BPH

Acute Urinary Retention In Men

The renal system has a critical role to play in the body. It ensures urine can be expelled from the body. A failure of the renal system means toxins and fluids cannot be removed effectively.

This can lead to the accumulation of toxins in the body. There may also be a collection of fluids. These factors lead to several serious complications. 

Several conditions can affect the urinary system. In men, acute urinary retention remains a serious concern. It is often accompanied by other conditions, of which many affect the prostate gland. Additional lower urinary tract symptoms can develop too. 

We take a closer look at what acute urinary retention is. The article also focuses on why the condition is considered a medical emergency. We will also consider the symptoms, causes, and the best treatment options for acute urinary retention in male patients. 

What Is Acute Urinary Retention?

Acute urinary retention is a condition of the urinary tract. It affects the renal system in the body. The condition can affect both men and women. Studies have revealed that men are at a higher risk of developing a condition than women. 

There are two types of urinary retention that men can develop. This includes acute urinary retention and chronic urinary retention. In this post, we will focus on the acute type of condition.

Acute urinary retention refers to a rather sudden onset of the symptoms. It is also essential for a male patient to get appropriate treatment as soon as possible if they develop acute urinary retention. 

The condition causes problems with voluntary urination. Voiding urine voluntarily is inhibited in men with acute urinary retention. 

Studies have shown that urinary retention is a common problem among male patients1. It has also considered secondary to a condition known as benign prostatic hyperplasia. This is a term that refers to an enlarged prostate. 

The prostate gland sits underneath the bladder. It also surrounds the urethra, a tube that connects the bladder neck to the tip of the penis. Urine is expelled from the bladder into the urethra during urination. 

Benign prostatic hyperplasia causes the prostate to grow in size. This can cause pressure on the bladder neck. The prostate also restricts the urethra. This reduces the man’s ability to urinate normally. The man may not be able to empty his bladder during urination completely. There may also be a strain and other lower urinary symptoms that develop. 

The risk for acute urinary retention increases with age. At the age of 70, at least 10% of all men will experience the condition—the prevalence of acute urinary retention increases in older men. About 33% of men experience the condition during their 80s. 

Symptoms

Acute urinary retention is generally considered to be a medical emergency. This means men need to consult a doctor when the symptoms develop.

Men also need to ensure they understand what symptoms may signal acute urinary retention. This is especially important among older men. Taking action early on can help to ensure the man avoids serious complications. 

The causes of acute and chronic urinary retention tend to differ. This is because acute urinary retention tends to happen quickly. The symptoms will usually have a sudden onset. It can also quickly escalate into a life-threatening condition if not treated as an urgent medical issue. 

The main symptom is a complete inability to urinate. The man will feel like he has to urinate. Even though there is an urgency to urinate, the man may not be able to get any urine out.

Other symptoms include:

  • Severe pain in the lower abdominal region

  • A significant amount of discomfort in the lower abdomen

Some men report signs of urinary incontinence when they have acute retention too. 

Causes

Determining the cause of acute urinary retention is an important part of providing the patient with appropriate treatment. There are a few different things that can cause the condition to develop in men.

A doctor will need to consider all possibilities. The reason for the acute urinary retention will usually be addressed during a treatment plan. 

Various systems in the body are involved in the renal system. This is why there are so many factors that need to be considered when looking at what causes acute urinary retention. 

Benign Prostatic Hyperplasia

A prevalent cause of acute urinary retention in men is benign prostatic hyperplasia. As previously noted, this is a condition where the prostate is enlarged. The larger the prostate grows, the more restriction it causes to the lower urinary tract. 

By pushing against the bladder’s neck, a man may find that they are not able to empty their bladder when they urinate. The pressure applied to the urethra reduces the flow of urine. In some cases, the prostate enlargement becomes more severe. This can lead to a more significant level of restriction applied to the lower urinary tract. 

Other conditions can cause the prostate gland to swell up too. Prostatitis is an example. The swelling can cause similar effects to benign prostatic hyperplasia. Prostate cancer is another prostate condition that can cause acute urinary retention in men2. 

Obstruction In The Urinary Tract

Some factors can cause an obstruction in the urinary tract. When this happens, urine is unable to flow from the bladder through the urethra. The urinary obstruction leads to the development of this condition. 

Stones that develop in the urinary tract are relatively common. This can cause the urinary tract to become obstructed. 

Other factors also linked to an obstruction in the urinary tract include:

  • Urethral stricture

  • Cancer in the intestine

  • Cancer in the pelvic region

  • A blood clot in the urethra or bladder

  • Severe constipation

When a foreign object is placed in the urethra, it can also cause acute urinary retention in men. One example of such an object is an indwelling catheter. A suprapubic catheter can sometimes also cause problems. 

Inflammation that affects the urethra may also lead to an obstruction. Various conditions may cause the urethra and other parts of the urinary tract to become inflamed. A urinary tract infection is only a single example. 

Nerve Health And Urinary Retention

Another possible cause for acute urinary retention would be issued with the patient’s nerves. There are several nerves involved in the urination process. Sphincters and nerves are found around the neck of the bladder. The brain sends a signal to these nerves to relax when the man urinates. 

