Bladder > Bladder Problems > Urinary Retention

Urinary Retention

There are a number of reasons why someone may find it difficult to urinate. Some people may find that they really have to strain to make themselves go. Others may find that they experience feelings of urgency and frequency and when urinating only a small amount comes out. Others may find that their urinary stream is very weak and intermittent.

There are 2 main causes for difficulty urinating. Difficulty can be attributed to either a blockage to the flow of urine through the urethra or a weakened bladder. The actual bladder muscle can become so weak that it can no longer contract strongly enough to empty. There could also be damage to the nervous system which makes it impossible for the bladder to contract or for you to give it the signal to contract. This can be found with Parkinson's disease, Multiple Sclerosis and Alzheimer's.

Another cause could be insufficient urine in the bladder to enable urination. There could also be a learned voiding dysfunction - for example, a fear to use the toilet or to use toilets outside the home.

The most common cause of difficult urination for men is a blockage due to the prostate. The reason that urinating becomes difficult is because it takes a higher pressure to force the urine out of the urethra that is partially blocked by the prostate.

For women, one of the common causes of difficulty in urinating is trying to urinate when there is too little urine in the bladder, as mentioned above. A woman may try to urinate with little urine in the bladder because they have an overactive bladder.

The most common symptoms of difficulty urinating are a weak stream and hesitancy. Hesitancy is when there is a delay in urinating. You can experience an urge to go to the toilet and once there, nothing comes out. Some people find that they have to push with their abdominal muscles and strain to release urine.

A weak stream can be a thin stream and it could also be an intermittent or dribbling stream. You may stop and start urinating a few times before you are completely finished.

Whilst your problem is being investigated your bladder will still not be emptying properly and there is a risk that the residual urine which stays in the bladder will become infected This could cause further complications and problems.

It is important that a way is found to empty the bladder and quite often this will mean using a catheter; classed as a type of management option. A catheter is a thin, flexible plastic tube that is passed into the bladder through the urethra so that the urine will drain away.

Sometimes the catheter will be left in place so that the urine can be constantly drained into a collection bag which is worn on the leg. There are two kinds of indwelling catheter: urethral and suprapubic. A urethral catheter is inserted into the bladder through the urethra and a suprapubic catheter is inserted into the bladder through a hole in the abdomen, a few inches below the tummy button.

Another management option is called intermittent self catheterisation. You can be taught to perform intermittent catheterisation on yourself at an interval specified by your healthcare professional. Most people find that catheterising intermittently is not as difficult or as uncomfortable as they had first imagined.

Normally, either form of catheterisation will only be needed until the cause of obstruction has been treated.

Please use the link boxes below to find out about treatment and product (catheter) options to help with urinary retention. B&BF also has a range of Fact Sheets available explaining the differences between the different types of catheters, please visit our Publications Section for these and other Fact Sheets that you may find helpful.

It is important to seek help if you experience any of the above symptoms. Please make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.

You can also call our helpline on 0845 345 0165 (24 hour answerphone) for medical advice, or visit our Continence Clinic Database facility within our Specialist Services section to find out where your nearest clinic is or call our general enquiries line on 01536 533255 for details.

It would be a good idea to keep a record of your bladder activity in a bladder diary for a few days before your appointment with your doctor or nurse. For more information about keeping a bladder diary and to download a blank copy of a diary to fill in yourself, please visit our main bladder diary/retraining section.

Tests

There are some tests that your doctor or healthcare professional may recommend that you have done:

Bladder diary - this takes various forms but usually you will be asked to record the times when you pass urine and how much, if you are incontinent, or if you have urgency. It is a good idea to keep this diary for a period of at least three days (see above).

Urinalysis - this test just needs a sample of urine to find out if there is any infection, or any blood in your urine. If you do have an infection, this could explain why you have been experiencing difficulty urinating and you would normally be prescribed antibiotics.

Uroflowmetry - if there is no infection found you may have an uroflow test which measures how forcibly urine comes out and also a measurement of post-void residual urine which investigates how efficiently your bladder empties.

These tests do not hurt and will usually be done within the same appointment. From these tests your doctor or nurse should be able to see what the cause is and suggest a course of treatment.

If the tests above do not determine a cause clearly, you may need to undergo further tests including Urodynamics. Urodynamics is the study of the pressure of urine in the bladder and the flow of urine leaving the bladder.