It is the inability to urinate voluntarily, even when the urinary bladder is full and there is an urge to urinate. It is the most frequent urological consultation in emergency departments.
It is usually due to a blockage of the urethra or bladder neck that prevents urine from flowing out. The most frequent obstructive causes in men are benign prostatic hypertrophy, prostatic cancer and urinary meatus stenosis secondary to surgery. In women, the most frequent causes are uterine prolapse, bladder prolapse and pelvic masses such as myomas or gynecological cancer. Although with a much lower incidence, it can also be due to infection or inflammation of the urological area; the most frequent causes are prostatitis and vulvovaginitis. Finally, urinary retention can occur when the bladder muscles do not have the strength to contract; this is known as hypoactive bladder. In this case the origin is a neurological disorder such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, etc.
It manifests as a sudden inability to urinate and pain in the lower abdomen. Sometimes it may be accompanied by swelling of the lower abdomen, corresponding to a urinary bladder full of urine.
Diagnosis is clinical, by questioning and physical examination. Urinalysis may be ordered to rule out infectious causes and to study renal function, and imaging tests may be ordered to demonstrate bladder fullness and whether there is narrowing of the final stretch of the urinary tract. The urologist may perform urodynamic tests, which analyze the function of the bladder, sphincters and urethra, as well as a cystoscopy to look inside the urethra and bladder.
The emergency treatment is to drain the bladder by means of a catheter or bladder catheter. Then the cause must be treated; if it is due to prostatic hypertrophy with medication; if it is due to scarring after surgery of the urethra with procedures that free them; if it is due to a prolapse or a tumor, by surgery. In cases caused by a weakness of the bladder wall, exercises to strengthen the pelvic musculature as well as bladder training, with programmed urination to prevent fullness, can be very useful.
If you suspect acute urinary retention, you should consult your doctor without delay to avoid severe complications.
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