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Mens Health Q4 2021

Urinary retention: a hidden problem for one in three men over 50

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Sarah Hillery

Urology Lead Nurse at York & Scarborough NHS Trust and Vice President, BAUN

Excellent bladder function isn’t something we think about regularly however, it is important to be aware of the signs and symptoms of urinary retention.

A healthy bladder will quietly and efficiently store wee until the right time to empty. However, bladder misbehaviour can develop gradually over time and it’s often only when men experience overflow leaks and urinary tract infections that urinary retention is identified. Unfortunately, urinary retention is a major cause of bladder problems for one in three men over 50.

Urinary retention awareness

Urinary retention (when the bladder keeps back urine as the person tries to urinate) has many causes, but most commonly occurs in men due to a blockage at the bladder outflow such as enlarged prostate or urethral stricture (a tight band of scar tissue within the urine pipe). Other causes include the action of some common medicines and neurological conditions. Here, the bladder muscle or the urethral sphincter function is affected rather than there being a physical blockage. For most men however, benign prostatic hyperplasia (BPH) is the leading cause of urinary retention.

Men with BPH may notice that their flow isn’t as powerful as it once was or are going more regularly to the toilet to pass small amounts. Initially, the symptoms relate to the increased resistance at the bladder neck when the bladder squeezes to empty, the bladder muscle has to work harder and over time may lose the ability to empty fully.

For most men, benign prostatic hyperplasia (BPH) is the leading cause of urinary retention. 

Acute and chronic urinary retention

An acute episode of urinary retention can happen after a man has been experiencing gradual onset bladder problems or occasionally completely out of the blue. Acute retention represents a sudden difficulty in voiding the bladder with the accumulation of large volumes of urine over a period of hours accompanied by the inability to urinate which can be exceptionally painful.

Chronic urinary retention, however, may develop over months and years and although the volumes retained by both types of cases may be identical, what is intolerably painful in the acute situation may feel entirely undetectable in the chronic. Due to the amounts retained building up gradually during chronic urinary retention, which can sometimes be painless, the bladder adapts and stretches to accommodate the extra volume.

Aside from pain, a very real risk of large volume urinary retention is that of back pressure up to the kidneys via the thin-walled ureters. This can cause significant kidney damage if not identified quickly however, the pressure can be relieved by inserting an indwelling urinary catheter. For this reason, it is important to be aware of changes in your bladder function and see your GP if problems occur.

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