Urinary Retention

What is and what causes urinary retention

What is Urinary Retention?

Urinary retention (UR) means someone is unable to completely empty their bladder. They may only produce a "dribble" of urine. Others strain to push out the urine, or can't urinate at all.1,5,6,8,9

There are two kinds of urinary retention. The first is called acute urinary retention (AUR for short). This happens suddenly and lasts only a short time. It can be very painful, and it can be a life-threatening medical condition. If you have AUR, you should go to the emergency room as soon as possible. 2,3,4,5,7,9

The second kind of urinary retention is called chronic urinary retention (CUR). Chronic means it is a long-lasting medical condition. People with chronic urinary retention can urinate but cannot completely empty all of the urine from their bladders. They may not know they have the condition until it causes another problem. One of these problems could be the accidental loss of urine (which is called urinary incontinence). Another of them is a urinary tract infection (UTI), which is an illness caused by harmful bacteria growing in the urinary tract. 2,5,9

Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional. 

What Causes Urinary Retention?

There are a number of conditions that can keep your bladder from emptying. Each typically falls under one of these four categories:

  • Your urethra is blocked (the urethra is the thin muscle tube that carries urine from the bladder)
  • Nerve problems
  • Medications
  • Weakened bladder muscles5,6,8,9

If your urethra is blocked or narrowed, urine can’t flow out of the body. Conditions that may cause this block include: 

Benign prostatic hyperplasia (BPH). BPH affects the prostate, which is typically a walnut-sized gland that surrounds the urethra. It is a condition in which the prostate is enlarged but not cancerous. When it is enlarged, it can compress the urethra, making it difficult to pass urine. Over time, the bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. This is a common cause of urinary retention for men in their 50s and 60s. 2,5,6,9

Urethral stricture. This means there is a narrowing or closure of the urethra. Surgery, scar tissue from surgery, disease, recurring UTIs, or injury can cause it. Prostatitis, which is inflammation of the prostate, is a common cause of urethral stricture in men. And since men have a longer urethra than women, urethral stricture is more common in men than women. Urethral stricture and acute or chronic urinary retention may occur when the muscles surrounding the urethra do not relax. This condition happens mostly in women. 5,6,7,9

Urinary tract stones. When crystals form in the urine, they can build up and form urinary tract stones. These crystals may build up on the inner surfaces of the kidneys, ureters, or bladder. Stones in your bladder may block the opening to the urethra and cause urinary retention. 5,9

Cystocele. A cystocele is when the bladder pushes into the vagina. This happens because the muscles and supportive tissues between a woman’s bladder and her vagina weaken and stretch. This allows the bladder to sag from its normal position and bulge into the vagina. It may also press against and pinch the urethra. 5,9

Rectocele. A rectocele is when the rectum pushes into the vagina. Like cystocele, this happens when the muscles and supportive tissues between a woman’s rectum and vagina weaken and stretch. The rectum sags from its normal position and bulges into the vagina and may press against and pinch the urethra. 5,9

Constipation. A hard stool in the rectum can cause urinary retention by pressing against the bladder and urethra. A rectocele makes this more likely to happen. 5,9

Tumors and cancers. A cancerous or noncancerous tumor in the bladder or urethra can gradually grow larger. Over time it may block the bladder outlet or press against and pinch the urethra. Either of these can block urine flow. 5,9

The second category of conditions that can cause urinary retention are nerve problems.

Nerves pass signals between the brain and the bladder and the sphincters. Both the bladder and sphincters (small ring-like muscles) tighten or relax to control the flow of urine. There are a number of events or conditions that can interfere with these signals. When this happens, the brain may not get the signal that the bladder is full. Or the bladder muscles that squeeze urine out may not get the signal to push. Or the sphincters may not get the signal to relax and allow the urine to flow out. 1, 5,8,9

Nerve problems like this can happen to you no matter how young you are. For example, a baby may be born with spina bifida, which affects the spinal cord and can cause urinary retention. 1,5,6

The most common causes of nerve problems that can lead to temporary or permanent urinary retention are:

  • Vaginal childbirth
  • Brain or spinal cord infections or injuries
  • Diabetes
  • Stroke
  • Multiple sclerosis
  • Pelvic injury or trauma1,5,6,9

Urinary retention can also be caused by medications that interfere with nerve signals to the bladder and prostate. 

  • Antihistamines to treat allergies
  • Anticholinergics/antispasmodics to treat stomach cramps, muscle spasms, and urinary incontinence
  • Tricyclic antidepressants to treat anxiety and depression 5,9

Other medications that seem to increase your chances of urinary retention include:

  • Decongestants
  • Nifedipine (Procardia), a medication to treat high blood pressure and chest pain
  • Carbamazepine (Tegretol), a medication to control seizures in people with epilepsy
  • Cyclobenzaprine (Flexeril), a muscle relaxant medication
  • Diazepam (Valium), which is used to relieve anxiety, muscle spasms, and seizures
  • Nonsteroidal anti-inflammatory drugs
  • Amphetamines
  • Opioid analgesics 5,9

If you are a man with prostate enlargement, some over-the-counter cold and allergy medications can increase your symptoms of urinary retention. This is true of the ones that contain decongestants, like pseudoephedrine, and antihistamines, such as diphenhydramine. 5

Finally, weakened bladder muscles can also cause urinary retention.

As you age, many of your muscles may weaken, including the bladder and the muscles around it. They may not contract strongly enough or long enough to empty the bladder completely, resulting in urinary retention. 5,6,9

Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional. 

How Can Urinary Retention Affect You?

When urinary retention is acute, it can be very painful. It can also be life-threatening.

