Other obstructive causes in men include prostate cancer, phimosis, and paraphimosis; Obstructive causes in women are prolapse of the pelvic organs of the bladder, rectum or uterus. Both men and women may experience direct physical obstruction due to stones, urethral strictures, clot obstruction related to hematuria, and bladder cancer. Sometimes foreign bodies, intraluminal or those that cause extrinsic compression, can cause urinary retention. In addition, fecal impacts, benign or malignant tumors, or other pelvic masses occupying the space can indirectly obstruct the urinary tract.5 Urinary retention in women is rare, occurring in 1 in 100,000 each year, with a female-to-male incidence rate of 1:13. This is usually temporary. The causes of UR in women can be multifactorial and can be postoperative and postpartum. Immediate urethral catheterization usually solves the problem. [17] Assessment of the patient suspected of urinary retention should begin with a detailed medical history to clarify the exact etiology, as summarized in Table 4.5. The initial assessment should also include a complete history of medications, including the use of over-the-counter medications and herbal supplements. The American Urological Association Symptom Index is a validated questionnaire that aims to quantify lower urinary tract symptoms in men compared to obstructive uropathy, often secondary to an enlarged prostate (www.aafp.org/afp/2014/1201/p769.html#afp20141201p769-f1).27 Acute urinary retention can be caused by failure of the BOO or detrusor.
Decompression with an indwelling bladder catheter is usually necessary first with careful monitoring of post-obstructive diuresis and electrolyte fluctuations. An assessment of renal impairment or hydronephrosis is also warranted. Avoid catheter clamping before removal, as this has shown no clinical benefit and only causes discomfort. In men with a history of BOO due to BPH, initiation of drug therapy with alpha-blockers or 5-alpha-reductase inhibitors may be considered. Urinary retention is a condition in which your bladder does not empty completely or at all when you urinate. Your bladder is like a storage tank for urine. Urine is made up of waste products that are filtered out of your blood by your kidneys. Once filtered, the urine travels into your bladder, where it waits until it`s time to move into the urethra and out of the body. Urinary retention may be associated with both epidural opioids and local anesthetics.
The exact incidence of urinary retention associated with continuous epidural analgesia with opioids or local anesthetics is unclear, as patients undergoing major surgery are often routinely catheterized. The incidence of urinary retention with neuraxially administered opioids can be as high as 70-80% [28, 57], which is higher than with parenterally administered opioids (-18%) [49, 57]. Continuous epidural administration of local anaesthetics may also be associated with a relatively high incidence of urinary retention, with a reported rate of approximately 10-30% [99, 100]. Once the bladder is safely decompressed, admission to hospital should be considered in relation to outpatient management. Hospitalization is indicated for patients who are uroseptic or who have an obstruction associated with a malignant tumor or spinal cord compression. The majority of patients can be treated on an outpatient basis after bladder drainage. Prophylactic antibiotics are not routinely indicated unless a urinary tract infection is suspected at the time of drainage. Additional instructions for catheter and drainage bag management should be given prior to emptying. Treatments for women with urinary retention: For women with cystocele or rectocele as the cause, mild or moderate cases can be treated with exercises that strengthen the pelvic floor muscles. They can also be treated by inserting a ring called a vaginal pessary to support the bladder. Your provider may suggest estrogen treatment if you have gone through menopause.
For more severe cases, surgery may be needed to lift the flaccid bladder or rectum. The physiology behind urinary retention associated with epidural opioid administration relies on activation of spinal opioid receptors, resulting in increased contraction of detrusor muscle strength.6 The incidence of urinary retention with epidural-rich opioids appears to be quite high (70% to 80%), especially compared to routinely administered opioids. where urinary retention occurs at only 18%.6,21,22 The development of urinary retention does not appear to be dose-dependent. Low-dose naloxone may be effective in treating opioid-induced epidural urinary retention, but carries the risk of reversing analgesia. Patients with urinary retention are often presented to the emergency room or a family doctor`s office. Patients are unlikely to see a urologist first, so it is essential that healthcare professionals become familiar with the initial treatment. Urinary retention can also be caused by certain medications. Medications such as antihistamines (Benadryl), antispasmodics (such as Detrol), opiates (such as Vicodin®), and tricyclic antidepressants (such as Elavil®®®) can alter the functioning of the bladder muscle.
Other medications can also cause side effects of bladder control, including anticholinergics, some antihypertensive medications, antipsychotics, hormonal agents, and muscle relaxants. Acute urinary retention is treated by inserting a urinary catheter (small, thin, flexible tube) into the bladder. This can be an intermittent catheter or a Foley catheter placed with a small inflatable plunger that holds the catheter in place. [ref. needed] Researchers don`t know how common chronic urinary retention is. However, researchers know that chronic urinary retention affects older men more than any other group. Acute urinary retention can cause severe pain and be life-threatening. If you suddenly stop urinating, it is important that you seek emergency medical treatment immediately. Urinary retention affects both men and women, but is more common in men, especially as they age.
Men with benign prostatic hyperplasia (BPH) – a condition in which the prostate is enlarged – are more likely to develop urinary retention. As the prostate grows, it presses against the urethra and blocks the flow of urine from the bladder. BPH is a common prostate problem in men over the age of 50. Self-inflicted causes of acute urinary retention include the use of external penis shrinkage devices used to maintain erections, as well as various other urogenital traumas.5 In the past, it was recommended to limit initial urinary drainage to 500-1000 ml to reduce complications of transient hematuria, hypotension and post-obstructive diuresis. Current practice has recognized that partial drainage and tightening are not necessary in AUR and may increase the risk of urinary tract infections. Rapid and complete decompression of the bladder can be performed safely, provided that careful supportive therapy is available and special attention is given to elderly or frail patients. Urinary retention of nervous diseases occurs in men and women at the same rate. Various infections can lead to edema of the urethra or bladder, resulting in acute urinary retention. Acute bacterial prostatitis, previously discussed in an AFP8 article, and balanitis/posthitis5 are common infectious causes in men; Vulvovaginal candidiasis and Behçet`s syndrome are infectious and inflammatory causes in women. In both sexes, urinary tract infections and other infections, including shingles, which affects the lumbosacral dermatome, can trigger urinary retention.5 Urinary retention or symptoms of impaired emptying in young women in the absence of obvious neurological disease have long intrigued urologists and neurologists; In the absence of a convincing organic cause, the condition was considered functional. A primary disorder of urethral sphincter relaxation (Fowler`s syndrome) is usually seen in young women after menarche, who have retention and bladder capacity that often exceeds one liter without the expected urgency. Polycystic ovaries are often associated.
Electromyography of the striated muscle of the urethral sphincter reveals complex repetitive discharges and a myotonia-like activity called explosion slowing. The urethral pressure profile and volume of the urethral sphincter are increased. Urinary retention is often successfully managed by sacral neuromodulation. After an initial episode of urinary retention, a patient may receive a catheter-free study (« urination test »).