Hello friends! Picture this, you just went to the bathroom to pee but now you need to go again. How can this be! Do you have frequent urinary tract infections (UTIs)? Slow urine stream with weak flow? Need to strain to pee? These can all be signs of a condition called urinary retention. (Mevcha, 2010).
Urinary retention can be acute (sudden) or chronic (happening for 6+ months). Acute urinary retention requires immediate medical attention, so it is important to see a license healthcare provider if you are having difficulty peeing. As always, we are pelvic physical therapists, but we are not YOUR therapists. The information in this blog post is not meant to be used as medical advice and should be used for educational purposes only. Talk with your provider about any concerns you may have.
Urinary retention is simply the body being unable to fully empty the bladder when peeing. While there is always a small amount of urine left in the bladder after peeing (this is called post void residual), it should be a small amount.
Why do we care if the bladder fully empties? If you have a large post void residual, meaning there is a large amount of urine in your bladder after you pee, you are more likely to have frequent UTIs (Sellius, 2008). Why is this? When we have leftover urine in our bladder, it will sit there until we are ready to go again. This urine sitting in the bladder allows bacteria to start to grow. This is why when you feel the initial symptoms of a UTI you are encouraged to drink lots of water to “flush out” the bacteria quickly.
Not emptying your bladder can also lead to a type of urinary incontinence called overflow incontinence (Sellius, 2008). This is most common when urinary retention is chronic.
There can be several causes of urinary retention but some of the most common are an enlarged prostate, cystocele (bladder prolapse), and overactive pelvic floor muscles.
What are the treatment options for urinary retention?
There are several medical interventions that can be done for urinary retention. Use of a catheter can help to drain the bladder immediately. This is typically done to treat acute urinary retention and can be done periodically to help with chronic urinary retention.
Your physician may prescribe certain medications to assist. These medications are often targeted to treat the cause of the urinary retention, like an enlarged prostate. Surgery to remove blockages or a sacral nerve stimulation implant may be suggested. (Jonas, 2001)
Lastly, you may have guessed it—a pelvic floor therapist can help, too! A pelvic floor therapist can ensure that the pelvic floor muscles are coordinated to do the right thing at the right time. The pelvic floor muscles need to be able to relax to let urine out when trying to pee, but they need to be engaged to prevent urinary leakage at other times. A pelvic floor therapist may use biofeedback to assist with pelvic floor muscle coordination and relaxation training (Haslam 2008, Nelson 2004). The goal of pelvic floor muscle training is to allow for conscious control of relaxation of the muscles at the right time.
A pelvic floor therapist can help to guide other behavioral treatments like proper postures while toileting, managing voiding intervals, breathing techniques, and more. A therapist may also use manual therapy techniques and exercises to treat pain related to pelvic floor muscles, perineum, pelvis if needed.
If you are experiencing urinary retention, talk with your providers and ask for a referral to a pelvic therapist. You can find one near you at www.mypfm.com/find-a-pt.
Here are some great resources to help you learn more about your pelvic floor muscles:
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Written by Emily Reul, PT, DPT
References
Haslam J, Laycock J. Therapeutic management of incontinence and pelvic pain 2nd ed. London: Springer. 2008.
Jonas U, Fowler CJ, Chancellor MB. Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol. 2001;165:15-19.
Mevcha A, Drake MJ. Etiology and management of urinary retention in women. Indian J Urol. 2010;26(2):230-235.
Nelson JD, Cooper CS, Boyt MA, Hawtrey CE, Austin JC. Improved uroflow parameters and post-void residual following biofeedback therapy in pediatric patients with dysfunctional voiding does not correspond to outcome. J Urol. 2004;172(4 Pt 2):1653-6.
Selius B, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician. 2008;77(5):1476-1478