What causes incomplete emptying of the bladder?

---

Incomplete emptying of a bladder can affect people across all age groups and be a cause for pain, irritation, and embarrassment to the person. The medical term for the condition is ‘Urinary Retention’.

If not treated in time, the condition can lead to complications including kidney failure that can be fatal. It’s important to recognize the symptoms and seek medical help immediately.

The Urinary System

As we all know, the kidneys eliminate wastes, from the blood and the food we consume, in the form of urine.

The kidneys produce urine which is then carried to the bladder by 2 long tubes, one each from either kidney, called ureters. The bladder is a temporary reservoir for the urine and also helps in pushing urine out of the body. A thin tube called the urethra connects the bladder to the outside of the body. Two types of sphincter muscles envelop the urethra and control its motion.

Once the bladder fills up, the brain signals the person to find a toilet. Once the person is ready to urinate, the brain signals the bladder to contract, and the sphincter muscles to relax so that the urine can be pushed out of the bladder and the body. As is clear, there are several organs or tissues involved in this process. A malfunction anywhere in this circuit can cause urinary retention. The urine that remains in the bladder even after going (urinating), is called post-void residue (voiding refers to the emptying of the bladder).

Signs and symptoms of Urinary Retention (UR)

Depending on the severity and duration of the condition, Urinary Retention can be early-stage, acute, or chronic and show symptoms that are similar but worsen over time.

If you ignore the condition when it’s early-stage, it can quickly progress to the acute stage. In the early stage, the person feels the urge to go again immediately after going.

In acute and chronic stages, symptoms include:

• The person has the urge to urinate frequently, more often than the normal routine
• It’s hard or takes time to start
• The urine stream is weak, or starts and stops a couple of times
• There is an urge to urinate again right after finishing
• The person wakes one or more times in the night to urinate
• There is urine leak from the bladder throughout the day causing embarrassment and social withdrawal
• Urge incontinence: An irresistible urge to go, and inability to stop while going
• The person can’t tell when the bladder is full
• There is constant discomfort or a feeling of fullness in the lower abdomen or pelvic area.

Causes for UR

Obstruction anywhere in the circuit

Anything that prevents the urine to get to the bladder from the kidneys can cause urinary retention. Some of the causes for obstruction that are common to men and women are:

• Kidney stones or urinary tract stones in general
• Any defect in the structure of the urethra
• Tumour or cancer in any organ or part of the lower abdomen
• A bout of severe constipation
• Blood clot due to bleeding in the bladder which can be due to various reasons
• A foreign object stuck or inserted into the urethra
• Severe inflammation of the urethra, which can be due to various reasons

Drugs and Medication

There are various drugs and medicines that prevent the bladder from voiding or emptying. In this case, the sphincter muscles contract instead of relaxing when the person wants to go.

• Amphetamines: a class of nervous system stimulants that are used to treat narcolepsy, obesity, and hyperactivity disorder.
• Antihistamines: used to treat various allergies
• Medication for Parkinson’s disease
• Medication for urinary incontinence described above
• Muscle relaxants used to treat hyperreflexia, muscle pain, muscle spasms, etc
• Nonsteroidal anti-inflammatory drugs (NSAIDs): used to reduce inflammation, pain, fever, and blood clots
• Pseudoephedrine: used as a stimulant for wakefulness, and to decongest the nose or sinuses
• Some Antipsychotics: Also called neuroleptics, these are used to treat psychotic disorders such as schizophrenia
• Some antidepressants that were used in the past
• Some opioid medication for pain such as morphine

Nerve or neurological issues

The signals from the brain travel through the spinal cord before it reaches the pelvic area, and then back again. Disruption of nerve function anywhere in this route can lead to UR. Such disruptions can be due to:

• Brain stroke
• Multiple sclerosis
• Trauma or injury to the brain or spinal cord
• Childbirth
• Diabetes from a long time
• Parkinson’s disease

Issues with urethral structure

There may be deformities in the structure of the urethra due to a bout of urinary tract infection, scarring after surgery, and inflammation, leading to UR.

Surgery

Some surgeries cause UR for a couple of days after the surgery. This can be due to the anaesthesia, medication given after surgery, or the nature of the surgery. Some of these are rectal surgery, spine surgery, hip replacement surgery, and surgery for women’s pelvic issues or hemorrhoids.

Men-specific reasons

Obstruction to urinary flow in men can come from non-cancerous enlargement of the prostate, prostate cancer, and penile-constriction bands. Un-circumcised men can develop conditions such as paraphimosis and phimosis which can cause UR. Men can also develop UR due to an infection or inflammation in the bladder (cystitis), urethra (urethritis), prostate (prostitis), and foreskin in uncircumcised men (balanitis). Injury or trauma to the pelvic area can also cause UR.

Women-specific reasons

Cancer in the uterus or downward movement of the uterus (prolapse) can block the urethra causing UR. Obstruction can be due to the bladder sagging and bulging into the vagina (cystocele) or the rectum pushing out and bulging into the vagina (rectocele). Infections such as vulvovaginitis and cystitis also can cause UR in women.

Sexually Transmitted Diseases

Can cause UR in both men and women

Weakened bladder muscles

With advanced age, bladder muscles can weaken in some men and women, causing UR.

Frequently Asked Questions

1. What is urinary retention, and what causes it?

Urinary retention is incomplete bladder emptying. Causes include obstruction, medication side effects, nerve issues, and post-surgery effects.

2. What are the symptoms of urinary retention?

• Frequent urge to urinate
• Weak urine stream
• Nighttime urination
• Urge incontinence
• Pelvic discomfort

3. Are there specific reasons for urinary retention in men and women?

Yes, men may experience it due to prostate issues, while women may face obstruction from uterine prolapse or infections.

4. Can medications contribute to urinary retention?

Yes, certain medications like antihistamines and muscle relaxants can interfere with bladder function, causing retention.

5. How is urinary retention treated?

Treatments include catheterization, medication adjustments, surgery, and lifestyle changes to prevent complications. Early intervention is key.

---

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801