Urinary Retention

Acute Urinary Retention

In women, this may occur after delivery or in various conditions such as multiple sclerosis, while in men it may also be caused by enlargement of the prostate. These patients are quite uncomfortable and require a catheter to relieve the bladder obstruction. Ordinarily, many of these patients can be given a voiding trial after one or more days of bladder decompression, and many will regain normal bladder function, especially those patients who have had a precipitating event such as anesthesia, alcohol, cough medicines, constipation or a urinary tract infection.

Residual prostatic symptoms may be treated with one of the various medications outlined above.

Chronic Urinary Retention

This may occur in women because of diabetes or various neurological disorders, while in men it is usually secondary to outflow obstruction, of which prostate enlargement is the most common cause. In this scenario, patients have very severe bladder outlet obstruction affecting the drainage of their kidneys or compromising their function. Patients are generally not too symptomatic but may complain of lower abdominal fullness and some incontinence.

Men may have some mild prostatic symptoms. These patients will require slow drainage of their bladder, as rapid decompression can result in significant hematuria. Because the bladder muscle has been so overexpanded over a period of time, it is possible that the muscle may not regain its function sufficiently after surgical treatment to relieve the obstruction. In order for the bladder to work properly, the patient may also be required to empty his bladder with clean, intermittent catheterization. The addition of a medication like Bethanechol may be helpful in improving bladder contractions.