We often hear about urinary incontinence—the involuntary loss of urine. But what about the other side of the coin? What happens when you can’t urinate, even though you feel the urge? This condition is called urinary retention, and it can range from a chronic, manageable issue to a sudden, painful medical emergency.
Urinary retention is the inability to completely empty your bladder. This can lead to a host of problems, including discomfort, pain, and, if left untreated, serious kidney damage. It’s a condition that can affect people of all ages and genders, but it is more common in older men due to benign prostatic hyperplasia (BPH).
Types of Urinary Retention
There are two main types of urinary retention:
- Acute Urinary Retention: This is a sudden and complete inability to urinate. It’s an emergency situation that is often accompanied by severe pain and discomfort in the lower abdomen. If you experience this, you must seek immediate medical attention.
- Chronic Urinary Retention: This is a long-term condition where you can urinate, but you can’t completely empty your bladder. You might not even realize you have it, as the symptoms can be less severe and develop gradually. You may notice a weak stream, a feeling of not being finished, or the need to urinate frequently, especially at night.
Why Can’t I Pee? Common Causes
Understanding the cause is the first step toward finding a solution. The reasons behind urinary retention can be broadly categorized into two groups:
- Obstruction (Blockage): Something is physically blocking the flow of urine out of the bladder.
- Benign Prostatic Hyperplasia (BPH): This is the most common cause in men. The prostate gland, which surrounds the urethra, becomes enlarged and squeezes the urethra, making it difficult for urine to flow.
- Urinary Tract Stones: Kidney or bladder stones can get lodged in the urethra, blocking the flow.
- Tumors: Tumors in the bladder, prostate, or urethra can cause an obstruction.
- Urethral Stricture: Scar tissue can narrow the urethra, making it difficult for urine to pass.
- Fecal Impaction: Severe constipation can put pressure on the bladder and urethra, leading to retention.
- Nerve Problems: The nerves that control the bladder and the muscles involved in urination aren’t working correctly.
- Nerve Damage: This can be caused by conditions like multiple sclerosis, Parkinson’s disease, stroke, or spinal cord injury.
- Medications: Certain medications, such as some antidepressants, decongestants, and antihistamines, can interfere with nerve signals to the bladder.
- Surgery: Procedures involving the pelvis, spine, or colon can sometimes temporarily or permanently damage nerves.
- Diabetes: Long-term diabetes can lead to nerve damage (neuropathy) that affects bladder function.
What to Do If You Can’t Pee
If you’re experiencing a sudden, painful inability to urinate (acute retention), go to the nearest emergency room immediately. A healthcare professional will need to insert a catheter to drain your bladder, which provides immediate relief and prevents further complications.
For chronic urinary retention, the approach is different. The first step is to see a doctor. They will perform a physical exam, take a medical history, and may order tests such as:
- Urine Flow Study (Uroflowmetry): Measures the speed and volume of your urine flow.
- Post-Void Residual (PVR) Measurement: Uses an ultrasound or a catheter to see how much urine is left in your bladder after you’ve tried to empty it.
- Cystoscopy: A small camera is inserted into the urethra to visualize the bladder and urethra for any blockages.
Treatment Options
The treatment for urinary retention depends entirely on the underlying cause:
- Catheterization: For both acute and chronic cases, a catheter may be used to drain the bladder. In chronic cases, intermittent self-catheterization may be an option, where the patient learns to insert and remove a catheter several times a day.
- Medications:
- For BPH: Medications can shrink the prostate or relax the bladder neck and prostate muscles to improve urine flow.
- For Nerve Problems: Medications may be used to help the bladder muscles contract.
- Surgery:
- For BPH: Procedures like transurethral resection of the prostate (TURP) can remove prostate tissue to relieve the blockage.
- For Strictures: Surgery can widen the narrowed part of the urethra.
- Lifestyle Changes:
- Double Voiding: After urinating, wait a few minutes and try to urinate again.
- Scheduled Urination: Urinate at set times, even if you don’t feel the urge.
- Pelvic Floor Exercises: Can help improve bladder control and muscle strength.
The Takeaway
Urinary retention is a serious condition that requires medical attention. Don’t dismiss the symptoms, no matter how minor they may seem. Whether you’re experiencing a sudden inability to pee or a persistent weak stream, a visit to your Urologist can lead to a diagnosis and a treatment plan that will improve your quality of life and prevent long-term health problems. Don’t be afraid to talk about it—your bladder will thank you.