Urinary Retention
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How It Turned Me Into An Angel
Let's start with my very first story I want to share with you. This happened about 5 years ago, but I still can't forget about it...
One night (2 am) the alarm rang at the emergency room door while I was extremely busy with several patients in the internist department of the ER. So I ran to the door of the ER and glimpsed through it to see who was coming (a private person or an ambulance!?) It turned out to be a young man (about 30 years old), not unattractive, writhing in pain. Of course, I got a wheelchair and took the man to the triage room.
Before I could examine him, he started like this: "I need a catheter, NOW!". I will never forget the following situation, as it was quite unusual for young men to demand something like this without hesitation. It quickly became clear to me that the poor guy was not doing well at all. So I asked him to lie down on the examination table and to undress "down there". I prepared everything and took his medical history throughout the entire procedure. He had never experienced anything like this before, but he hadn't been able to go to the toilet for almost 24 hours. Of course, he was initially embarrassed to tell anyone about it, but when the pain became unbearable, he knew he had to act. He did some research on the internet and came to the conclusion that a catheter would be the only solution to end his misery (for the time being).
Well, I had often experienced such situations and confidently placed the young man's catheter without any problems. 2.3 litres of urine later, he looked me in the eye, held my hand and said: "You are my angel!"... We both had to laugh at this bizarre situation... After all, no one has ever been able to resist the charm of a catheter, have they?
But What Was The Condition He Was In?
This condition is called urinary retention, which describes the inability to fully empty the bladder, which can lead to discomfort, bloating, and the urgent need to urinate without being able to do so. There are two main types: acute (sudden and painful, often needing immediate treatment) and chronic (gradual, with mild symptoms that worsen over time).
Several factors can cause urinary retention:
Obstruction: Blockages in the urinary tract, such as an enlarged prostate in men, kidney stones, or tumors, can restrict urine flow.
Nerve Problems: Nerve damage from conditions like diabetes, stroke, or spinal cord injuries can disrupt signals between the brain and bladder.
Medications: Certain drugs, including antihistamines, antidepressants, and muscle relaxants, can interfere with bladder muscle function.
Infections and Inflammation: Urinary tract infections (UTIs) or inflammation can cause swelling, obstructing normal urine flow.
Surgery: Some surgical procedures, especially those involving anaesthesia or spinal blocks, can temporarily impair bladder function.
Finding the underlying cause of urinary retention involves a series of diagnostic steps that help pinpoint the specific reason behind the condition. Here’s how healthcare providers typically investigate it:
Medical History and Physical Exam: A doctor will start by discussing symptoms, any relevant medical history (such as diabetes, surgeries, or medication use), and lifestyle factors. They’ll also perform a physical examination, which might include assessing the abdomen, lower back, and pelvic area to check for tenderness or blockages.
Urinalysis and Blood Tests: These tests can reveal signs of infection, inflammation, kidney function, or underlying conditions like diabetes that might affect bladder function.
Bladder Scan: An ultrasound is often used to measure the amount of urine left in the bladder after urination, indicating how effectively the bladder empties. This can highlight issues with muscle function or obstructions.
Imaging Studies: X-rays, CT scans, or MRI scans provide detailed images of the urinary tract and pelvic region, helping detect any physical blockages, such as an enlarged prostate, tumors, or kidney stones.
Cystoscopy: A small camera on a thin tube (cystoscope) is inserted through the urethra to examine the bladder and urethra directly. This allows doctors to identify structural abnormalities, inflammation, or signs of infection.
Urodynamic Testing: This test measures bladder pressure, urine flow rate, and bladder muscle function, helping diagnose nerve-related issues or weak bladder muscles. It’s particularly useful for chronic urinary retention.
Post-Void Residual (PVR) Test: By using ultrasound or catheterization, this test measures how much urine remains in the bladder after urinating. High residual urine can indicate an issue with bladder muscles or nerve signals.
By carefully interpreting these tests, healthcare providers can determine whether the urinary retention is due to an obstruction, nerve problem, muscle weakness, or other cause, allowing for targeted and effective treatment options.
Read more about urinary retention here.
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