Symptoms and Signs of Inability to Urinate

Medical Author:
Medically Reviewed on 1/8/2022

Doctor's Notes on Inability to Urinate

An inability to urinate means that a 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 who 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 time span. 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
  • 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. Such causes include

  • 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,
  • strokes,
  • nerve disease, and
  • vaginal childbirth.

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
  • Severe pain in the lower abdomen

Chronic urinary retention symptoms and signs may include

  • 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, and
  • nocturia (waking up two 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:

What Is the Treatment for an Inability to Urinate (Acute Anuria)?

The definitive treatment of an inability to urinate is a visit to a doctor that can place a catheter into your bladder to drain urine. Emergency department and many clinics and urgent care centers have caregivers trained to insert a catheter. If a catheter cannot be inserted because of underlying problems, then a urologic surgeon may be consulted to surgically open a channel using one of the following methods:

  • Prostate resection
  • Urethral scarring removal
  • Tumor removal
  • Removal or bypass any other blockage (damaged bladder, pelvic organ prolapse)

Inability to urinate (acute anuria) is not the same as urinary retention; inability to urinate is a medical emergency while urinary retention is often treatable by medicines and/or elective surgery methods. Acute anuria must be treated before other treatments are done.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.