Urinary retention

What is urinary retention?

Urinary retention means the accumulation of urine in the bladder owing to a condition affecting the emptying of the bladder. Urinary retention can be acute or chronic. In acute retention, the bladder does not empty despite a strong urge to urinate and there is a sudden painful accumulation of urine. In chronic retention, the bladder can no longer be fully emptied, resulting in a gradual, painless accumulation of urine in the bladder. ⁵⁹⁸

What are the complaints associated with urinary retention?

Symptoms of acute urinary retention develop within a few hours: abdominal pain and a disturbing and painful urge to urinate without being able to do so. In people who are particularly susceptible, such as elderly people, people with dementia, sensory disorders or polypharmacy, acute urinary retention is also associated with an increased risk of delirium: a reduction in consciousness involving disorientation, delusions and hallucinations, usually with, but sometimes without, agitation. ⁶⁰⁰

These unpleasant experiences can be seen as behavioural change, particularly in someone who is unable to communicate them adequately.

Chronic urinary retention does not usually cause pain. The symptoms usually develop slowly: a frequent urge to urinate; a swollen abdomen; it is difficult to start urinating; a weak urine jet that ends with dripping; in some cases, there can be urine leakage between visits to the lavatory. Urinary retention can cause kidney damage if urine cannot flow out of the kidneys and it may also cause recurring bladder infections.

How common is urinary retention in the general population?

The precise prevalence of urinary retention in the general population is not known. It is more common in men than in women. The incidence of acute urinary retention in adult males is 0.2% to 0.7%. ⁴⁰¹

Chronic urinary retention is usually caused by an enlarged prostate, a condition seen in 8% of men aged over 40, 60% of men aged over 70 and 90% of men aged over 80. ⁴⁰²

The estimated prevalence of urinary retention in the geriatric population is 7 to 11%. ^{403 , 404}

How common is urinary retention in people with intellectual disabilities?

A study of urinary retention in 346 Dutch people with moderate to very severe intellectual disabilities found undiagnosed urinary retention in 8.7%; total prevalence was 10.2%. Risk factors were higher age, the use of laxatives, a chronic disease other than epilepsy, very serious intellectual disability and immobility. ⁴⁰⁵

A study of 51 children with intellectual disabilities showed that 35.2% had problems with emptying the bladder, a percentage that was significantly higher than in the control group without intellectual disabilities (8.3%). More severe intellectual disability was associated with a higher risk of problems emptying the bladder. ⁶⁰¹

A prevalence rate of 9% was found in a small study sample of people with Down syndrome. ⁶⁰²