How is acute urinary retention treated?

Acute Urinary Retention

This is a common urologic problem. The individual cannot pass urine, although it is present in the bladder. Retention has to be differentiated from the absence of urine formation, which is due to some form of kidney failure. Retention means that the force for the passage of urine is diminished or that the passage exit is blocked. The extent of urinary retention is evaluated by asking the individual to void and then demonstrating, by catheterization, that there is still a considerable volume of urine left in the bladder.

I haven't been able to urinate normally for twelve hours and I have a severe pain in the lower abdomen. Can I get relief? 

You are correct in noting that the dribbling is not an adequate urination. It is a sign of urinary retention with a very full bladder that is overflowing without emptying. The pain in the lower abdomen is due to the distended bladder and will be alleviated when the bladder is emptied. Catheterization gives prompt symptomatic relief.

Why did this come on so suddenly? 

Actually it is not as sudden as you think. This acute attack has been preceded for a long time by symptoms of prostatism with urinary frequency, difficulty initiating the urinary stream, getting up at night to urinate, and impaired force of urination.

What will happen now that I have the catheter in?

 If the catheter corrects the problem of returning the force of the muscle or correcting an infection, then all will get well after it is removed. Otherwise it will be necessary to correct the obstructive cause by surgery.

Why is this such a common problem after abdominal surgery performed far away from the bladder? 

Transitory postoperative urinary retention may occur in perfectly normal people. In that case it is a result of temporary weakness, position or inability to contract the abdominal muscles forcibly in the recumbent position. Any operation may precipitate a borderline prostatic problem into a complete obstruction. In other instances the operation may have altered the bladder supports sufficiently to have changed the direction of the propulsive force that normally empties the bladder.

How does this come about in women or younger people? 

When repeated episodes of urinary retention are encountered in this group, the surgeon is aware that the cause may be in some disease of the nervous system, in which case there would be interference with the control of the bladder. The patient then requires a neurologic examination to be sure that there is no spinal cord tumor, multiple sclerosis or other such disease. An internal examination will determine whether there is a tumor block in the pelvis.

Urinary retention is sometimes encountered in pregnancy, with other enlargements of the uterus, or in states of hysterics.


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