What Causes Urinary Retention, and How Is It Treated?

Symptoms may differ slightly for acute and chronic urinary retention.

Acute

Urinary retention that appears suddenly can be dangerous. You may feel like you need to urinate badly, but nothing comes out when you try to urinate.

You can feel extreme pain or discomfort in the lower abdomen if you’re not able to urinate for a long time. This is because your bladder continues to expand and put pressure on the surrounding nerves and tissues.

Seek immediate medical attention if you experience acute urinary retention.

Chronic

Chronic urinary retention happens when you can urinate but all the urine does not drain from your bladder. Over time, urine leftover in the bladder may build up and expose you to toxins that your body would typically release.

Over time, this chronic condition can also cause complications. It’s important to see a doctor if you start to notice persistent symptoms of chronic urinary retention, such as:

• You urinate more than eight times a day and often feel like you have to urinate urgently.
• You have some trouble starting to urinate before urine comes out.
• When you urinate, the stream of urine is erratic, weak, or stops before you feel finished.
• Even after you urinate, you have the urge to go again shortly after.
• You regularly urinate a few times during the night.
• You have some leakage from your bladder during the day.
• You feel like you have the sudden urge to urinate, then feel like you can’t stop peeing once you start. This is known as urge incontinence.
• You’re not always sure if your bladder is full and if you actually have to urinate.
• You often feel some discomfort in your hip area or like you still have some fluid in your bladder.

First, it’s helpful to know what’s down there and what exactly happens when you urinate.

Your bladder holds your urine and is part of your lower urinary tract, which also includes your:

• Urethra. This is the tube that transports urine from your bladder to outside your body.
• Internal sphincter. The internal sphincter is located near where the bladder and urethra meet (known as the bladder outlet). This keeps urine from releasing into the urethra too soon. You can’t control this sphincter.
• External sphincter. The external sphincter is located in the urethra to keep urine in and let urine out when you urinate. It opens and closes to control when urine can leave the bladder. You can control this sphincter — it’s the one you use when you try to “hold it.”
• Prostate (only in people with a penis). This is a gland that stores some of the fluids in semen. It’s not part of your urination function, but it’s close to the rest of your urinary tract.

Now, here’s what happens when you urinate:

1. Bladder muscles push urine from the bladder into the urethra.
2. Nerves signal for your sphincter to let urine be released from your body.
3. The urine stream stops and starts when you control your external sphincter.
4. Your urge to urinate goes away once your nerves sense that the bladder is emptied and no longer putting pressure on nearby tissues.

There are several possible causes of urinary retention based on issues that can affect any of these parts or processes.

Obstruction

An obstruction happens when something gets in the way of urine leaving your bladder.

If something suddenly gets in the way and blocks your urine, this causes acute urinary retention. If the obstruction happens slowly over time and still allows some urine out, this results in chronic urinary retention.

Some possible causes of obstructions include:

• swelling in the urethra
• a constriction of the urethra that makes it hard for urine to come out
• an object blocking the urethra
• being constipated
• stones from the kidney or other part of the urinary tract
• a tumor or other mass in the gut or hip area that’s constricting the urinary tract
• a clot from blood in the urethra

Medication

Some medications can result in urinary retention due to muscle weakness or symptoms affecting your internal sphincter. These medications include:

• pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs)
• muscle relaxers
• urinary incontinence medications
• pseudoephedrine
• some antidepressants
• medication for Parkinson’s disease
• some antipsychotics
• amphetamines
• opioids (such as morphine)

Nerve problems

Damage to or disruption of the nerves near your urinary tract can lead to urination issues. Problems with these nerves make it more difficult for nerve signals to be sent to your brain and back to your body. This is needed to help stimulate the urge to urinate.

Some possible causes of nerve problems that can lead to urinary retention include:

• diabetes complications
• injury to the brain or spine
• vaginal birth
• multiple sclerosis
• Parkinson’s disease
• stroke

Surgery-related

You may find it hard to urinate right after a surgery such as a spinal or joint replacement surgery.

A 2015 study suggests that people have an increased risk of urinary retention right after joint replacement surgery. Urinary retention is about 1.5 times more likely after joint replacement surgery than other surgeries.

A 2017 study found that nearly 60 percent of people have some urinary retention right after a spinal surgery.

According to 2014 research, more than 50 percent of urinary retention in people with a penis has to do with the prostate.

The prostate is very close to the lower urinary tract. Urinary retention can be caused by both benign and cancerous masses, such as tumors or tissue buildup from conditions like benign prostatic hyperplasia (BPH). These masses can constrict or block the urethra and make it harder to urinate.

Prostate growth is typical as people with a prostate age, even when cancerous tissues are not involved. Up to 90 percent of people with a prostate have some prostate enlargement by the time they reach 80 years old.

Obstruction in people with a penis

Possible causes of obstruction in people with a penis include:

• benign prostatic hypertrophy, which happens when the prostate gets larger but is not cancerous
• prostate cancer
• meatal stenosis, a condition that can happen in babies when the urethra opening swells because of blood flow, urine contact, or scraping against material in a diaper

People with an uncircumcised penis may also experience:

• phimosis, which happens when you can’t pull the foreskin back from the head of the penis
• paraphimosis, an emergency condition that happens when your foreskin is stuck under the penis head

Infection and inflammation

Infections or swelling in the lower urinary tract can result in urinary retention. This includes:

• urethra inflammation (urethritis)
• bladder inflammation (cystitis)
• prostate inflammation (prostatitis)
• foreskin inflammation (balanitis)

Trauma

Injuring the penis can cause swelling that blocks the urethra or other internal parts of the lower urinary tract, blocking urine from coming out.