If you have any of these symptoms, you should see a health care provider right away:

  • Cannot urinate at all
  • Have discomfort or pain in your lower abdomen
  • Painful, urgent need to urinate
  • Bloating of the lower abdomen 5,7,8,9

With chronic urinary retention you may experience these symptoms: 

  • Urination eight or more times a day
  • Trouble beginning a urine stream
  • A weak or an interrupted urine stream 
  • An urgent need to urinate with little success when trying to urinate
  • Feeling the need to urinate after finishing urination
  • Mild and constant discomfort in the lower abdomen and urinary tract 5,8

None of these symptoms may seem severe enough to require seeing a doctor. But if you have chronic urinary retention and do not get treatment, you have a higher chance of developing more serious medical problems. 5

Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional. 

What to Expect When You See Your Doctor

Your doctor will try to diagnose your problem with a physical exam and by measuring how much urine is left in your bladder after you urinate.5,9

The physical exam includes the doctor finding out more about your symptoms and examining your lower abdomen. He or she may tap on your belly to see how full your bladder is. An ultrasound machine (which uses sound waves to create a picture) is sometimes used to measure the amount of urine remaining after you urinate. A catheter may also be used. It is a thin, flexible tube the doctor inserts through the urethra into the bladder. It drains any remaining urine. If 100 milliliters or more remains, it tells the doctor your bladder is not emptying completely.5,9

To find out what may be causing your urinary retention, your doctor may use an instrument called a cystoscope to see if anything is blocking the urinary tract like urethral stricture or bladder stones. He or she may also use a CT scan. This device uses a combination of x-ray and computer technology to create a picture of your lower abdomen. It helps your doctor determine if a urinary tract infection, urinary tract stones, tumor, cyst or injury could be causing your urinary retention.5,9

A technique called electromyography provides more information for your doctor. It measures the electrical activity of the muscle and nerves in and around the bladder and sphincters. This helps your doctor understand if the messages sent to the bladder and sphincters coordinate correctly.5,9

Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional. 

Treatments for Urinary Retention

With both acute and chronic UR, your doctor will ask you questions about your medical history, give you a physical examination, and may perform tests to...

With acute UR, your doctor’s first concern will be to relieve your pain by draining the urine from your bladder. He may do this by inserting a catheter into the urethra. In some cases the catheter may be inserted through your abdomen and into the bladder. In this case, he may use local or general anesthesia to prevent pain. When BPH is the cause, he may also prescribe medicine to prevent future UR episodes. 5,9

With both acute and chronic UR, your doctor will ask you questions about your medical history, give you a physical examination, and may perform tests to determine what’s causing your urinary retention. 5,9

There are a number of treatment options. This includes:

Bladder Drainage
If your UR is chronic, your doctor may prescribe clean intermittent catheterization (or CIC for short). CIC is where you insert a catheter yourself several times a day to empty your bladder. A condition known as neurogenic bladder (which is caused by nerve problems) can cause chronic UR. If you have neurogenic bladder, your doctor may recommend CIC or long-term catheter use if other treatments do not work. 5,9

Urethral Dilation
If your UR is caused by a urethral stricture, your doctor may try to open the stricture by placing wider and wider tubes in the urethra to try and widen it.5

For men who have BPH, your doctor may recommend different medications that can help to shrink your prostate such as Avodart or Proscar or others that may help to relax the bladder muscles such as Uroxatral, Cardura, Cialis, Flomax and many others. 2,5,9

Surgery is an option for men with an enlarged prostate (BPH). There are a number of different procedures. Some can be done in your doctor’s office and others require hospitalization 2,5

For women, if UR is caused by cystocele or rectocele, you may need surgery to lift the fallen bladder or rectum into its normal position. There are a number of ways your doctor may make this repair and your doctor will recommend the best procedure for you based on your conditions.5,8

The key is if you are having any of these symptoms, contact your doctor. They will be able to determine what the primary cause of your problem is and provide the most appropriate treatment. Remember, there is always the risk of complications with any treatment. This can include urinary tract infections, bladder and or kidney damage, and urinary incontinence.

Your doctor will present you with the options that are available to treat your specific condition and explain the risks and benefits of the procedures that may best serve your needs.

Places You Can Find More Information

About Urinary Retention - National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
The Urinary System and How it Works - the Urology Foundation
• Imaging of the Urinary Tract - National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)

Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional. 

References for the article above

Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional...


  1. Urology Care Foundation – Neurogenic Bladder Symptoms, Updated May 2014 https://www.urologyhealth.org/urology/index.cfm?article=9#SymptomNB
  2. Kirby R.S. Prostate Disease and their Treatments, Health Press Oxford 2010
  3. Diseases and Conditions; Benign Prostatic Hyperplasia (BPH), Updated 12/2001 https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/basics/symptoms/con-20030812
  4. Lepo H, Managing and Preventing Acute Urinary Retention, Urol. 2005; 7 (Suppl 8) S26-S33
  5. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) Urinary Retention Updated 8/2014 https://kidney.niddk.nih.gov/KUDiseases/pubs/UrinaryRetention/UrinaryRetention_508.pdf
  6. R Appell MD, Voiding Dysfunction – Diagnosis and Treatment, Humana Press Inc. New Jersey 2000
  7. A Wein MD, Campbell-Walsh Urology, Elsevier Saunders, Philadelphia PA, 2012
  8. A Slack, D Newman, A Wein MD, Fast Facts: Bladder Disorders, Oxford Press Ltd., Oxford UK, 2011
  9. B Selius DO, R Subedi MD, Urinary Retention in Adults: Diagnosis and Management, American Family Physician, Volume 77 Number 3, 2008

Information is as of 12/2014. Please check references for updated information.

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