Doctor's Notes on Inability to Urinate
An inability to urinate means that person cannot pass urine out of the body through the urethra. Another broad term for inability to urinate is urinary retention, although urinary retention may be considered as either partial or complete. This is different from anuria, which means the person’s body is not producing urine in the kidneys, because people that cannot acutely urinate still produce urine.
There are two types of urinary retention, acute and chronic. Acute may occur suddenly and chronic may occur over a longer timespan. Acute obstruction is a medical emergency and can be life threatening. The causes of the inability to urinate can be either obstruction of the urethra or non-obstruction of the urethra but are due to muscle and/or nerve problems that interfere with normal signals between your brain and your bladder. The inability to urinate is a symptom itself of underlying medical problems that may affect the urinary tract.
Obstructive urinary retention or the inability to urinate are due to underlying causes. The causes include the following and frequently involve putting pressure on the urethra or obstruction of the urethral lumen that results in little or no ability for urine to pass out of the body.
- enlarged prostate in men (BPH or benign prostatic hypertrophy),
- tumors and/or cancers,
- urethral strictures,
- cystocele (prolapse bladder),
- rectocele (prolapse of the wall between the rectum and the vagina),
- constipation, and
- kidney or bladder stones.
Non-obstructive urinary retention or the inability to urinate are also due to underlying causes that alter the body’s nerves and/or musculature involved in urination include the following:
- pelvic injury or trauma,
- accidents that cause injury to the brain and/or spinal cord,
- medications and/or anesthesia that results in impaired muscle or nerve function,
- nerve disease, and
- vaginal childbirth.
What are the signs and symptoms of a person’s inability to urinate?
Symptoms and signs differ between acute and chronic urinary retention. Acute urinary retention symptoms need to be treated emergently as they can further develop into life-threatening conditions (for example, bladder rupture, sepsis). The following symptoms need emergent medical attention:
- an acute inability to urinate,
- urgent and painful feeling or need to urinate, and
- severe pain in the lower abdomen.
Chronic urinary retention symptoms may include the following:
- urinary frequency (about 8 or more times per day)
- urgent need to urinate with little success in urination
- difficulty beginning a urine stream
- weak or interruptions urine stream
- feeling that you need to urinate even after you just finished urination
- urge incontinence (uncontrollable urge to frequently urinate; may develop bed-wetting)
- difficulty emptying your bladder
- relatively constant mild to moderate discomfort in the lower abdomen and/or urinary tract
- straining to empty your bladder
- nocturia (waking up 2 or more times per night to urinate)
In some individuals, chronic urinary retention may lead to an acute episode of urinary retention; if this occurs, it is a medical emergency.
Complications that may occur with acute and/or chronic urinary retention include the following:
- Urinary tract infections
- Kidney damage
- Bladder damage
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.