What is Urinary Retention?
Urinary Retention is when you cannot urinate (pass your pee ). Because no urine is passing, the bladder fills causing severe discomfort. Men with urinary retention are miserable.
Quickcare or ER?
Simple routine difficulty urinating may be seen in a clinic. Urinary retention, however, is best treated in the ER. Not a walk-in clinic.
What will your doctor ask?
The story for guy who cannot urinate is normally very very short. There may be preceding urinary hesitancy before retention. That is, the flow starts to slow down.
Typical story: “I haven’t peed since yesterday and now I feel like my stomach is going to explode.”
What will your doctor look for?
Your doctor will look for SIGNS. A sign is an objective finding discovered during the examination.
One of the first signs noticed is the agony experienced by the patient. Many times I will see a patient pacing around the room holding on to their lower abdomen. Trouble urinating can be serious.
On exam, the bladder is enlarged and very tender to the touch. The genitals are normally intact.
What is your doctor thinking?
Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
In men, the most likely cause for urinary retention is an enlarged prostate. An enlarged prostate does not mean cancer. I may be benign.
Urine passes along a tube through the prostate. As it enlarges, then the flow decreases and decreases until it finally stops.
Some medications may cause retention.
Although I have never seen it in all my years, it is possible that a large kidney stone may be the cause of acute urinary retention.
What is the treatment of Urinary Retention?
For the more common enlarged prostate, I will use a catheter. At times I will use a special angulated catheter called a coude catheter.
Typically, I send my patients home with the catheter inside. This allows for continued urine flow until they see a urologist. Once the catheter is in, it stays in until cleared by the urologist.It is not uncommon to get over 1 liter of urine out. It is instant relief.
How long will you be sick?
Most persons get relief as soon as the catheter goes in. It is best to see the urologist in a timely manner for definitive care.
The urologist will check for cancer. An enlarged prostate may need to be opened up a bit surgically to allow the urine to pass.
Let me tell you a story
The professor checked into the ER at 2 in the morning. The elderly gentleman left his bed and came to the ER in his pajamas. I thought to myself that he must have been either a little strange or in real discomfort. He walked very slowly around the exam room. Pacing. Eyes fixated on the floor.
When I walked into the room, I introduced myself and sat on the round stool by the bedside.
“Professor, please lay down,” I said.
“Hold on doctor. That is a common mistake. I have to correct my students all the time.”
I stood there confused. What mistake did I make?
“What do you mean, Professor?”
“Well, you told me to lay down. You should have asked me to ‘lie’ down. You see, the present tense is ‘lie’ which is to ‘lie down’ and past of lie is ‘lay’ but ‘lay’ is also present tense. You lay something down but you lie yourself down. The past tense of lay is ‘laid.’
I sat there dumbfounded. It’s 2 am and I am getting a grammar lesson from the professor! He was right but I had a dozen other patients to treat and an ambulance out on a call.
“Well, Professor,” I said. “Thank you for the correction. Tell me. After a long day of teaching, when you get home to your lady friend, do you get ‘lied’ or do you get ‘laid’?”
The old man smirked showing all his wrinkles. “I get laid….as often as I can.” We shared a manly laugh and then got down to business.
“I feel like my bladder is about to burst,” said the Professor. He had known that his prostate was enlarged. Luckily his urologist had cleared him for cancer already.
I was able to pass in a regular catheter and he went home with a leg bag. He went home to lie down with his girlfriend.
I hope this helps
David Reyes MD