Difficulty Urinating: What To Do When You Can’t Pee

Feeling like you can’t empty your bladder all the way might be a sign that you have urinary retention.

Urinary retention can happen to anyone at any age but is most common in older people with penises.

Infection, something blocking urine flow, or a nerve problem may be the cause, and retaining urine can be uncomfortable and even painful at times. 

In this article, I’ll go over what causes urinary retention and what treatments are available.  

Causes

Your bladder is a small balloon-like organ that sits low in your pelvis.

It’s connected to your two kidneys by ureters.

The urethra, which is at the bottom of the bladder, allows urine to exit your body.

A small muscle called a sphincter controls when the urethra opens and closes to allow urine to drain out. 

There are several other organs in the same area, including the intestines, uterus, and prostate. 

Problems within the urinary system such as an infection, stricture, or stone, can be the cause of retention.

Surrounding structures such as the prostate, muscles, nerves, or even conditions such as constipation can also cause retention. 

Urinary Tract Infection (UTI)

The urinary tract is susceptible to infections.

Certain risk factors such as being sexually active, age, taking certain types of birth control, having a kidney stone, having a recent UTI, or using a urinary catheter make you more vulnerable.  

Symptoms of a UTI include a burning feeling when you pee and feeling like you have to frequently and urgently pee even when you don’t have much urine to pass. 

Urethral Stricture

A stricture is an abnormal narrowing of a body part.

A urethral stricture is when the urethra has a narrowing making it more difficult to pee.

Swelling, scar tissue, or infection can be the cause. 

Symptoms of urethral stricture include pain and difficulty urinating, dark or bloody urine, slow urine stream, and lower abdominal pain. 

Urinary Tract Stones

A urinary tract stone is formed by small crystals joining together in the kidneys when your diet includes too much calcium or oxalate.

The stone can get stuck in the ureters and cause a blockage.

Symptoms include pain in the lower back, sides, or belly which starts when the stone leaves the kidneys and travels down the ureters.

You may also have bloody urine, fever, chills, and trouble urinating. 

Pelvic Floor Dysfunction

The pelvic floor is the group of muscles that stretches across the bottom of your pelvis and holds all your pelvic organs in place.

When these muscles and connective tissue become weak, it’s called pelvic floor dysfunction.

This condition can cause several medical conditions.

The cause of the weakening is not well understood but could be related to chronic constipation, surgery, sexual abuse, or traumatic vaginal birth, among other reasons.

Symptoms can include pelvic pressure or feeling of a bulge in the vaginal canal, difficulty urinating, or leaking urine. 

Pelvic Organ or Bladder Prolapse

Bladder prolapse, also called cystocele or fallen bladder, is the most common form of pelvic floor dysfunction.

This occurs when the bladder slips through the muscles and falls into the vaginal canal. 

Symptoms include feeling pressure and a bulge in your vagina, leaking urine, trouble starting urine flow, difficulty emptying your bladder, and feeling like you have to pee frequently.  

Neurological Conditions

Your nerves communicate with your brain to let you know when the bladder is full and needs to be emptied.

The nerves also control the sphincter that opens and closes your urethra.

Several neurological disorders disrupt the communication, including:

• Parkinson’s disease
• Multiple sclerosis (MS)
• Stroke
• Alzheimer’s disease
• Spinal cord injury
• Traumatic brain injury
• Guillain-Barre syndrome
• Fowler’s syndrome

Symptoms will vary depending on the medical condition but may include the inability to empty the bladder or the failure to hold the urine. 

Prostate Problems in Males

The most common prostate problem affecting people with penises is benign prostate hyperplasia (BPH).

During puberty the prostate doubles in size; it starts growing again at age 25.

Later in life, the prostate can become large enough to pinch the urethra, which can cause problems emptying the bladder. 

Symptoms include needing to pee frequently, urinary urgency, weak urine stream that causes dribbling at the end, and the need to make multiple trips to the bathrom at night.  

Pelvic or Urinary Masses

There are several abnormal growths that can happen in and around the urinary system including tumors, fibroids, or blood clots: 

• Tumors (non cancerous or cancerous) can grow in the urethra, bladder, ureters, or kidneys. Depending on their size, these tumors can press against or pinch the urethra causing an obstruction. 

• Fibroids are muscular tumors that grow in the muscle layer of the uterine wall. Some of them are as small as an apple seed while some get as large as a grapefruit or larger. These fibroids can put pressure on the bladder causing problems with urination.

• Blood clots can get stuck in the urethra and cause a blockage. Bleeding in the bladder can be caused by trauma, a blood clotting disorder, bladder cancer, or a recent surgical intervention. 

Constipation

Constipation is when a person has three or less bowel movements a week or their stool is firm and difficult to pass.

It can be caused by dehydration, poor diet, medication side-effects, or other causes.

The colon is close to the urethra, and when the stool is lodged in the colon it can press against it or pinch it. 

Symptoms of constipation include bloating, abdominal pain, straining to have a bowel movement. 

Certain Medications

Various classes of medications can cause retention by disrupting the nerve signals between the bladder and the brain.

