If someone isn’t able to empty their bladder, they are considered to have urinary retention. It may be acute, which is usually very painful, but more commonly it is a chronic problem that is uncomfortable due to the individual only being able to pass reduced amounts of urine. It can also make sufferers want to go to the toilet more often, have difficulty in starting to urinate, and experience weak flow and dribbling when finishing passing urine and/or between toilet trips.

There are many reasons why urinary retention occurs. A physical obstruction, such as crystals in the urine combining in the bladder to form a stone that reduces urine flow into the urethra; nerve damage; narrowing of the urethra due to constipation, infection or inflammation; and enlargement of the prostate gland (see panel below). Medicines that have anticholinergic effects can also cause issues, including some antihistamines and antidepressants. Medicines such as oxybutynin, tolterodine and solifenacin, can be used for this very effect in order to manage incontinence.

Urinary retention needs treating by managing the underlying cause, in order to stop urine backing up into the kidneys where it can cause damage. This can lead to reduced kidney functioning or chronic kidney disease, which in turn can mean the individual requires dialysis – where the blood is diverted to a machine for filtration – or a kidney transplant. 

Benign prostatic hyperplasia

The prostate gland, which is instrumental in semen production, usually increases in size as men age, which is known as benign prostatic hyperplasia (BPH), or prostate enlargement. The process is gradual – and harmless – but it can eventually compress the urethra, causing problems with urination.

Because it becomes more difficult to empty the bladder as BPH develops, there is a risk of chronic urinary retention, bladder infections and bladder stones developing, so it is important to diagnose and manage the condition. Patients with BPH should be reassured that the fact that they have an enlarged prostate does not mean they are at increased risk of developing prostate cancer.

Treatment depends on symptom severity, but usually starts with lifestyle changes such as reducing intake of alcohol, caffeine, fizzy drinks and artificial sweeteners, drinking less in the evenings, eating more fibre to avoid constipation, remembering to empty the bladder pre-emptively, and exercising regularly. Regular check-ups are also in order.

As symptoms worsen, bladder training may be recommended, which is an exercise programme that aims to increase the capacity of the bladder and extend the time between toilet trips. Taking medication may also be necessary, such as an alpha-blocker (e.g. tamsulosin, alfuzosin), anticholinergic, or 5-alpha reductase inhibitor (e.g. finasteride, dutasteride). Sometimes it is necessary for a catheter to be inserted, or to have a surgical procedure.