Acute urinary retention

Many people suffer from bladder problems. 's inability to hold urine is one such problem. Urinary retention is the inability to empty the bladder and can be acute or chronic. Acute fluid retention requires urgent medical attention. This phenomenon is most common in men between the ages of 50 and 60 due to an enlarged prostate.

Women may experienceurinary retentionif their bladder sags or moves out of position (cystocele), or is pulled out of position by sagging of the lower part of the colon (rectocele). The causes, symptoms and methods for diagnosing this problem are described below in the article.

What is acute urinary retention?

Urinary retention is the inability to completely empty the bladder. The onset may be sudden or gradual. With the sudden onset of the disease, the symptomsare manifested ininability to urinate. With gradual onsetof the problem,there is loss of bladder control, mild pain in the lower abdomen, and a weak stream of urine. Patients with long-term problems are at riskof developing inflammatory diseasesof the urinary tract.

Causes ofurinary retention include:blockage of the urethra,nervous stress, certain medications, and weak bladder muscles. The delay can be caused by benign prostatic hyperplasia (BPH), urethral strictures, bladder stones, cystocele, constipation, or tumors. Problems withinnervationcan result from diabetes, trauma, spinal cord problems, stroke, or heavy metal poisoning.

Medications that can cause problems include anticholinergics, antihistamines, tricyclic antidepressants, decongestants, cyclobenzaprine, diazepam, amphetamines, and opioids. Diagnosis is usually based on measuring the volume of urine in the bladder after urination. Treatment is usually with a catheter either through the urethra or in the lower abdomen. Men are more often affected than women. Among men over forty, about 6 per 1,000 people a year suffer from this th syndrome. Among men over the age of eighty, this percentage rises to 30%.

Causes of acute urinary retention

Urinary retention is characterized by a weak stream of urine with intermittent flow, tension, a feeling of incomplete urination, and hesitancy (delay between attempting to urinate and actually starting the flow). Because the bladder remains full, this can lead to incontinence, nocturia (need to urinate at night), andfrequent urination. Acute retention causing complete anuria is a medical emergency, as the bladder can stretch to an enormous size and may rupture if the force of urine is not quickly controlled. If the bladderis overstretched, it causes pain. In this case, suprapubic constant dull pain may be observed. An increase in bladder pressure can also cause hydronephrosis and possibly pyonephrosis, renal failure, and sepsis. A person should go to the emergency room immediately if they cannot manage a painfully full bladder.

Causes of fluid retention:

  1. Neurogenic bladder (usually pelvic cancer of the schizophrenic nerve, Caud Aquin syndrome, demyelinating disease or disease Parkinson).
  2. Iatrogenic (treatment/procedure-induced) scarring of the bladder neck (usually from removal of indwelling catheters or cystoscopy operations).
  3. Bladder injury.
  4. Benign prostatic hyperplasia (BPH).
  5. Prostate cancer and other malignant tumors of the pelvis.
  6. Prostatitis.
  7. Congenital urethral valves.
  8. Circumcision.
  9. Obstruction in urination, such as a stricture (usually caused by trauma).
  10. Side effects (gonorrhea causes multiple strictures, chlamydia usually causes a single structure).
  11. Postoperative complications.

Diagnosis of acute urinary retention

Ultrasonography demonstrating the trabecular wallshowsslight abnormalities. It is strongly associated with urinary retention. Urine flow analysis can help determine the type of urinary disorder. Common findings on bladder ultrasound include slow flow, intermittent flow, and large amounts of urine retained in the bladder after voiding.

Normal test result should be 20-25 ml/s peak flow. Residual urine greater than 50 ml is a significant amount of urine and increases the likelihood of recurrent urinary tract infections. In adults over 60 years of age, 50-100 ml of residual urine may remain after each urination due to decreased contractility of the detrusor muscle. With chronic retention, bladder ultrasound can demonstrate a significant increase in bladder volume (normal capacity is 400-600 ml).

Neurogenic chronic urinary retention does not have a standardized definition; however, urine volumes > 300 ml can be used as an informal indicator. Urinary retention is diagnosed within 6 months with two separate measurements of urine volume. Measurements must have a PVR (residual) volume > 300 ml.

Serum prostate-specific antigen (PSA) testing can help diagnose or rule out prostate cancer, although ittcan also be elevated in BPH and prostatitis. A TRUS biopsy of the prostate (transrectal ultrasound guidance) can distinguish between these conditions of the prostate. Serum urea and creatinine modifications may be necessary to rule out kidney damage. Cystoscopy may be required to examine voiding and rule out urinary retention.

In acute cases of retention, when there are associated symptoms in the lumbar spine, such as pain, numbness (saddle anesthesia), paresthesias, reduced anal sphincter tone, or altered deep tendon reflexes, shouldbe performedMRI of the lumbar spine for further assessment of the state of the body.

Risk factors

Chronic urinary retention is associated with bladder blockage, which can be caused by muscle or neurological damage. If the retention is due to neurological damage, there is a gap between the brain and muscles, which can make it impossible to completely emptythe bladder. If the retention is due to muscle damage, it is likely that the muscles are not able to contract enough to completely empty the bladder.

The most common cause of chronic fluid retention is BPH. BPH is the result of a continuous process of converting testosterone to dihydrotestosterone, which stimulates prostate growth. During life, the prostate gland has a constant growth due to the conversion of testosterone to dihydrotestosterone. It boils down to the prostate putting pressure on the urethra and blocking it, which can lead to retention.

Risk factors include:

  • age;
  • drugs;
  • anesthesia;
  • prostatic hyperplasia.

Age: in the elderly, degeneration of neural pathways associated with bladder function may occur, and this may lead to an increased risk of postoperativeurinary retention, whichdoubles for people over 60 years of age.

Medications: anticholinergics, alpha-adrenergic agonists, opiates, non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, and beta-adrenergic agonistsalsomay increase the risk.

Anesthesia: General anesthetics during surgery can cause disruption of the bladder. General anesthetics can directly affect the autonomic regulation of detrusor tone and predispose people to bladder loading and consequenturinary retention. Spinal anesthesia results in blockade of the urinary reflex, demonstrating a higher risk of postoperativeurinary retentioncompared with general anesthesia.

Benign prostatic hyperplasia: men withthis diagnosishave an increased risk of acuteurinary retention.

Risks associated with surgery:Operations lasting more than2 hours may result in a 3-fold increased risk of postoperative urinary retention.

Symptoms of acute retention are severe discomfort and pain, an urgent need to urinate butan inabilityto do so,severe discomfort and painin the lower abdomen. Chronic retention symptoms are mild but persistent discomfort, difficulty starting to flow, weak urine flow, needing to go to the toilet frequently, or feeling like you still need to urinate again after you've finished. If you experience these symptoms, you should talk to your doctor.

Anyone can experience urinary retention, but it is most commonly diagnosed in men in their fifties and sixties due to an enlarged prostate. In women, there isretentionif the bladder is out of position, and this condition is quite rare. People of all ages and both sexes can have nerve disease or nerve damage that interferes with normalbladder function.