Common symptoms
- Sudden inability to pass urine with a painful, swollen lower abdomen
- A weak, slow stream and straining, which point to a blockage such as the prostate or a stricture
- Passing small amounts often, or dribbling and leaking from a full bladder
- Waking many times at night to pass urine
- Fever or burning, which suggests infection in the stagnant urine
- Numbness around the back passage, leg weakness or new back pain, which points to a nerve cause
- Blood at the tip of the penis after a fall or injury
When not to wait: Not being able to pass urine is an emergency. Go to the nearest emergency department at once so the bladder can be drained with a catheter; do not wait to reach a particular hospital. After a pelvic injury or with blood at the urine opening, make sure the doctor knows, as the catheter may need to be placed differently.
Acute and chronic urinary retention: what is the difference?
In Hindi it is often described as peshab ruk jana or peshab band hona. There are two main forms, and they are handled differently.
| Acute retention | Chronic retention | |
|---|---|---|
| How it starts | Suddenly, over hours | Slowly, over months |
| Pain | Severe lower abdominal pain | Often none |
| What you notice | No urine comes despite a strong urge | Weak stream, frequency, night-time urination, leaking |
| The bladder | Tense and tender | Stretched, holding a large amount even after you pass urine |
| Main risk | Pain and bladder strain until it is drained | Slow kidney damage from back pressure |
| First step | Catheter in the emergency department | Ultrasound, kidney tests and planned treatment |
Some men have chronic retention and then a sudden acute episode on top of it. This is called acute-on-chronic retention and is managed in the same urgent way.
What causes urinary retention?
| Cause | Other clues | What is done |
|---|---|---|
| Enlarged prostate (BPH) | Men over 50, weak stream and night-time urination for months before | Catheter, an alpha-blocker, then a trial without catheter; surgery if needed |
| Urethral stricture (narrowed urine passage) | Thin or spraying stream; past injury, infection or catheter | Urethrogram X-ray; laser DVIU or urethroplasty |
| Medicines | Started after cold and allergy tablets, some antidepressants, strong painkillers or bladder-calming medicines | Stopping or changing the medicine where safe |
| Constipation | Hard stools for days, especially in older people | Treating the constipation; catheter if needed |
| After surgery or anaesthesia | Within hours of an operation, especially with spinal anaesthesia or hernia and piles surgery | Short-term catheter; usually recovers within a day or two |
| Nerve problems | Long-standing diabetes, spinal injury, slipped disc, stroke, multiple sclerosis | Nerve and bladder assessment; sometimes self-catheterisation |
| Infection or prostatitis | Fever, burning, pain between the scrotum and back passage | Antibiotics and a catheter, sometimes through the lower abdomen |
| Blood clots or a stone | Visible blood or clots, or a stream that stops suddenly | Clot washout or stone removal, and tests for the cause of bleeding |
| Injury to the urethra | Pelvic fracture or a fall astride something, blood at the urine opening | Careful bladder drainage first; repair later |
Sudden retention with back pain, leg weakness or numbness around the back passage can mean pressure on the spinal nerves and needs an emergency MRI scan. In women, retention is less common and may follow childbirth, prolapse or sling surgery. In baby boys, it can come from posterior urethral valves, which need specialist care.
What happens in the emergency: the catheter
A catheter is a thin, soft tube passed through the urine passage into the bladder, using numbing jelly. Relief usually comes within minutes. The amount drained is measured, because it shows whether the retention is sudden or has been building for a long time.
If a catheter cannot be passed, often because of a stricture or a large prostate, a urologist may place a suprapubic catheter instead. This goes into the bladder through a small puncture in the lower abdomen under local anaesthesia. After long-standing chronic retention, the kidneys may produce a large amount of urine for a day or two once the blockage is relieved, so some people stay in hospital to have their fluids, salts and kidney function watched.
Do not try to force urine out by drinking large amounts of water, taking water tablets or pressing hard on the abdomen. These do not help and can make things worse.
Trial without catheter: can the catheter come out?
For many men with retention from an enlarged prostate, an alpha-blocker (a medicine that relaxes the prostate and bladder neck) is started, and the catheter is removed after a few days in a trial without catheter, often called TWOC. You drink normally, and the doctor checks that you pass urine well and measures any urine left behind with an ultrasound.
A trial is more likely to work when the retention followed a clear trigger, such as constipation, a cold medicine or an operation, and when the amount first drained was not very large. If it does not work, the catheter is put back and a planned operation is usually advised, because repeated retention can harm the bladder and kidneys. Read more about whether a blocked urine pipe can damage the kidneys.
Treatment of urinary retention by cause
- Enlarged prostate: after a failed trial or repeated retention, surgery removes the blocking tissue. HoLEP laser prostate surgery, using the 150W Holmium laser available at ManglamPlus Medicity in Jaipur, and TURP are the usual options. The enlarged prostate treatment page compares them.
- Urethral stricture: a short stricture may be opened with laser DVIU; longer or repeated strictures usually need urethroplasty. See the urethral stricture page.
- Urethral injury: the bladder is drained first, and the urethra is repaired once healing allows; see urethral injury treatment.
- Medicines and constipation: removing the trigger is often enough, with a check that you empty well afterwards.
- Weak bladder muscle or nerve problems: clean intermittent self-catheterisation, passing a fine catheter yourself a few times a day, lets the bladder empty without a permanent tube. It is taught before you go home. Some people need a long-term catheter instead.
Tests that may be needed
- Bladder ultrasound, which measures the urine held and left after passing
- Kidney function blood tests and a kidney ultrasound to look for back pressure
- Urine test and culture for infection
- Uroflowmetry once the catheter is out
- Retrograde urethrogram, an X-ray that shows a stricture
- MRI of the spine when a nerve cause is suspected
Cost, insurance and government schemes
Cost depends on the procedure and your hospital stay. See how estimates, insurance and schemes work.
Frequently asked questions
Can urinary retention go away by itself?
Sometimes, when the trigger was temporary, such as constipation, a cold medicine or an operation. Even then, many men have a prostate problem underneath that needs follow-up. Acute retention should never be left untreated in the hope it will pass.
How long will I need to keep the catheter?
It varies. For many people it is a few days before a trial without catheter. If surgery is planned, the catheter usually stays until the operation, and you are shown how to care for it at home.
Is it safe to live with a catheter for a few weeks?
Yes, with care: keep the bag below the bladder, drink enough, keep the area clean and change the catheter when advised. Fever, blood clots or a catheter that stops draining need prompt attention.
Does urinary retention mean prostate cancer?
Usually not. BPH, which is not cancer, is the most common cause in men. A PSA test may be done later, after the catheter and any infection have settled, because both can raise PSA for a while.
Can retention damage my kidneys?
Chronic retention can, through back pressure on the kidneys over months. This is why a weak stream, leaking and night-time urination in older men should be checked with an ultrasound and kidney tests. Read how a urologist treats urinary retention.
Which medicines can cause retention?
Common ones include cold and allergy tablets containing antihistamines or decongestants, some antidepressants, strong painkillers, some bladder-calming medicines and some medicines for spasms. Men with an enlarged prostate should check with a doctor before taking these.
This page is general information, not a diagnosis. Please read our medical disclaimer.