You may be surprised to learn that one cause of incontinence is urinary retention. This may seem counterintuitive since bladder leaks are the opposite of urine retention. However, there's a wide variety of causes and symptoms involved in urinary retention. Although discreet and reliable incontinence products can help you stay worry-free in your active lifestyle, understanding the causes of urinary retention might help you discover what is at the root of your symptoms. This could even lead to treatment that may help you experience a reduction of, or even relief from, bladder leaks altogether.
What Is Urinary Retention?
Urinary retention, simply put, is your body's inability to empty your bladder. This may mean difficulty starting to urinate, emptying the bladder completely, or going at all. For women, urination involves all of the following parts working correctly together:
- Bladder: Where urine is stored prior to release
- Urethra: A tube that leads outside the body from which urine is expelled
- Bladder neck: Connects the urethra to the bladder and is surrounded by a group of muscles called the sphincter that controls urine flow
Men have the same liquid-waste elimination parts, only they have a second sphincter to control urine entering the urethra from the bladder. An issue with any one of these parts can cause urinary retention.
Who Does Urinary Retention Affect?
Women who have experienced childbirth or have lower estrogen levels due to menopause are at higher risk. However, older men are most likely to develop urinary retention, especially if they have an enlarged prostate gland.
Urinary retention may present with a variety of symptoms in both women and men, depending on whether it's chronic or acute.
Acute Versus Chronic Urinary Retention
Although urinary retention can happen for various reasons, and the symptoms may look dramatically different from person to person, medical professionals divide the condition into two broad categories: acute and chronic.
What Is Acute Urinary Retention?
Acute urinary retention is defined as a sudden onset of severe symptoms when you previously were able to go to the bathroom normally. The symptoms of acute urinary retention include:
- Suddenly only being able to go in small amounts with a full bladder
- Suddenly not being able to urinate at all with a full bladder
- Urgent need to go
- Lower abdominal swelling
- Lower abdominal pain, often severe
A complete blockage is considered a serious, potentially life-threatening medical emergency. If your bladder doesn't drain, it could lead to infection, kidney damage, and even loss of life. A medical professional can give you immediate relief by draining the bladder with a catheter. In some cases, a doctor may also recommend surgery to remove any tissue causing the blockage, such as a tumor.
What Is Chronic Urinary Retention?
Chronic urinary retention, by contrast, is a long-lasting medical condition that may progress over time but is more common and not as serious. You could have chronic urinary retention if you have any of the following symptoms:
- Weak or slow flow
- Hard time urinating
- Occasions where you can't go at all
- Frequent need to go in small amounts
- Still feeling bladder pressure after urinating
- Bladder leaks from a full bladder
People with mild urinary retention will still have some urine in their bladder even after a trip to the bathroom. In more severe cases, the bladder has such difficulty emptying that it remains full most of the time. In this situation, the pressure of a full bladder can lead to periodic uncontrolled leaks.
Some people have no symptoms, while others may have additional symptoms, such as:
- Frequent urinary tract infections
- Nocturia, which involves waking up at night two or more times to urinate
- Inability to tell when the bladder is full
- Straining to urinate
What Causes Urinary Retention?
Urinary retention has three main causes: an underactive bladder, the narrowing of either the urethra or bladder neck, or a blockage.
The walls of the bladder contain smooth muscle that contracts to exert pressure to push urine out of the body. When the bladder isn't contracting with enough force, it can cause urinary retention. The primary issues that lead to an underactive bladder are:
- Weak bladder muscles
- Side effects from certain medications or anesthesia
- Post-surgery scarring in an area near the bladder
- Neurological problems
Neurological problems are usually caused by conditions that affect the nerves or the ability of the brain to communicate with your bladder. Common issues include diabetes, pelvic injury, vaginal birth, Alzheimer's, traumatic brain injury, and stroke.
