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Unable to Urinate – Causes, Symptoms, Treatment

Updated on August 18, 2014

When a person is unable to urinate, then that condition is called urinary retention. Individuals with chronic urinary retention may be able to pass urine, but they may face problems fully emptying the bladder or commencing a stream. Patients may frequently urinate; they may have a strong desire to pass urine, but are unable to urinate; or they may still have the urge even after finishing urination.

People with acute urinary retention cannot pass urine at all, even when the bladder is full. It is an emergency situation and requires immediate medical care. Chronic urinary retention may not appear serious, but it can result in dangerous health issues and hence also needs to be treated.

People of all age groups and both genders may be ‘unable to urinate’. However, males in their 50s and 60s are more susceptible due to prostate enlargement. Women may suffer from urinary retention due to an underlying case of cystocele or rectocele. Both genders may experience urination problems due to nerve damage or nerve disease.

Symptoms of urinary retention/unable to urinate

Some common signs and symptoms of chronic urinary retention include:

  • Patients may face problems commencing the outflow of urine. It may be weak after starting.
  • Presence of minor but continuous discomfort.
  • Urge to urinate frequently. The desire persists even after passing urine.
  • Presence of overflow incontinence, wherein the patient may suffer from a perennially full bladder, causing him/her to dribble between visits to the bathroom/toilet.

Some common signs and symptoms of acute urinary retention include:

  • Severe discomfort
  • Bloating in the lower abdomen
  • Pain
  • An urgent need to pass urine, but still unable to urinate.

Causes of urinary retention/unable to urinate

A person may be unable to urinate due to nerve anomalies that hamper the signaling process between the bladder and the brain, or due to urinary tract obstructions.

Nerve dysfunction may prevent the brain from getting a ‘full bladder’ message. Even if the information is passed on, the bladder muscles required for squeezing out urine may not get the signal to push, or the sphincter muscles may not get the ‘time to relax’ signal. Weakened bladder muscles can also result in urinary problems.

Some common causes of urinary retention are listed below:

  • Bladder stone: A stone present in any part of the urinary tract can get stuck in the bladder. A big bladder stone can completely obstruct and plug the urethral opening.
  • Prostate enlargement: With an increasing age, the prostate gland in males tend to enlarge. The disorder is referred to as benign prostatic hypertrophy, or BPH/ benign prostatic hyperplasia.The expansion of a continuously enlarging prostate is stopped by the surrounding tissue layers. This causes the gland to exert pressure against the urethra, leading to irritation and thickening of the bladder wall. The bladder then starts contracting even when small quantity of urine is present, leading to frequent urination. The bladder eventually becomes weak and is unable to empty itself, and the patient is then unable to urinate.
  • Rectocele and cystocele:Cystocele is a condition characterized by sagging of the bladder into the vagina due to weakening of the wall between the vagina and the bladder. Such abnormal bladder location can cause urinary retention.Rectocele involves sagging of the rectum into the rear vaginal wall. Both rectocele and cystocele usually arise due to drooping of bladder’s pelvic support floor.
  • Surgery: Most surgeries involve intravenous administration of fluids and anesthesia. Such a combination may lead to a packed bladder with weakened nerve functionality. As a result, several individuals are unable to urinate post surgery.
  • Spinal cord injury or nerve disease: The nerves as well as the nerve pathways can get damaged due to varied causes such as spinal cord or brain infections, vaginal childbirth, diabetes, injuries to spinal cord or brain due to accidents, stroke, multiple sclerosis, pelvic trauma or injury, and heavy metal poisoning.Some children may also have congenital nerve anomalies which can prevent the bladder from eliminating urine.
  • Urethral stricture: A person may also be unable to urinate because of urethral constriction, which in turn is due to scarring resulting from trauma/injury to penis, or infection.
  • Medications: Different drugs used to counter anxiety, allergies, muscle spasms, etc., work by depressing hyperactive nerve signals. Medications for treating an overactive bladder or urinary incontinence also affect the ability to pass urine. Some common drugs that may cause urinary retention include antihistamines, antispasmodics/anticholinergics, and tricyclic antidepressants.
  • Urinary Tract Infection or UTI: A UTI is caused due to infection of the urinary system by bacteria or other pathogens. It causes inflammation, irritation, swelling, and other urinary problems. It may also cause the urethra to swell up and get blocked, thereby causing urinary retention.
  • Constipation: The urethra may get pinched shut due to elevated pressure exertedon the urethra and bladder by a hard stool present in the rectum.

Treatment of urinary retention/unable to urinate

Treatment of urinary retention is dependent on the underlying cause. After diagnosis, doctors may opt for any of the below listed treatment options for people who are unable to urinate.

  • Catheterization.
  • Drug therapy or surgery for prostate enlargement.
  • Surgery or stenting for urethral stricture.
  • Rectocele or cystocele may be corrected via surgery.

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