STOPPAGE of water” is a term used commonly in Jamaica and is erroneously associated with prostate cancer. Stoppage of water is medically described as urinary retention. Urinary retention is not synonymous with prostate cancer. Let’s discuss urinary retention.

What is urinary retention?

Urinary retention is the inability to voluntarily pass urine. This must be differentiated from renal/“kidney” failure, where there is a disorder in making urine in the kidney. In urinary retention, urine is made in the kidneys and passed to the bladder; however, there is an inability to empty the bladder. This disorder may be acute and associated with lower abdominal pain and distension.

In chronic urinary retention, patients retain large volumes of urine in the bladder; however, there is no abdominal pain. This latter condition may be dangerous as the retained volumes of urine may ultimately negatively affect kidney function. Such persons sometimes present to hospitals in “kidney failure”.

Can urinary retention affect women?

Though urinary retention commonly affects men, the condition may also be seen in women. In a retrospective study conducted at the University of the West Indies, it was recognised that urinary retention in women is rare. The two commonest causes or associations with urinary retention in these women were diabetes mellitus and obstruction or blockage of the urinary outlet by fibroids. Eighty-six per cent of the women affected were either able to empty their bladders spontaneously or with assistance after treatment.

Can urinary retention affect children?

Urinary retention is rare in children and is mostly associated with neurological conditions.

Who is at the highest risk for urinary retention?

Urinary retention is most commonly seen in men. The overall incidence in men 40-83 years of age is 4.5-6.8 per 1000 men per year (Meigs, JB, 1999). A man in his 70s has a 10 per cent chance of developing urinary retention. This incidence increases to 30 per cent in a man in his 80s.

What are the common causes of urinary retention?

The causes of urinary retention must be related to either:

1. An inability of the bladder to contract and expel urine. This is due commonly to a nerve-related condition eg diabetes mellitus, spinal cord injury; or

2. An obstruction or blockage of the outlet of the bladder eg in enlargement of the prostate due to benign prostatic hyperplasia (BPH), prostate cancer, bladder stone, or stricture/scars within the urethra.

In women, obstructing causes include fibroids or pelvic masses. Other causes of urinary retention include infections such as prostatitis.

Overall, the commonest obstructive cause of urinary retention in men is a benign enlarged prostate (BPH).

Can medication cause urinary retention?

Certainly medication may cause urinary retention by reducing the contractility of the bladder or increasing tone and obstruction at the bladder outlet. Some of these agents include drugs used to treat depression, psychotic conditions, selected antihistamines for example Benadryl, and agents like Sudafed and Neo-synephrine. Painkillers like morphine have been associated with urinary retention.

How is urinary retention treated?

Urinary retention is always treated with decompression of the bladder by inserting a urinary catheter. The catheter is inserted by passing it through the urinary passage. If it cannot be inserted through the urethra, it may be placed directly into the bladder by passing the tube in the lower abdomen. The catheter is connected to a drainage bag which may be concealed by strapping to the upper thigh. The catheter should never be inserted and removed immediately after. If this is done, the chance of recurrence of urinary retention is high, considering that a cause has not been established and definitive treatment not given.

Additional tests are usually required to determine the cause of urinary retention. These usually include a urinalysis to look for signs of an infection, blood tests to assess the kidney function, blood glucose to detect undiagnosed diabetes mellitus, and an ultrasound of the urinary tract. In atypical presentations, for example women or young men, additional tests may be required to exclude other causes such as neurological ones. A PSA may be done at a later date to check for prostate cancer.

What is the definitive treatment of urinary retention?

Urinary retention is definitively treated based on the underlying cause. This may be with the use of medications, particularly in men with BPH. In some situations surgery may be required. In other cases, patients may have to be taught clean intermittent self-catheterisation, whereby they insert a catheter in the penis to drain the bladder at intervals during the day to empty the bladder. This allows the patient autonomy of management of their bladder and avoids permanent catheterisation with its underlying risks.

Can a man have urinary retention and still pass urine?

Yes, technically, though urinary retention is the inability to voluntarily pass urine, some persons may be in urinary retention and pass very small volumes of urine. This may be due to what is called overflow incontinence where they have exceeded the maximum bladder capacity and small volumes of urine are able to escape. Consider the analogy of a bucket being filled with water and the excess drains despite the maximum capacity being reached.

Urinary retention is a urological emergency. All persons with urinary retention should be evaluated and treated. Treatment must allow for either normal voiding or safe emptying of the bladder with preservation of the kidney function.

Dr Belinda F Morrison is a Consultant Urologist and Lecturer at the University of the West Indies and Mona Institute of Medical Sciences, Mona, Kingston 6. Please send questions and comments to: belinda.morrison02@uwimona.edu.jm.