BPH

Urinary Retention in Men: Symptoms, Causes, and Treatments

Discussing bladder control problems, even with the doctor, can cause discomfort, and embarrassment.

Bladder control, however, is an issue that affects far more people than perceived. So bear in mind, if you are unable to empty your bladder properly, you are definitely not alone.

Urinary retention is defined as having great difficulty in completely, or even partially, emptying the bladder.

Many people have problems starting urination, as well as keeping the urine volume going, which results in the bladder not being fully drained. 

The bladder is a very integral part of the body, and when it is not functioning as it should, it is very distressing, and at times, even painful.

Fortunately, there are several treatments available, most of which have a good record of success.

Types of Urinary Retention

There are only 2 types of urinary retention, namely obstructive and non-obstructive. 

The obstructive type is characterized by a blockage such as kidney stones, cancer, or an enlarged prostate in men.

The obstruction prevents urine from effectively flowing through the urinary tract and the urethra. This causes some urine to remain in the bladder after voiding.

Non-obstructive urinary retention is mostly due to medical conditions which may be caused by a neurological issue, or a physical reason such as a traumatic injury to the pelvis. 

Any of these conditions can lead to a weakened bladder muscle, and nerve problems that interfere with the neurological signals between the brain and the bladder.

urinary retention
Urinary retention is defined as having great difficulty in completely, or even partially, emptying the bladder.

Common Causes of Urinary Retention

Examples of some of the most common causes of non-obstructive urinary retention are:

A pelvic fracture is a break that affects the structure of the pelvis, which can include the hip bones, sacrum, or coccyx, and be extremely painful. If complications occur, it may lead to internal bleeding or an injury to the bladder.

Certain medications, such as antihistamines, and antispasmodic drugs which aid digestion, can cause urinary retention. They decrease bladder muscle contraction, preventing the bladder from being completely emptied. 

Antidepressant meds have anticholinergic properties at therapeutic doses that contribute to urinary problems.

The side effects of anesthetics after surgery can impair muscle or nerve function of the bladder. The pain-relieving drugs often have a disruptive impact on the neural messaging to the part of the brain, which controls the nerves and the muscles in the urinary process.

Accidents that injure the brain or the spinal cord can also impact negatively on the neurological process of the urinary system.

Fortunately, no matter what type of urinary retention you may have, there is treatment available.

Symptoms of Urinary Retention

Some symptoms which you may experience:

• Difficulty starting to urinate.

• Inability to pass urine, the best you can manage is a weak stream which seems to dribble out.

• Constantly being unable to empty the bladder completely.

• Leaking which may occur during the day, especially if you move suddenly, cough or sneeze.

• A bloated feeling as if the bladder is always full, but no real urge to urinate.

• Some abdominal pain when urinating.

• A frequent need to urinate, often only a few drops, which may cause you to experience a burning sensation, could indicate a bladder and urinary tract infection.

• Cauda Equina Syndrome is a rare condition that happens when nerves at the bottom of the spine are damaged. The symptoms include numbness around the anus and a loss of bladder or bowel control.

• Guillain-Barre syndrome is another neurological disorder whose symptoms include eventual paralysis, and great difficulty with bladder function. 

• Weakened pelvic floor muscles, which no longer give the support the bladder needs. 

None of these symptoms should be ignored.  Experts agree that if you suffer any of them, consult a doctor. Your doctor will probably schedule tests for a diagnosis, to establish the root of the problem. 

How is Urinary Retention Diagnosed?

Diagnosis of urinary retention symptoms can involve the following:

  • urine samples.

  • blood tests.

  • a possible spinal tap to draw fluid.

  • an ultrasound of the bladder.

  • in some instances a CT scan or an MRI.

Specific conditions of urinary retention that only apply to men 

Enlarged Prostate (BPH)– The major reason men experience urinary retention is due to a problem with the prostate gland. The urethra passes through the prostate from the bladder to the penis where urine is expelled from the body.

An enlarged prostate caused by an infection, benign prostatic hyperplasia (BPH) or prostate cancer, presses down on the prostate and hampers the normal flow of urine from the body.

The larger the prostate gets, the more difficult it becomes to expel urine. This is very common in older men, who may then have hassles with leaking.

STI’s– Diseases spread by sexually transmitted infections can also cause swelling in the genital areas as well as the prostate, and add to the blockage issues.

Blockage problems- Blockage problems in men can cause urine to back up into the system. This can lead to other unpleasant urinary hassles such as leaking and bladder infections.

• Scar tissue– This may develop as a result of radiation, or surgical procedures involving the urinary tract and can constrict the urethra or bladder outlet, causing urinary blockage.

Infection- An infection on the tip of the penis that may develop from STI or thrush issues is likely to cause painful, difficult urination.   

Whether you are male or female, and whether you have an obstructive or non-obstructive type of urinary retention – or even both – it is essential to visit a doctor as soon as possible to stop serious health issues developing.

Complications of Urinary Retention

Complication issues may include:

Frequent urinary tract infections resulting from bacteria if the urine stays in the bladder.

Long term obstruction of the urinary tract may lead to painful bladder stones.

Serious bladder damage, such as losing the ability to contract if it becomes stretched for a lengthy period of time.

If urine backs up into the kidneys, it can lead to congestion, reducing kidney function. It can also leave you with a high risk of falling prey to chronic kidney disease.  

Urinary retention may also promote the formation of small pouches in the bladder wall, similar to those in the bowel (known as diverticulosis) which can trap bladder stones, causing pain and discomfort. Bacteria present in the pouches can multiply and are liable to cause infections.  

