Chronic Urinary Retention In Women

What is chronic urinary retention?

Chronic urinary retention is a long-term condition that develops if your bladder does not empty when you urinate.

What causes chronic urinary retention?

• Blockages: The bladder, uterus, or rectum can move out of place and block the flow of urine from your bladder or urethra. This is called a prolapse. The blockage also may come from bladder stones or a growth in the urinary tract. The pressure caused by constipation can block the normal flow of urine.
  
  
• Medicines: Some prescription and over-the-counter medicines can affect the nerves that control urine flow.
  
  
• Weak bladder muscle: If you do not urinate when you feel you need to, the bladder stretches. Over many years, the muscle tone of the bladder changes and it does not empty as it should.
  
  
• Nerve damage: Diabetes, stroke, spinal cord injuries, or other health problems can damage the nerves that control urine flow.

What are the signs and symptoms of chronic urinary retention?

You may have any of the following:

• Frequent urination, or the urge to go again after you just went
  
  
• An urge to urinate, but your urine does not come out or dribbles out slowly and weakly
  
  
• Frequent urine leaks that happen during the day or while you sleep
  
  
• Discomfort or pain in your lower abdomen

How is chronic urinary retention diagnosed?

Your caregiver will ask about your symptoms and any other health conditions you have. He will ask for a complete list of the medicines you take. He will ask about your history of surgery and childbirth. He will check how much urine is left in your bladder after you urinate. To do this he will press or tap on your lower abdomen or do a bladder scan using a handheld ultrasonic device. You may have urine collected for a lab test to check for blood, infection, or other problems.

• Other tests may help identify the cause of your retention problems and help caregivers decide how best to treat it. You may have any of the following:
  
  
  • Pelvic exam: He may do a pelvic exam to find out if your bladder, uterus, or rectum have moved out of place.
    
    
  • Neuro exam: Your caregiver may test your strength, balance, and movement. A neuro exam looks for changes in your brain and nerve system.
    
    
  • Ultrasound test: This is a test using sound waves to look at your bladder. Pictures of your bladder show up on a TV-like screen. An ultrasound can show if you have bladder stones, a deep infection, or other problems.
    
    
  • CT scan:
    
    
    • This is also called a CAT scan. An x-ray machine uses a computer to take pictures of your abdomen to look at the organs and blood vessels in your abdomen, and to check for problems and abnormal changes.
      
      
    • You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregivers see the pictures better. People who are allergic to iodine or shellfish (crab, lobster, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
    
    
  • Magnetic resonance imaging: This test is called an MRI. During the MRI, pictures are taken of your abdomen or brain. An MRI may be used to look at the organs and blood vessels in your abdomen, and to check for problems and changes. An MRI of your brain will also take pictures of the blood vessels and structures in your head. You will need to lie still during this test. The MRI machine contains a very powerful magnet. Never enter the MRI room with any metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
    
    
  • Cystoscopy: A cystoscopy allows caregivers to look for problems inside your bladder. A cystoscope is put into your bladder through your urethra. The urethra is the tube that urine flows through when you urinate. The cystoscope is a long tube with a lens and a light on the end. The scope may be hooked to a camera or monitor, and pictures may be taken. A tissue sample may also be taken during your cystoscopy. During this test, small tumors may be removed or bleeding may be stopped.
    
    
  • Other urinary studies: Caregivers may do tests to see how your bladder works. They may use a special catheter to test how well your bladder can empty.
  
  

How is chronic urinary retention treated?

• Urinary catheters:
  
  
  • Foley catheter: Your caregiver may send you home with a Foley catheter in your urethra to drain urine from your bladder. This is an indwelling catheter, which means it stays in your bladder until you no longer need it.
    
    
  • Intermittent (short-term) catheter: You may need to learn how to use a catheter when you cannot urinate on your own. You put the catheter in your urethra and remove it once your bladder is empty.
    
    
  • Suprapubic catheter: This is another type of indwelling catheter. It is inserted into your bladder through an opening made in your abdomen. It may be used when you have a long-term need for bladder drainage. Ask your caregiver for more information about suprapubic catheter insertion and care.
  
  
• Surgery: You may need surgery to lift any organs that have shifted out of place or to remove growths near your bladder.
  
  
• Sacral neuromodulation: This is a long-term treatment that may be needed if other treatments do not work. A device that works with your bladder's nerves is used to help you urinate.

What are the risks of chronic urinary retention?

• You may see blood in your urine while you use or after you use a catheter. The catheter may cause discomfort, and can injure your urinary tract. The catheter used to treat urinary retention can lead to having an infection. An infection can spread from your urinary tract into your blood and become life-threatening.
  
  
• Without treatment, the bladder may stretch too much. You may have long-term problems emptying your bladder. You can have occasions when you have acute retention. You may develop skin damage if you often have leaking urine. You can get chronic urinary tract infections that lead to kidney stones and infections in your kidneys or blood. Too much urine in the bladder can cause long-term damage to the kidneys that may require lifelong treatment, or even a kidney transplant.

How do I care for my catheter?

• Foley catheter: The catheter tube attaches to a bag that your urine drains into. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter. This may cause pain and bleeding, and the catheter could come out. Keep the catheter tube and drainage bag tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection. Ask your caregiver for more information about Foley catheter insertion and care.
  
  
• Intermittent (short-term) catheter: Caregivers will teach you how to use this type of catheter. You must clean your hands and the area around the urethra before placing the catheter to prevent infection. If your catheter is for single-use only, throw it away after you pass urine. If your catheter can be used again, clean it as directed. Ask your caregiver for more information about self-catheterization.

When should I follow up with my caregiver?

Ask your caregiver if you need to schedule a follow-up visit with him or a urologist. Write down your questions so you remember to ask them during your visits.

When should I contact my caregiver?

Contact your caregiver if:

• You have a fever.
  
  
• You feel pain when you urinate.
  
  
• You feel the need to urinate more often than usual.
  
  
• You see blood in your urine, or more than you have seen before.
  
  
• You are having problems using your catheter.
  
  
• You have questions about your condition or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your feet and ankles are swollen.
  
  
• Your face and hands are puffy.
  
  
• You have severe pain in your abdomen.
  
  
• Your breathing and heart rate are faster than usual.
  
  
• You feel confused or have trouble thinking clearly.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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