URINARY RETENTION

Category: Medical

Topic: Genitoury and Renal Problems

Level: Paramedic

Next Unit: Urinary Tract Infections

7 minute read

Urinary retention is the inability to completely empty the bladder. It is a common complication of benign prostatic hyperplasia (BPH), though it can also be caused by nerve dysfunction, tethered spinal cord syndrome, infection, medications, and constipation.

Causes of Urinary Retention: Urinary retention pathophysiology includes

  • detrusor sphincter dyssynergia,
  • neurogenic bladder,
  • iatrogenic scarring of the bladder neck,
  • damage to the bladder,
  • benign prostatic hyperplasia,
  • prostate cancer and other pelvic malignancies,
  • prostatitis,
  • congenital urethral valves,
  • phimosis on pinhole meatus,
  • circumcision,
  • obstruction in the urethra,
  • STD lesions,
  • tethered spinal cord syndrome,
  • psychogenic causes,
  • psychoactive substances,
  • anticholinergic drugs,
  • renal calculi, and
  • muscarinic antagonists.

Urinary retention commonly affects males after the age of 50 years or older due to benign prostatic hyperplasia (BPH), with symptoms usually starting 10-15 years after initial BPH onset.

Another special patient population affected is the neurologically impaired such as those who have sustained a traumatic brain injury post trauma, ischemic or hemorrhagic stroke or one who has Parkinson's disease.

When there is an insult to the brain, spinal cord, or nerves immediately associated with the urinary system, the ability to void urine is hampered or even disabled. Many of these patients either take medication or have surgery to correct the issue. Some patients do end up with indwelling urinary or suprapubic catheters or have to self-cath in order to empty their bladder. This can lead to an increase in urinary tract infections (UTI).

Signs and Symptoms of Urinary Retention

  • the inability to urinate,
  • bladder enlargement or distention,
  • lower abdominal pain, and
  • delirium (especially in the elderly).

Furthermore, look for signs and symptoms of infection such as

  • fever,
  • elevated heart rate and
  • altered mental status

...due to an acute kidney infection known as pyelonephritis as a result of the inability to void for long periods of time. (The body doesn't like standing fluid. All standing fluid is eventually colonized with bacteria.)

 

Management of Urinary Retention

►Call to Action: TRANSPORT

Management of patients with urinary retention is primarily supportive, with a high need for transport to an ER. IV access should be obtained with fluids at KVO in the event of abdominal pain. If medical direction and local protocols allow, a urinary catheter may be indicated.

CAUTION: sudden decompression of a distended bladder due to urinary retention (via catheter) may create a vagal response that could provoke severe bradycardia and/or cardiac arrest. When draining a bladder, it is advisable to stop after every 100 cc (via clamping) and waiting a few minutes before the next 100 cc is drained, and repeat in this fashion until the bladder is completely drained and the catheter left in for transport. 

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