Narrowing of Urethra or Bladder Neck
When either the urethra or the bladder neck becomes too narrow, it creates a bottleneck effect that causes the urine to flow out more slowly. Medical problems are usually behind these issues and can range in seriousness from constipation to a cancerous tumor. In some cases, a previous surgery causes scar tissue to create a stricture in the urethra or bladder neck, which reduces urine flow.
Women in particular can experience pelvic floor prolapse, where the weakening of the vaginal wall can cause a cystocele, which is when the bladder hangs below its normal position. Women can also experience sagging of the rectum, called a rectocele, which can also push the bladder out of place. Both pregnancy and menopause put women at greater risk of pelvic floor prolapse.
Blockages can have many causes and may occur due to a kidney or bladder stone, urinary tract infection, sexually transmitted disease, tumor, or cyst. A woman can experience a complete blockage from a pelvic floor prolapse, while a man may have issues related to an enlarged prostate, known as benign prostatic hyperplasia.
How Is Urinary Retention Diagnosed?
Acute urinary retention has an obvious diagnosis. Meanwhile, chronic urinary retention involves a complex process for finding the root cause of why the bladder won't empty. The first determination is if the issue is with the bladder, bladder neck, or urethra. This starts with a full medical history and exam, followed by any specific diagnostics, imaging, and tests.
Common Urinary Retention Tests
Your medical provider will likely order an ultrasound of your bladder, especially after you urinate. This is called a post-void residual measurement, and it may also be conducted with a catheter under local anesthetic. During the ultrasound, the technician measures the volume of urine that remains in your bladder.
Other tests may include:
- Cystoscopy: A cystoscopy is a medical procedure and test that allows doctors to see the inside of your urinary tract by inserting a tube with a camera.
- Electromyography: This test measures muscle and nerve activity near the bladder and urethra.
- Urodynamics tests: These are a group of tests, including a urethral pressure profile, uroflowmetry, and videourodynamics, that examine the functioning of your lower urinary tract.
Once the tests are complete, your doctor will have a better understanding of what is causing your urinary retention.
Treating Chronic Urinary Retention
Effective treatment has everything to do with the underlying cause. For example, if your medical provider determines you have a urinary tract infection, then you'll be treated with an appropriate antibiotic. If the ultrasound or cystoscopy uncovers bladder stones, you may need to undergo surgery to remove them.
For women, pelvic floor physical therapy may help strengthen the muscles, which is especially important if this plays a role in your urinary retention. Post-menopausal estrogen therapy, surgery, and other options, such as a vaginal pessary, may also help relieve symptoms.
Surgery to remove a mass or other obstruction may actually increase urinary retention symptoms, including bladder leaks. Often, this is temporary, and you should see improvement as the surgical site heals.
Other treatments, depending on the diagnosis, may include:
- Bladder drainage
- A change in medication
- Urethral stents
- Urethral dilation
In some cases, mild urinary retention may resolve on its own. This could be true when the underlying cause is something temporary, such as constipation, anxiety, or inflammation from an infection. However, it's important to seek professional medical advice if you have any symptoms that could potentially have a serious cause.
Neurological issues and nerve damage are sometimes temporary. When the problem is irreversible or shows no signs of improvement, you'll usually receive catheters for at-home use, so you can drain your bladder on your own. Doctors may also recommend incontinence products, such as the ones we provide on our site.
Urinary Retention Revealed
Urinary retention is a troubling condition that affects millions of women and men. If you're experiencing bladder leaks, it could be due to urinary retention. This may especially be true if you feel an almost constant urge to visit the bathroom or you've noticed a greater difficulty in emptying your bladder.
We understand how these symptoms can disrupt your quality of life, which makes this an important topic to discuss with your medical provider. Your doctor can determine exactly why this is happening and may even help improve your symptoms with the right treatment plan. In the meantime, no matter the cause or size of your bladder leaks, Nexwear has you covered. With discreet and comfortable pads and underwear to help protect against small leaks or any level of incontinence, we can help you get your confidence back. Get started today.