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Urinary Retention in Women

Urinary Retention in Women

Urinary retention is a problem that a lot of people face all across the globe. If you are a woman who is experiencing difficulty in urination, then this article is for you. Read on, to know all about the possible reasons behind this condition, and how it can be treated.
Shalu Bhatti
Last Updated: Feb 8, 2018
Urinary retention, as the term suggests, is the inability to release the urine from the bladder completely. The condition could be either acute, or chronic in nature. In acute urinary retention, a person is unable to pass urine at all. It is a medical emergency and immediate professional assistance is a must! In chronic urinary retention, a person can pass the urine; however, some amount of difficulty is experienced while starting to release the urine; also, the bladder is unable to empty itself completely. Chronic urinary retention can pose a lot of health problems including bladder stones and kidney problems. Therefore, this should be treated as soon as possible. Urinary retention can occur in both the sexes; however, this article will focus on the causes, effects, and treatment of this condition in reference to the female anatomy.
How Does the Urinary System Work?

In order to understand this topic in a better way, it is important to first know how the urinary system works. A female urinary tract consists of organs including -- kidneys, ureters, bladder, sphincter muscles, and urethra. The kidneys are the organs responsible for filtering the waste material consisting of urea, from the blood stream. The urea is then mixed with water and other waste substances to form urine. Once the urine is formed, the kidneys transfer the urine to the bladder through the ureters. The ureters are two thin tubes (8 - 10 inches long) that contract as and when the urine is passed to the bladder. The bladder stores the urine till its capacity, and when it is full, a signal is sent to the brain to indicate the urgency to empty the bladder. The sphincter muscles are located at the bottom of the bladder, which tighten in order to prevent the leakage of the urine. When we urinate, the bladder muscles are tightened and the sphincter muscles are relaxed so that the bladder can be emptied completely. Any problem in the urinary tract organs, or the nerves that sent the signals to the brain, can cause urinary retention. Mentioned below are some possible causes for the same.
Causes of Urinary Retention in Women

There could be various possible causes which can lead to urinary retention in females. Factors like increasing age, overall health, injury, medications, surgery, etc., can make you prone to this condition. While dealing with urinary retention, one may feel the urge to visit the toilet; however, due to certain obstruction, it becomes difficult to release the urine from the body. The retention of urine in the bladder causes abdominal pain, discomfort, and bloating. The following are some common causes behind the same.
Infection in the Urinary Tract

One of the main causes of urinary retention is the Urinary Tract Infection (UTI), which is a more common phenomena in women as compared to men. If you are suffering from UTI, then you will experience difficulty in emptying your bladder completely. There will also be pain and a burning sensation while trying to urinate.
Obstruction from Bladder Stones

Another reason of urinary retention is the obstruction of bladder stones in the opening of the urethra. Because of this obstruction, you would feel the urge of urinating but will have a hard time passing urine. If this is the cause behind your problem, then you will experience abdominal pain during urination. Sometimes you might also see blood in your urine.
Pelvic Organ Prolapse

There are variants of this condition, affecting the different organs present in the pelvis area. The two main conditions in this section, that can cause urinary retention in women are -- cystocele and rectocele. Cystocele is when the bladder prolapses into the vagina. The change in the position causes inability to empty the bladder completely. Rectocele is when the rectum prolapses into the back wall of the vagina and causes an obstruction. Prolapses of such nature can also occur in women post vaginal childbirth and menopause.
Reaction of Certain Medications

Consumption of certain medications like antidepressants, antihistamines, and medications related to muscle spasms, etc., tend to alter the signals sent from the nerves to the brain, which may lead to urinary retention. Apart from this, if you have had a surgery using anesthesia, then this might also lead to the acute form of this condition.
Dysfunctional Voiding

