Urinary retention

Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When it is of sudden onset, symptoms include an inability to urinate and lower abdominal pain, while symptoms accompanying gradual onset may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. About 7 per 100,000 of the general population are affected annually, and those with long-term urinary retention are at risk of urinary tract infections. Causes include blockage of the urethra, nerve problems, certain medications, and weak bladder muscles. Blockage can be caused by benign prostatic hyperplasia (BPH), urethral strictures, bladder stones, a cystocele, constipation, or tumors. Nerve problems can occur from diabetes, trauma, spinal cord problems, stroke, or heavy metal poisoning. Medications that can cause problems include anticholinergics, antihistamines, tricyclic antidepressants, cyclobenzaprine, diazepam, nonsteroidal anti-inflammatory drugs (NSAID), stimulants, and opioids. Diagnosis is typically based on measuring the amount of urine in the bladder after urinating. Treatment is typically with a catheter either through the urethra or lower abdomen. Other treatments may include medication to decrease the size of the prostate, urethral dilatation, a urethral stent, or surgery. Males are far more often affected than females, at a ratio of 13:1, in particular because of their possession of a prostate gland but also because their urethra is more susceptible to strictures, as it is far longer than the female one. In men, acute urinary retention is usually secondary to BPH. In males over the age of 40 about 6 per 1,000 are affected a year; among males over 80 this proportion increases to 30%.