Article Content

Q: A 73-year-old male patient said to me, "I always feel like I have to go, but when I try to go, I can't!!" What's causing his problem?

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

A: Your patient has urinary retention, the inability of the bladder to empty completely when voiding is attempted. It can be acute or chronic (see Causes of urinary retention).


Why does urinary retention occur? It has two basic causes:


* a deficit in detrusor muscle function. Blame the loss primarily on aging; the muscle's just not as flexible as it once was. Failure to urinate regularly (4 to 6 times per day) can also weaken the muscle, as can a chronically overfull bladder.


* a blockage. This can be caused by an intrinsic narrowing or external compression of the bladder neck or proximal urethra. The body tries to compensate at first, but in time the normally smooth walls of the bladder are replaced by hypertrophied smooth muscle fibers, creating resistance. More pressure is needed to contract the muscle and expel urine; the end result is muscle fatigue before the bladder is empty.



No matter what the cause, interruption in normal bladder elimination can lead to secondary health risks, like urinary tract damage and infection, overflow incontinence, and urine reflux.


My cup runneth over

Patients with urinary retention may present with an urge to void and/or sensations of incomplete emptying. Hesitancy, straining, and terminal dribbling with overflow incontinence may be evident. Patients may complain of frequency, nocturia, and pain in the lower abdomen from an overly distended bladder.


The goal of treatment is to release the retained urine. Continuous and intermittent catheterization are the most commonly used techniques. Medical treatment may include a cholinergic agent, like bethanechol (Urecholine). An alpha-adrenergic antagonist, like terazosin (Hytrin), doxazosin (Cardura), or tamsulosin (Flomax), can be used to relax constriction around the urethra in treating prostatic hyperplasia.


Teach patients to avoid medications that tighten the muscles around the urethra, like the popular over-the-counter decongestant pseudoephedrine. Also, they should avoid antihistamines, like diphenhydramine (Benadryl), which can relax the bladder and prevent effective contraction. Advise patients to limit caffeine intake after 2 o'clock in the afternoon. Caffeine increases urine production and can cause nocturia. Running water or pouring warm water over the meatus can stimulate urine flow.


This topic is often a difficult one for patients to discuss, so encourage them to tell all and ask anything. If the information flows freely, so may the pee!!


Causes of urinary retention