Urinary Retention Treatment and causes

Urinary retention is a medical condition in which a patient is unable to  empty the bladder completely due to blockage or nerve problems. In men urinary retention can come when you have a prostate gland enlargement or cancer. Chronic urinary retention prevents the bladder from emptying entirely over time as opposed to acute urinary retention, which causes an abrupt inability to urinate.

How do the urinary bladder work?

Your brain tells the sphincters of the bladder to relax before you urinate. The muscular bladder wall is then told to contract, forcing urine out of the bladder into the urethra.

How quickly your kidneys generate the pee that fills the bladder and how much urine your bladder can comfortably hold will determine how frequently you need to urinate. The sphincter muscles continue to contract to retain pee in the bladder while the muscles of your bladder wall remain relaxed while the bladder fills with urine. Signals are transmitted to your brain when your bladder fills, telling you to find a bathroom as soon as possible. One of the mentioned processes may become problematic causing you to fail passing urine. 

Image Credit: Humanbiology.pressbooks.tru.ca. Urinary system on a man

What causes urinary retention

The causes of urinary retention are either a blockage that prevents urine from exiting your bladder or urethra partially or completely, or your bladder's inability to maintain a strong enough force to completely expel the urine.

The causes of urine to fail being passed out of the bladder can be due to blockage of the bladder outlet or urethra or weakness of bladder muscles that contracts to expel urine out. The muscles weakness is due to failed nervous system.

1. Obstruction (Bladder neck or urethra)

All elements of your urinary tract must function in harmony and in the proper order for you to be able to urinate normally. Normally, urine passes from your kidneys through your ureters, bladder, and urethra before leaving your body. You can have trouble peeing if there is a blockage or narrowing along the urinary tract, and if it is severe, you might not be able to urinate at all.

The following medical conditions might cause the urethra to constrict and obstruct urine flow:

• Enlarged prostate, or benign prostatic hyperplasia or prostate cancer.
• Pelvic organ prolapse, including cystocele and rectocele;
• Constipation;
• Urethral stricture
• Infections, such as STDs, or prostatitis 
• Injury to penis, urethra or pelvic area.
• Pelvic masses, such as non-cancerous or cancerous tumors, fibroids, polyps, or clots;
• Tight pelvic muscles 
• Strangulated penis neck Paraphimosis

2. Poor bladder contraction

When your bladder muscles, also known as your underactive bladder, aren't able to contract strongly enough or for long enough to properly empty your bladder, you may experience urinary retention. The following list of factors includes:

Neural disorders (Problems of nervous system)

When there is an issue with your neurological system, messages from your brain to your bladder and urethra cannot be sent, urinary retention might happen when external link is disturbed. Numerous factors might lead to neurological issues, including:

• Cerebrovascular accident (CVA)  aka Stroke
• Injury to the spinal cord, brain or pelvis
• Congenital malformations example Spina bifida
• Diabetes mellitus
• Birth through vagina
• Lead poisoning
• Syndromes like Guillaine barre or Fowler's
• Brain degenerative disorders example: Alzheima's disease, Parkinson's disease
• Multiple sclerosis

Drugs 

Certain medications that disrupt nerve signals to your bladder, urethra, or prostate can result in urinary retention. Some examples of these medications are:

• Antidepressants
• Drugs used to treat Parkinson's diseases
• Benzodiazepines such as Diazepam 
• NSAIDs such as ibuprofen and aspirin
• Noradrenaline and serotonin reuptake inhibitors
• Antipsychotic drugs
• Antispasmodics and anticholinergics
• Antihypertensive drugs called calcium channel blockers
• Common Cold drugs such as decongestants and antihistamines
• alpha-adrenergic agonists

Surgical operations

Urinary retention that lasts just temporarily is a common side effect of surgery. You may experience a full bladder as a result of intravenous (IV) fluid administration during surgery. Additionally, you receive anesthetic, which might keep you from feeling the urge to urinate even when your bladder is full. In addition, trauma, scarring, and edema brought on by pelvic surgery may partially or totally obstruct the passage of urine from your bladder or urethra.

Weak bladder muscles

Weak bladder muscles might not contract with enough force to completely empty the bladder. There are a variety of potential causes of weakness.