The condition when the muscles around the urethra are unable to relax sufficiently, making it difficult to pass the urine freely from the bladder, is known as dysfunctional voiding! You must check with your healthcare specialist as soon as possible to cure this condition which can be done either by physical therapy or medications!
Hypnotic Bladder

A hypnotic bladder can be referred to as a bladder infection wherein, muscles of the bladder are unable to contract properly, thereby unable to empty the bladder completely. The muscles need to be squeezed properly in order to release the stored urine, which doesn't happen in the case of hypnotic bladder, also known as neurogenic bladder.
Other Causes

Other possible causes include health conditions like -
  • Diabetes
  • Multiple Sclerosis
  • Stroke
  • Brain Injury
  • Pelvic Injury
  • Constipation
  • Heavy Metal Poisoning
  • Infections or trauma in the spinal cord
  • Some experts also relate this condition with psychogenic disorders
Procedure for Diagnosis

When you visit the doctor, it is advisable to note down the specific symptoms that you feel while urinating. For example, if your bladder feels full but no urine is released, or, if you feel a burning sensation or pain while urinating. The doctor will tap your lower belly very lightly to feel the bloated bladder. Your urine sample may be examined to check if there are possible chances of infection causing urine retention. Other diagnostic tests include -- ultrasounds, CT scans, and x-rays to check for the possible obstruction. MRI scans can also be done to check for conditions like multiple sclerosis, or a stroke.
In order to check for the amount of urine that is retained inside the bladder, after the patient has urinated, a doctor may use a cystoscope. It is a device consisting of lenses (like a telescope / microscope) that enables the doctor to view the objects at the other end. One end of a cystoscope consists of a thin tube like structure which is inserted in the urethra for possible examination. Apart from that, various urodynamic tests can also be performed to evaluate the capability of the bladder to empty on its own.
Treatment Options for Urinary Retention in Women

The treatment can be both surgical and nonsurgical, depending upon the cause. While your doctor may suggest medication depending upon the condition, he may also advice some physical therapy. Some of the treatment options are discussed as under.
Pelvic Floor Therapy

For this therapy a specialized physical therapist would use various techniques like biofeedback, functional electrical stimulation, manual therapy, bladder training, behavioral training, and gentle manipulation of the joints and tissues which can help the bladder work properly.
Catheterization

Clean intermittent self-catheterization is usually done by the patient itself. In this treatment, a small tube is inserted to the urethra, all the way into the bladder. This is done a few seconds after urination, so as to help drain the remaining urine from the bladder completely. However, in case of acute urinary retention, the doctors insert a catheter to empty the bladder. If the condition is chronic, then self-catheterization is the best option.
Surgery

There are a few surgical options that are used to treat urinary retention. One of the option, is the InterStim therapy that is approved by the FDA, in which a small device is implanted under the skin of any one of the upper buttocks. This helps in nerve stimulation which in turn helps the bladder function normally. If cystocele or rectocele is the cause, then sutures are placed in a membrane known as fascia. This is the membrane wall responsible for separating the vagina from the other organs present in the pelvic region. The surgery is done to enable proper support to the pelvic organs.
Vaginal Pessary

Another nonsurgical way to enable complete urination from the bladder is by inserting a device known as vaginal pessary, in the vagina. This helps in supporting the vaginal wall which enables the bladder to push back into its normal position, making it possible for the bladder to be emptied completely. There are many sizes available for the same.
Urinary retention, be it acute or chronic, can pose a lot of complications if not treated properly. The accumulation of urine in the bladder can allow bacteria to grow, which, in turn, can lead to various infections. Also, because of the impairment in the organs of the urinary tract, there are cases when the urine reverts back to the kidneys, thereby causing severe kidney damage, which could prove to be fatal, if not treated on time. You should consult a trusted doctor as soon as possible for proper diagnosis and treatment. Also, consult about all the possible treatment options that you have, and the complications that you could expect.
Disclaimer:This HerHaleness article is for informative purposes only, and should not be used as a replacement for expert medical advice.