When there is an issue with the signaling between nerves, then urinary retention can occur in some cases. 

Various conditions have been shown to cause severe damage to nerve health. Studies have provided evidence that a link exists between diabetes and bladder dysfunction3. People with diabetes often experience nerve-related problems. This is due to the damage that diabetes does to nerves in the body. When this happens, the brain’s signaling to the bladder may be disrupted. 

Individuals who suffered a stroke will also usually experience nerve damage. In some cases, this nerve damage may affect the signaling to the bladder’s sphincter. 

Other conditions also linked to nerve damage include:

  • Brain injury

  • Injury to the spinal cord

  • Parkinson’s disease

  • Multiple sclerosis

Women who deliver a baby may also suffer nerve damage. This can, in rare cases, lead to an increased risk of acute urinary retention. 

Medication That Causes Urinary Retention

In addition to these factors, it has been found that some pharmaceutical drugs can contribute to acute urinary retention. 

Men should take note of if they use any of these drugs. They should also understand the increased risk when they take these drugs daily. 

Some drugs associated with a risk of acute urinary retention include:

  • Antihistamines

  • Certain antidepressant drugs

  • Morphine (and other opioid medications)

  • Nonsteroidal anti-inflammatory drugs

  • Pseudoephedrine

  • Certain antipsychotic drugs

  • Parkinson’s disease medication

  • Amphetamines

  • Drugs for urinary incontinence

  • Some muscle relaxants

Risk Factors

There are a few risk factors that increase a man’s likeliness of developing acute urinary retention.

By understanding these risk factors, a man will be able to determine how likely they are to develop the condition. This also ensures the man can recognize the symptoms for acute urinary retention. 

  • Male gender is one of the most critical risk factors. There is a 10x higher chance for men to develop acute urinary retention compared to women. 

  • Men with certain prostate conditions have a higher risk too. This includes prostate cancer, as well as benign prostatic enlargement. 

  • Men who use penile constriction bands also put themselves at a higher risk of developing acute urinary retention. 

  • Uncircumcised men have also been found to be more likely to develop the condition. 

Complications

We have already touched the topic that acute urinary retention is a medical emergency. Men should ensure they understand why seeking medical assistance as an urgent matter is so important. This brings us to the possible complications that the condition can cause. 

There are a few possible complications that men can suffer when they have untreated acute urinary retention. 

When the bladder cannot empty, it means toxins may enter the body. This also leads to fluid accumulation. 

There is also a risk of renal failure associated with acute urinary retention4. This can cause damage to various parts of the renal system. The renal system consists of the kidneys, bladder, urethra, and more. Kidney damage leads to serious problems in the body. 

Men also have a risk of developing an infection if they have acute urinary retention. 

Treatment

Treatment for acute urinary retention needs to be provided as quickly as possible. When a patient comes to a doctor with symptoms associated with the condition, the doctor will act fast. They will treat it as an emergency. 

The first step is to place a catheter into the male patient’s bladder. This will allow the collected urine in the bladder to drain. It is a relatively fast procedure and also considered easy. 

There are times when a catheter cannot be placed into the bladder. In such a case, a small surgical procedure may be required. The doctor will make a tunnel on the skin. The tunnel will connect to the bladder. A suprapubic catheter is then placed into the bladder. This ensures urine can drain from the bladder. 

This is the first step to treating acute urinary retention. Treatment does not end here. When the bladder is drained, the patient should feel better immediately. 

Once this is done, the doctor will need to consider why the man experienced the event. Several tests may be ordered to assist in determining the cause. The doctor will then address the cause of the condition as part of the treatment approach. 

Prevention

There are a few ways that men can possibly prevent or at least reduce the risk of acute urinary retention. Men with chronic urinary retention symptoms should not ignore them. Seeking treatment for voiding dysfunction, prostatic infarction, and other issues like postoperative urinary retention help to prevent serious complications. 

Men should also consider the drugs they use. Speaking with a doctor can help the man realize if any medications can be changed or adjusted to reduce their risk. 

Men who require intermittent catheterization should talk to their doctor about the specific type of catheter used. Some options provide a lower risk of urinary retention and other side-effects. 

Conclusion

Urinary retention is often a medical emergency. The symptoms can cause discomfort, and the condition can lead to severe complications. Men with prostate problems are at the highest risk of acute urinary retention. Recognizing the symptoms of the condition is important. This allows a man to understand when they need to see a doctor. Early treatment for acute urinary retention helps to provide a reduced risk of complications. 

Sources

  1. StatPearls [Internet]. (2020) Male Urinary Retention. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK538499/
  2. Reviews in Urology. (2000) Spotlight on Bladder and Prostate Cancer and Urinary Retention at Glasgow Gathering. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153010/
  3. Frontiers in Pharmacology. (2010) Bladder Dysfunction in Diabetes Mellitus. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153010/
  4. American Family Physician. (2008) Urinary Retention in Adults: Diagnosis and Initial Management. [online] Available at: https://www.aafp.org/afp/2008/0301/p643.html#:~:text=1%20Chronic%20urinary%20retention%20is,include%20infection%20and%20renal%20failure.

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