• Overdistention, which results in a stretched bladder with weakened muscles
• Weak bladder muscle due to old age
• Injury 
• Complications of pregnancy and delivery

Treatment options of urinary retention

Treatment of urinary retention depends on whether its acute or chronic retention. Acute retention occurs suddenly while chronic starts slowly and worsens by time with so many complications. Here are treatment according to the type:

Acute

Urinary retention that is acute requires immediate medical attention. To assist the urine drain faster, a catheter will probably be put. To ensure that you don't experience any pain or discomfort as a result of the catheter, local anesthetic will be utilized.

A doctor may place a suprapubic catheter into the skin above your bladder to drain your pee if a catheter is damaged or unable to be used due to another condition or injury.

Chronic

If you have consequences from this illness, such as chronic urine retention, you could require more long-term or regular treatment.

Catheterization

If the reason cannot be treated, a catheter will be placed right away to drain any pee in the bladder that cannot be released.

Catheters are often not a permanent fix. Infections brought on by bacteria entering the body through the catheter might result from using them regularly.

Catheters must be changed frequently throughout the day if you must use them at home to treat chronic urine retention.

it that you may change a catheter without contacting medical assistance, a doctor will demonstrate how to do it securely at home.

Stent and Urethral dilatation

By putting tiny tubes into your urethra that can aid in loosening a urethral stricture, the urethra can be safely enlarged (dilated). To finally enlarge the urethra enough to release pee, a doctor will progressively increase the size of the implanted tube.

In order to clear a stricture, a doctor may also carefully insert a balloon into the urethra and slowly inflate it.

A tiny tube known as a stent, which can be enlarged to aid with urine flow, may be inserted by the doctor. To ensure that you don't develop more urinary retention, the stent may be placed in your urethra for a lengthy time.

Cystoscope assisted treatment

A cystoscope is a device used to view inside bladder and that is possible because the device is flexible and has a camera on its end with a light.

This can assist a doctor in locating and treating any obstructions in your lower urinary system, such as stones, so you can urinate more freely.

Drugs

Urinary retention can be treated by using drugs such as

• Anti BPH drugs to reduce the size of the prostate gland.
• Antibacterial medicines are used to treat infections of the urinary tract and prostate gland
• Drugs that relaxes the sphincter muscles of the bladder and prostate thereby allowing urine to leave without resistance.

Surgical

If medication and lifestyle changes fail to relieve urinary retention, surgery may be considered.

A physician might be able to introduce a tool via the urethra in patients who have a penis and remove obstructions using a laser or specialized equipment. Most of the time, these procedures are less invasive and leave little recuperation time. Usually, you can return home the same day as your procedure.

• Transurethral resection of the prostate, or TURP, is the removal of prostate tissue that may be obstructing the urethra.
• Removal of your prostate (Prostatectomy)
• Making a hole in the urethra to repair a stricture to provide way for urine out (Urethrotomy)
• A heat and needle can be pushed through urethra to unblock any blockages

For more difficult diseases, some surgeries may be performed laparoscopically (with only a few tiny incisions and a small camera with surgical equipment), or by opening up skin and tissue nearby, including:

• prostate malignant tissue removal
• the excision of a uterus that has become too big or is afflicted by health issues
• repositioning the bladder or rectum following a cystocele or rectocele to its proper location in the body
• excision of malignant urethral or bladder tissues
• removal of further malignancies or pelvic organ cancer

Lifestyle changes

Here are a few lifestyle adjustments  that you can use to perhaps lessen urine retention is: Drink fluids at specific times to regulate your urination schedule. To have more control over your urinary sphincters, perform pelvic floor exercises. Learn about exercises that can strengthen the muscles in your bladder that govern your urination (for both vaginal and penile users).

Complications of urinary retention 

Urinary retention can affect other organs especially if it remains untreated for a longer time.

The complications that occur due to failure to pass urine include:

• Bladder damage
• Urinary tract infections
• Kidney damage due to urine accumulation that can lead to Kidney failure
• Hypertension due to kidney failure
• Feet edema

Summary

Failing to urinate has complications that may bring worse medical conditions, treating it early can help lessen them. Symptoms of urinary retention are obvious simply going hours without urinating should make you start thinking of seeking treatment before things goes to worse.