There are a few common causes specific to people with a vagina that can result in urinary retention, even though it’s less common.

Obstruction in people with a vagina

A benign or cancerous mass in the uterus can constrict the bladder or urethra, blocking urine from coming out.

Other common obstructions include:

• Cystocele. Cystocele occurs when the bladder lowers and pushes against your vagina.
• Rectocele. This is when the rectum expands and pushes against your vagina.
• Uterine prolapse. Uterine prolapse occurs when the uterus lowers and pushes against the bladder.

Infection

An infection called vulvovaginitis affects the external part of your vagina and can result in urinary retention. Bladder infections and urinary tract infections can also cause urinary retention.

To diagnose urinary retention, a doctor will first ask about the history of your symptoms and perform a physical exam. The physical will include an examination of your genitals and rectum to look for any symptoms affecting those areas that may also affect the urinary tract.

Some other tests that may be used to confirm a diagnosis include:

• urine samples
• blood tests
• urodynamic tests that measure how much urine your bladder holds
• post-void residual (PVR)
• cystoscopy
• electromyography
• CT scan
• ultrasound

Acute

You’ll need treatment right away for acute urinary retention. A catheter will likely be inserted to help quickly drain the urine. Local anesthesia will be used to make sure you don’t feel pain or discomfort from the catheter.

If a catheter doesn’t work or can’t be used because of an injury or other condition, a doctor may insert a suprapubic catheter into the skin above your bladder to drain the urine.

Chronic

You may need more long-term or consistent treatment if you experience chronic urinary retention or complications from this condition.

Catheterization

A catheter will be used right away to drain any urine in the bladder that can’t be released in case the cause can’t be treated.

Catheters are not typically a long-term solution. Using them frequently can cause complications like infections due to bacteria entering the body through the catheter.

If you do need to use catheters at home to treat chronic urinary retention, they’ll need to be changed several times per day to avoid complications.

A doctor will show you how to safely use a catheter at home so you can change them without having to seek medical help.

Urethral dilation and stents

The urethra can be safely widened (dilated) by inserting small tubes into your urethra that can help open up a urethral stricture. A doctor will gradually increase the size of the inserted tube to eventually widen the urethra enough to release urine.

A doctor can also guide a balloon into the urethra and slowly inflate it to unblock a stricture.

The doctor may insert a small tube called a stent that can be widened and help urine flow through. The stent may be left in your urethra for the long term to make sure you don’t experience further urinary retention.

Cystoscope

A cystoscope is a flexible tube with a light and camera on the end that can go into your urethra and view the inside of your bladder.

This can help a doctor find any obstructions, such as stones, in your lower urinary tract and remove them so you can urinate more freely.

Medication

Medications that can help treat urinary retention include:

• antibiotics for infections of the prostate, bladder, or urinary tract
• medications to relax your prostate or sphincters and help urine flow more freely
• medications to reduce the size of your prostate (if you have BPH)

Behavior modification

Here are some lifestyle changes you can make that may help reduce urinary retention:

• Drink fluids at certain times so you can control when you’ll urinate.
• Do pelvic floor exercises to gain more control over your urinary sphincters.
• Learn exercises that can help build the muscles that control your bladder (for both people with a vagina and people with a penis)

Surgery

Surgery may be considered if medication and lifestyle changes do not help resolve urinary retention.

For people with a penis, a doctor may be able to insert a tool through the urethra and get rid of obstructions using a specialized tool or laser. These surgeries are usually not invasive and require minimal recovery time. You can also typically go home the same day as the surgery.

Some surgical options for urinary retention include:

• needles and heat delivered through the urethra
• opening a hole through a urethral stricture (urethrotomy)
• removal of prostate tissue that may be restricting the urethra (known as a transurethral resection of the prostate, or TURP)
• prostate removal

Some surgeries may be done laparoscopically (with only a few tiny cuts and a small camera with surgical tools) or by opening up skin and tissue near the area for more complex conditions, including:

• removal of cancerous prostate tissue
• removal of a uterus that has become too large or affected by medical conditions
• putting the bladder or rectum back to where it belongs in the body after a cystocele or rectocele
• removal of cancerous tissues in the urethra or bladder
• removal of other tumors or cancer of your pelvic organs

Quickly draining a full bladder can result in your bladder filling up again more quickly. A symptom like this only tends to happen for about 24 hours and won’t cause any major issues. However, this can cause you to lose a lot of salt and water from your body and can result in dehydration and dangerously low blood pressure.

These conditions can be dangerous if unmonitored over time. A doctor may request that they consistently watch how much fluid and electrolytes you lose when you pee so they can recommend how much to drink to keep these levels consistent.

In this case, a doctor will recommend keeping a catheter in until you produce a healthy amount of urine so your urine production can be monitored.

Over time, keeping a catheter in too long can cause:

• urinary tract infections that can also lead to infection in your bloodstream
• injury or destruction of the urethra
• restrictions in the urethra that can block urine

Untreated chronic urinary retention can result in kidney damage from urine that isn’t drained and can cause complications like:

• high blood pressure
• swelling or fluid buildup in the legs (edema)
• further kidney damage that can lead to kidney failure

It’s typically easy to diagnose either acute or chronic urinary retention, especially if you see a doctor quickly after noticing changes in your urination or that you can’t urinate at all.

Several types of treatment may be used to help you manage your symptoms and reduce your risk of complications. In some cases, you may need long-term treatment, such as a catheter, to make sure your bladder is able to fully release urine.