How is Urinary Retention Treated?

Treatments vary according to the type of urinary retention, and the needs of the individual concerned.

The impact of urinary retention with its associated issues of urine leaking, or dribbling, can have a dramatic effect on any person’s life.

Fortunately, there are several avenues to treat urinary retention.

Here are some of the recommended treatments for urinary retention:

Catheter- Acute urinary retention when the urine is almost unable to flow is extremely painful and needs the urgent placement of a catheter in the urethra to clear the blockage and drain the urine. In severe cases, a urethral stent or surgery may be necessary to keep the urethra open.

Intermittent catheterization– Older people with ongoing problems may require intermittent catheterization. The frequency of the catheterizations depended on fluid intake and bladder capacity. A permanently fitted urinary catheter is known to cause pain and discomfort that can last for days at a time.

Alpha-blocker medication– Some men with prostate enlargement (BPH) can be successfully treated with meds to reduce the size of the gland and relieve pressure on the urethra.

The type of medications that may be used is known as alpha-blockers. They relax the muscle of the bladder neck and the prostate, make it easier for urine to flow more freely from the bladder. However, it should be noted that they can have severe side effects.

Natural treatments, such as beta-sitosterol and saw palmetto, can also bee effective in relieving symptoms of benign prostatic hyperplasia (BPH). To find out more natural alternatives to Flomax, click hereSpeak with your urologist about available treatments.

Surgical removal– Uterine fibroid growths can press against the bladder and cause frequent urination as well as prevent the bladder from emptying properly. The only treatment which will help is surgical removal of the growths or even a hysterectomy.

 Surgery- Bladder endometriosis (tissue which grows into or onto the outside of the bladder) is usually treated with surgery. 

The doctor will try to remove all the tissue from inside and outside of the bladder. This should help to relieve the symptoms of frequent urination and painful voiding.

A prolapsed uterus causing the bladder to sag can also be surgically corrected.

Bladder lift– Surgery in the form of a bladder lift will help to strengthen weakened bladder muscles, and may potentially improve the signals between the brain and bladder which are needed for urinating.

Pelvic Exercises– Bladder control therapy, such as pelvic floor exercises, or Kegel exercises, strengthen pelvic muscles. The exercises are easy to do and will benefit both men and women who suffer from urinary retention.

• Lifestyle changes– Some health professionals also recommend lifestyle changes. This includes taking in fewer fluids, following a healthy diet, and if necessary – losing weight. Implementing these simple changes can help with the management of urinary retention.

Treatments are always tailored to suit the needs of the individual. They can only be established once tests have been conducted to get to the root cause of the retention.

Conclusion

An overview of urinary retention and all the related issues reveals that the condition is far more serious than people realize. 

Unfortunately, this lack of knowledge has led to many people not seeking timely medical intervention. This makes them vulnerable to complications which may be irreversible and eventually life-threatening. 

Nerve damage from a spinal cord injury, a stroke, or medical conditions like multiple sclerosis and Parkinson’s, disrupt messages from the bladder to the brain, resulting in a lack of bladder control – known as a neurogenic bladder. 

This may result in bladder therapy with set times to empty the bladder using catheterization, and in many cases massage of the bladder itself to expel urine.

The American College of Physicians (ACP) has published guidelines to the effect that urinary retention, is often under-reported, under-diagnosed, and under-treated. 

Research has shown that millions of Americans suffer from bladder and urinary abnormalities.

There are several treatment options available, and there have been reports of many successes.

The ACP recommends that for the best outcomes of treatment, both men and women should seek medical advice at the first sign of a problem. 

Urinary retention is not an issue on its own, which just suddenly happens out of nowhere. It is almost always the result of an underlying and possibly undiagnosed, medical condition.

Examples are an enlarged prostate, uterine fibroids, bladder endometriosis, cancer, and nerve damage.

These are serious conditions and may require surgery or specialized treatment for recovery. Very often, people tend to ignore apparent symptoms and delay visiting the doctor. 

Some take-home advice

Symptoms such as:

• Any sudden urges to urinate more than usual, and difficulty to hold it in.

• Pain or burning when urinating.

• A problem starting to urinate, and have a weak stream when it starts.

• Pain in the lower abdomen and a bladder that seems distended.

• Blood in the urine (hematuria).

• An extremely painful blockage in the urethra which may be a kidney or bladder stone.

• Unusual pelvic pain.

• Chronic constipation.

These are just a few of the symptoms which may point to the presence, or the start, of urinary retention.  Get medical advice, as early detection will give you the best chance of overcoming this distressing condition.

Sources

  1. Dougherty JM, Aeddula NR. Male Urinary Retention. [Updated 2019 Jul 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
  2. Muruganandham K, Dubey D, Kapoor R. Acute urinary retention in benign prostatic hyperplasia: Risk factors and current management. Indian J Urol. 2007;23(4):347–353. doi:10.4103/0970-1591.35050
  3. https://my.clevelandclinic.org/health/diseases/15427-urinary-retention
  4. https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-retention
  5. https://www.healthline.com/health/urinary-retention
  6. http://www.cmej.org.za/index.php/cmej/article/view/2429/2316
  7. https://www.medicalnewstoday.com/articles/316673.php
  8. https://www.uptodate.com/contents/benign-prostatic-hyperplasia-bph-beyond-the-basics
  9. https://www.depend.com.au/urinary-incontinence/
  10. https://www.bcm.edu/healthcare/care-centers/obstetrics-gynecology/conditions/urinary-retention
  11. https://www.emedicinehealth.com/inability_to_urinate/article_em.htm

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