Urinary retention

Overview

Urinary retention is when you have trouble emptying your bladder completely. It means urine stays in your bladder even after you try to pee. It can happen suddenly (acute) or come on slowly over time (chronic).

Yes. Urinary retention is fairly common, especially in older men. About 1 in 10 men over age 70 have some degree of urinary retention. It also occurs in women, though less often.

Urinary retention can affect people of all ages, but it is most common in older men, often due to an enlarged prostate. It can also affect women after childbirth or pelvic surgery, people with nerve damage (such as from diabetes or spinal cord injury), and children with certain birth defects or infections.

Symptoms

Common symptoms

• Difficulty starting to urinate
• Weak or interrupted urine stream
• A feeling that the bladder is not empty after urinating
• Needing to urinate frequently, especially at night
• Straining to pee

Symptoms in children

• Crying or straining when trying to pee
• Frequent urinary tract infections
• Bedwetting after being toilet trained
• A swollen lower belly (distended bladder)

Symptoms in older adults

• Urinary leakage (incontinence) or dribbling
• Getting up many times at night to urinate
• Feeling a sudden, strong need to urinate
• Confusion or agitation, especially in those with dementia

Causes

Main causes

• Blockage in the urinary tract, such as an enlarged prostate (in men), a narrowed urethra, bladder stones, or constipation pressing on the urethra
• Nerve problems that affect the signals between your brain and bladder, such as from diabetes, multiple sclerosis, spinal cord injury, or stroke
• Medications like cold and allergy medicines with antihistamines, some decongestants, muscle relaxants, or certain antidepressants
• Weakened bladder muscles, often due to aging or long-term overdistension of the bladder
• Infection or inflammation, such as a urinary tract infection or prostatitis (infection of the prostate in men)

Risk factors

• Getting older, especially men over 50
• Having an enlarged prostate (benign prostatic hyperplasia or BPH)
• Having diabetes or other conditions that affect nerves
• Taking certain medications that can relax the bladder or tighten the urethra
• Being constipated or having pelvic surgery
• Having had a previous episode of urinary retention

When to see a doctor

See a doctor urgently if:

• If you suddenly cannot urinate at all and have severe pain, call your local emergency number immediately.
• If you have a high fever, chills, and cannot urinate, see a doctor right away.

Book a routine appointment if:

• If you have trouble urinating, a weak stream, or feel like your bladder isn’t emptying fully, make an appointment with your healthcare provider.
• If you notice blood in your urine or have frequent urinary tract infections, see a doctor.

Diagnosis

Your doctor will ask about your symptoms, medical history, and medications. They will examine your lower belly and may insert a small tube (catheter) to measure the amount of urine left in your bladder after you pee (post-void residual).

Tests that may be done

• Urine tests (urinalysis) to check for infection or blood
• Ultrasound or bladder scanner to see how much urine stays in the bladder
• Cystoscopy: a thin camera tube inserted into the urethra to look inside the bladder
• Urodynamic studies to measure pressure and flow during urination
• Blood tests to check kidney function and prostate-specific antigen (PSA) in men

What to expect at your appointment

The process is usually straightforward and may take place in your doctor’s office or a clinic. For some tests, like cystoscopy, you may need a local anesthetic. The doctor will explain each step and why it’s being done.

Treatment

Treatment depends on the cause and whether the retention is acute or chronic. The main goal is to relieve the blockage or help the bladder empty more completely. In an emergency, the bladder is drained immediately with a catheter.

Self-care at home

• Try to relax when urinating — do not strain or push hard.
• Double void: after you urinate, wait a moment and try to go again.
• Stay hydrated, but avoid drinking large amounts right before bed.
• If you are constipated, treat it with more fiber, fluids, and gentle exercise.

Medical treatments

Your doctor may prescribe medications that relax the prostate and bladder neck or help bladder muscles contract. These are not over-the-counter drugs; your doctor will choose what’s right for you based on your specific cause. Never take any medication for urinary retention without a prescription. If you have an infection, antibiotics may be prescribed. Catheterization — either a single drain or a temporary tube left in — may be needed to empty the bladder and give it time to recover.

When is surgery considered?

If urinary retention is caused by an enlarged prostate, a narrowed urethra, or bladder stones, surgery may be recommended to remove the blockage. Procedures can include removing part of the prostate (transurethral resection of the prostate, or TURP) or dilating a narrowed urethra. Your doctor will discuss options and risks.

Living with this condition

Living with chronic urinary retention may involve managing a catheter or using regular self-catheterization at home. This sounds daunting, but with training and support, many people manage it well. Keep a symptom diary and tell your doctor if you notice changes.

Lifestyle tips

• Urinate on a schedule — try to go every 3 to 4 hours even if you don’t feel the urge.
• Practice double voiding to empty your bladder more completely.
• Avoid caffeine, alcohol, and acidic foods if they irritate your bladder.
• Stop smoking — it can worsen bladder symptoms.

Diet and exercise

Eat a balanced diet with plenty of fiber to prevent constipation, which can worsen urinary retention. Regular physical activity, such as walking, can improve bowel and bladder function. Pelvic floor exercises (Kegels) may help strengthen the muscles that control urination, but talk to a specialist first — they are not right for all types of retention.

Mental health and emotional wellbeing

Living with urinary retention can be frustrating and embarrassing. It is normal to feel anxious or self-conscious. If you notice sadness, worry, or loss of interest in activities, talk to your doctor. Mental health support and counseling can help you cope.

Prevention

Some causes of urinary retention cannot be prevented, but you can reduce your risk by staying hydrated, treating constipation promptly, avoiding excessive use of medications that affect urination (only as directed by your doctor), and managing conditions like diabetes or prostate enlargement early.

Screening programmes

Routine screening for urinary retention is not standard. However, if you have symptoms or risk factors such as an enlarged prostate, your doctor may check your bladder emptying during regular check-ups.

Complications

If left untreated

• Urinary tract infections (UTIs) that can spread to the kidneys
• Bladder stones, which can cause pain and blood in urine
• Permanent bladder damage, leading to incontinence or inability to pee at all
• Kidney damage or failure if back-pressure from urine damages the kidneys

Long-term outlook

With proper treatment, most people with urinary retention get better or manage it well. Acute retention is usually relieved quickly with a catheter, and chronic retention can be managed with medication, catheterization, or surgery. The outlook is hopeful. Talk to your doctor about the best plan for you.

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