Urinary retention

The most common causes of urinary retention are:

• Enlarged prostate (benign prostatic hyperplasia, BPH): In older men, an enlarged prostate is one of the most common causes of urinary retention. The prostate presses on the urethra and blocks the flow of urine.
• Urethral stricture (urethral stricture): A narrowing of the urethra due to scar tissue or injuries can obstruct urine flow.
• Neurological disorders: Conditions such as multiple sclerosis, stroke, or spinal cord injuries can impair nerve function that controls bladder emptying.
• Medications: Some medications, especially antihistamines, antidepressants, or narcotics, can affect the bladder muscle and lead to urinary retention.
• Bladder stones or tumors: Bladder stones or tumors in the bladder or urethra can block urine flow and cause urinary retention.

• Inability to completely empty the bladder
• Strong urge to urinate but inability to do so (in acute urinary retention)
• Pain or discomfort in the lower abdomen
• Frequent urge to urinate in small amounts (in chronic urinary retention)
• A weak or interrupted urine stream
• In more severe cases: Incontinence or leaking of urine when the bladder is overfilled

The diagnosis of urinary retention is made through a combination of physical examination, medical history, and diagnostic tests:

- **Physical examination**: The doctor may palpate the abdominal area to detect a distended bladder.

- **Bladder scan (ultrasound)**: An ultrasound is used to measure the amount of residual urine in the bladder after urination and to determine if the bladder is emptying completely.

- **Uroflowmetry**: This test measures the strength of the urine flow to assess bladder function.

- **Cystoscopy**: An examination of the urethra and bladder with an endoscope to identify structural causes such as strictures or tumors.

- **Blood tests**: In some cases, blood tests may be conducted to rule out kidney dysfunction or infections.

• Catheterization: In cases of acute urinary retention, a catheter is usually inserted through the urethra into the bladder to drain urine and reduce pressure on the bladder.
• Medications: In chronic urinary retention, especially due to prostate enlargement, medications such as alpha-blockers or 5-alpha-reductase inhibitors may be prescribed to alleviate symptoms.
• Surgical procedures: In cases of structural problems such as urethral strictures, bladder stones, or severe prostate enlargement, surgery may be necessary to remove the blockage and restore normal urine flow.
• Bladder training: In cases of neurologically induced urinary retention, bladder training or self-catheterization may be required to ensure regular bladder emptying.

The prevention of urinary retention depends on the cause. In men with prostate enlargement, regular check-ups can help reduce the risk of urinary retention. Early treatment of urinary tract infections, urethral strictures, or neurological disorders can also help prevent urinary retention. When taking medications that can cause urinary retention, possible alternatives should be discussed with the doctor.