Doctor Answers: What is Acute Urinary Retention In Men?

The kidneys (renal system) plays a critical role in the body. They ensure 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 with Dr. Justin Houman. 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.

Q: What is Acute Urinary Retention?

Dr. Houman answers: This is a condition of the urinary tract that affects the renal system. Acute urinary retention can affect both men and women, but men are at a significantly higher risk. There are two types: acute and chronic urinary retention. Acute urinary retention refers to the sudden onset of symptoms, often requiring immediate medical attention.

This condition inhibits voluntary urination. Men with acute urinary retention are unable to void urine despite the urge. It is a common issue among older men and is frequently linked to benign prostatic hyperplasia (BPH), where the enlarged prostate compresses the urethra and bladder neck, impeding urine flow. At age 70, 10% of men are affected, rising to 33% by their 80s.

Q: What are the Symptoms of Acute Urinary Retention?

Dr. Houman answers: Acute urinary retention is considered a medical emergency. The hallmark symptom is a sudden and complete inability to urinate, often accompanied by a strong urge to urinate. Other symptoms include severe pain and significant discomfort in the lower abdomen. Some men may also experience overflow incontinence. Because the condition can rapidly become life-threatening, immediate medical evaluation is crucial.

Q: What Causes Acute Urinary Retention in Men?

Dr. Houman answers: Causes vary and must be properly diagnosed to determine effective treatment. Among the most common causes is benign prostatic hyperplasia (BPH), which enlarges the prostate and compresses the urethra. Other contributing conditions include prostatitis and prostate cancer.

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 would be issues 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 dysfunction. 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 have 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

Q: What are the Risk Factors for Acute Urinary Retention?

Dr. Houman answers: Risk increases with several factors. Men are 10 times more likely to develop acute urinary retention than women. Prostate-related conditions like BPH and prostate cancer raise the risk substantially. Additional risk factors include the use of penile constriction bands, being uncircumcised, or long-term use of certain medications mentioned earlier.

Q: What Complications Can Arise from Acute Urinary Retention?

Dr. Houman answers: This condition can lead to severe complications if untreated. When the bladder cannot empty, toxins accumulate and fluids build up, potentially resulting in infections or bladder damage. There is also a risk of renal failure, where damage to the kidneys or other parts of the renal system can occur. Prompt treatment is vital to avoid these life-threatening outcomes.

Q: What is the Treatment for Acute Urinary Retention?

Dr. Houman answers: Treatment starts with immediate bladder decompression using a catheter. If this is not possible via the urethra, a suprapubic catheter may be surgically inserted through the lower abdomen. This provides rapid relief from symptoms.

Once decompressed, doctors conduct tests to identify the underlying cause. Treatment then focuses on managing that cause, whether it involves prostate enlargement, infection, nerve damage, or medication-induced retention. Further treatments may include medication adjustments, surgical interventions for prostate conditions, or ongoing catheter use in severe cases.

Q: How Can Men Prevent Acute Urinary Retention?

Dr. Houman answers: Men should not ignore symptoms of chronic urinary retention or other lower urinary tract symptoms. Seeking early medical attention for voiding difficulties, BPH, or post-surgical complications is key. Medication reviews with a physician can identify drugs that may be increasing the risk.

For those using catheters, selecting the correct type and size reduces the chance of retention. Preventive strategies also include managing underlying conditions like diabetes, avoiding constipation, and maintaining regular urological checkups.

FAQs on Acute Urinary Retention in Men

Q: Can dehydration cause or worsen acute urinary retention?

Dr. Houman answers: Yes, dehydration can absolutely contribute to or worsen acute urinary retention (AUR), though it’s often an underappreciated factor. When you’re dehydrated, your body conserves water by producing less urine, leading to more concentrated, irritative urine that may aggravate underlying bladder outlet obstruction such as benign prostatic hyperplasia (BPH) in men or trigger bladder spasms in both sexes. In patients with borderline urinary function, like those with an enlarged prostate, detrusor underactivity, neurogenic bladder, or a history of incomplete voiding, dehydration can push them over the edge. When they suddenly rehydrate, especially after surgery, alcohol, travel, or hot weather, the kidneys may flood the bladder with a large volume of urine the patient cannot empty, leading to bladder overdistension and triggering AUR.

Q: Is acute urinary retention always painful?

Dr. Houman answers: Acute urinary retention is often, but not always painful. Most patients describe a sudden, intense urge to urinate with an inability to void, accompanied by severe lower abdominal or suprapubic discomfort as the bladder becomes distended. However, in certain populations such as older adults, individuals with diabetes, or patients with spinal cord injuries, the sensation of bladder fullness may be blunted or absent altogether. In these cases, retention can be surprisingly painless, and the first clue may be a distended abdomen, worsening kidney function, or confusion. As a urologist, I always caution that the absence of pain does not rule out urinary retention, especially in high-risk or neurologically impaired patients.

Q: Can acute urinary retention happen suddenly after surgery?

Dr. Houman answers: Yes, acute urinary retention can absolutely occur suddenly after surgery, and it’s one of the more common postoperative complications we manage as urologists. This typically results from a combination of factors including anesthesia, intravenous fluid shifts, opioid pain medications, and immobility, all of which can impair bladder contractility or increase outlet resistance. Patients with underlying risk factors like an enlarged prostate, previous voiding issues, or neurologic disease are particularly vulnerable. Even surgeries unrelated to the urinary tract, such as orthopedic or abdominal procedures, can precipitate retention. That’s why proactive bladder management protocols and early identification are critical in the perioperative setting.

Q: Can alcohol or caffeine intake trigger acute urinary retention?

Dr. Houman answers: Yes, both alcohol and caffeine can act as triggers for acute urinary retention, particularly in individuals with underlying bladder outlet obstruction or voiding dysfunction. Alcohol is a diuretic and can lead to rapid bladder filling, while also impairing the sensation of fullness and inhibiting the normal detrusor muscle response. Caffeine, found in coffee, tea, and energy drinks, is also a diuretic and bladder irritant that can exacerbate urgency and frequency. In someone with an enlarged prostate or compromised bladder function, this combination of increased urine production and impaired emptying can precipitate sudden retention. Clinically, we often see this in social settings where a patient consumes large amounts of alcohol or caffeine and then is unable to void, leading to a painful distended bladder requiring catheterization.

Q: How does long-term catheter use affect the risk of acute urinary retention?

Dr. Houman answers: Long-term catheter use can paradoxically increase the risk of acute urinary retention, especially when the catheter is removed after prolonged dependence. Over time, the bladder can become deconditioned due to continuous drainage, leading to detrusor underactivity or even atony. When the catheter is removed, the bladder may lack the contractile strength to generate an effective void, resulting in immediate retention. Additionally, chronic catheterization can lead to urethral trauma, bladder neck fibrosis, or infection, all of which can impair normal voiding. As urologists, we carefully assess bladder function before removing long-term catheters, often using a voiding trial or bladder scan to ensure the patient can empty adequately.

Conclusion

Acute urinary retention in men is a medical emergency that requires immediate intervention. The inability to urinate, paired with abdominal discomfort, signals the need for urgent medical evaluation. 

Prompt treatment, beginning with bladder drainage and followed by identifying the cause, can prevent serious complications like infections and kidney damage. 

Men with prostate issues should remain vigilant and consult their doctors at the first sign of urinary difficulties to ensure swift and safe management of the condition.

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