These include:

Antihistamines, used to treat allergies:

• cetirizine (Zyrtec)
• diphenhydramine (Benadryl)
• fexofenadine (Allegra)

Anticholinergics/antispasmodic, used to treat muscle spasms, stomach cramps, and urinary incontinence:

• oxybutynin (Ditropan)
• tolterodine (Detrol)

Tricyclic antidepressants, used to treat anxiety or depression:

• amitriplyline (Elavil)
• doxepin (Adapin)
• nortipyline (Pamelor)

Risk Factors

Several factors put you at higher risk for urinary retention:

• Being over 40 years of age
• Having a prostate gland
• Being chronically constipated
• A history of recurrent UTIs
• Having kidney stones
• Having a neurologic disease
• Having had multiple vaginal births
• Having had urinary medical procedures

Diagnosis

To diagnose what is causing your urinary retention, your healthcare professional will start by reviewing your medical history and ask you about your current medications, vitamins, and supplements. 

Then they will ask you about your current symptoms, any past medical problems with your urinary system or prostate, pregnancies, eating and drinking habits, and your bowel movement pattern. 

Physical Exam

Your physical exam will likely include your medical professional checking your lower abdomen, a rectal exam, a pelvic exam, and a neurological evaluation. 

Lab Tests

Some labs may be ordered to check for certain medical conditions or diseases that cause urinary retention.

Urinalysis is when you give a sample of urine in a small cup to be evaluated for infection, kidney problems, or diabetes. 

Blood tests can give clues how your kidneys are functioning and tell you about any potential chemical imbalances. 

Postvoid Residual Urine Measurement

This test measures how much urine is left in your bladder after you pee.

Your medical professional will ask you to use the restroom then will have you lay down and will either use an ultrasound to look in your bladder and measure the urine, or a catheter will be inserted and the urine drained and measured. 

Imaging

There are several imaging tools that can be used to diagnose what is causing your urinary retention. 

• Ultrasound uses sound waves to look at the internal structures without exposing you to radiation.

• Voiding cystourethrogram (VCUG) shows the flow of urine through the bladder and urethra using x-ray. 

• Magnetic resonance imaging (MRI) takes pictures of the urinary tract and the surrounding structures using magnets and radio waves. This is most frequently used to exclude spinal cord problems as the cause of urinary retention.

• Computed tomography (CT) scan creates images of your urinary tract using a combination of x-ray and computer technology. 

Urodynamic Testing

Your healthcare profession may order this group of tests to see how well your bladder, sphincters, and urethra work together to store and release urine. 

• Uroflowmetry is a measurement of how quickly urine is released and the total amount released.  

• Pressure flow studies measure the flow rate of your urine as it’s released and the pressure inside your bladder.

•  Video urodynamics takes videos and pictures of the bladder as it fills and empties. 

• Cystometry takes a measurement of how much urine your bladder can hold, what the pressure is inside your bladder while storing the urine, and how full your bladder is when you feel like you have to pee. 

• Electromyography measures the response of your muscles to your nerves in and around your sphincters and bladder.

Cystoscopy

This is a procedure that uses a cystoscope (a long, thin instrument) which looks inside your urethra and bladder and checks for swelling, signs of infection, cancer, or other structural problems. 

Treatment 

If you are in immediate pain and can’t empty your bladder, a medical professional will insert a urinary catheter to completely drain your urine to relieve the pressure and prevent damage to your kidneys.

In some cases, people need to continue using a urinary catheter until their retention is fixed.

The catheter can be either used as needed, or continuously.

Medication

Some medications help treat urinary retention, including the following: 

• 5-alpha reductase inhibitors stop the prostate from growing and sometimes will shrink it to allow for better urine flow.

• Alpha-blockers relax the muscles of your urethra and prostate to make for easier flow.

• Antibiotics treat an infection if that is causing your retention.

If your medical professional thinks one of your current medications is causing you to retain urine, you may be asked to lower the dose or stop taking it. 

Physical Therapy

A physical therapist who specializes in pelvic floor problems can help you stretch tight pelvic floor muscles and keep them relaxed.

They may also teach you Kegel exercises, which work the muscles or the pelvic floor and help your nerves and muscles work together better. 

Sacral Nerve Stimulation

The sacral nerve’s job is to carry signals between the bladder and the spinal cord to release and hold the urine.

Sometimes the nerve doesn’t work correctly and needs help.

Sacral nerve stimulation works like a “bladder pacemaker” to help control signals.

A wire is implanted under the skin in your lower back which is then connected to a pacemaker.

At first it is kept on the outside of your body to see if it helps and if it does it can be implanted as well. 

Surgery

In some cases, surgery is needed to treat the underlying cause.

It could include removing part of your prostate, opening a stricture, repairing a prolapse, or removing a tumor.

Prevention

Preventing urinary retention is not always possible, but there are steps you can take to reduce your risk. 

• Use the bathroom when you need to and don’t regularly hold it for too long

• See a pelvic floor physical therapist

• Take medication as prescribed to prevent BPH

• Eat a balanced diet and drink plenty of fluids to prevent constipation

When to See a Medical Professional

Let your medical provider know if you have symptoms of retaining urine as it can lead to further complications, including the following:

• Urinary frequency

• Feel like you can’t fully empty your bladder

• Need to frequently use the bathroom

• Have urinary urgency

• Pain or discomfort in the urinary tract or lower abdomen

Seek immediate medical care if you experience the following:

• If you have a complete blockage and cannot pass urine

• You are experiencing pain in the low abdomen and urinary tract

How K Health Can Help

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