Acute Urinary Retention In Men: One Of Many Signs Of A Problem With The Prostate

Urinary retention is a common disorder in elderly males. The most common cause of urinary retention is BPH. This disorder starts around age 50 and symptoms may appear after 10–15 years. BPH is a progressive disorder and narrows the neck of the bladder leading to urinary retention. By the age of 70, almost 10 percent of males have some degree of BPH and 33% have it by the eighth decade of life. While BPH rarely causes sudden urinary retention, the condition can become acute in the presence of certain medications (blood pressure pills, anti histamines, antiparkinson medications), after spinal anaesthesia or stroke.

In young males, the most common cause of urinary retention is infection of the prostate (acute prostatitis). The infection is acquired during sexual intercourse and presents with low back pain, penile discharge, low grade fever and an inability to pass urine. The exact numbers of individuals with acute prostatitis is unknown, because many do not seek treatment. In the USA, at least 1-3 percent of males under the age of 40 develop urinary difficulty as a result of acute prostatitis. Most physicians and other health care professionals are aware of these disorders.

Worldwide, both BPH and acute prostatitis have been found in males of all races and ethnic backgrounds. Cancers of the urinary tract can cause urinary obstruction but the process is more gradual. Cancer of the bladder, prostate or ureters can gradually obstruct urine output. Cancers often present with blood in the urine, weight loss, lower back pain or gradual distension in the flanks

Acute urinary retention is a very serious and potentially life-threatening condition where urination can't happen.

Suddenly you can't go no matter how hard you try. Not a drop of urine escapes. And then the pain builds and builds.

Your bladder keeps filling drop by drop from your kidneys, increasing the urge to go and adding even more pressure.

Most often these are signs of problem with your prostate. In some cases, it can mean you have a severe bladder infection. But if it comes on suddenly, then most likely you are having what I call a 'prostate attack'.

Something you ate, or some medication or anti-histamine you took, triggered an allergic-like reaction in your prostate. You may have already been experiencing some prostate problems or symptoms. Others could be disorders in the bladder disorders, Penile urethra, Circumcision, Obstruction in the urethra, for example a stricture (usually caused either by injury or STD), STD lesions (gonorrhoea causes numerous strictures, leading to a "rosary bead" appearance, whereas chlamydia usually causes a single stricture), Tethered spinal cord syndrome, Psychogenic causes (psychosocial stresses, fear associated with urination, Paruresis ("shy bladder syndrome")- in extreme cases, urinary retention can result.

Diagnosis
Analysis of urine flow may aid in establishing the type of micturition (urination) abnormality. Common findings, determined by ultrasound of the bladder, include a slow rate of flow, intermittent flow, and a large amount of urine retained in the bladder after urination. A normal test result should be 20-25 mL/s peak flow rate. A post-void residual urine greater than 50 ml is a significant amount of urine and increases the potential for recurring urinary tract infections. In adults older than 60 years, 50-100 ml of residual urine may remain after each voiding because of the decreased contractility of the detrusor muscle. In chronic retention, ultrasound of the bladder may show massive increase in bladder capacity (normal capacity is 400-600 ml).

Determining the serum prostate-specific antigen (PSA) may help diagnose or rule out prostate cancer, though this is also raised in BPH and prostatitis. A TRUS biopsy of the prostate (trans-rectal ultra-sound guided) can distinguish between these prostate conditions. Serum urea and creatinine determinations may be necessary to rule out backflow kidney damage. Cystoscopy may be needed to explore the urinary passage and rule out blockages.

In acute cases of urinary retention where associated symptoms in the lumbar spine are present such as pain, numbness (saddle anesthesia), parasthesias, decreased anal sphincter tone, or altered deep tendon reflexes, an MRI of the lumbar spine should be considered to further assess Cauda Equina Syndrome.

Urinary retention often occurs without warning. It is basically the inability to pass urine. In some people, the disorder starts gradually but in others it may appear suddenly. Acute urinary retention is a medical emergency and requires prompt treatment. The pain can be excruciating when urine is not able to flow out. Moreover, one can develop severe sweating, chest pain, anxiety and high blood pressure. Other patients may develop a shock-like condition and may require admission to a hospital. Serious complications of untreated urinary retention include bladder damage and chronic kidney failure. Urinary retention is a disorder treated in a hospital, and the quicker one seeks treatment, the fewer the complications.

In the longer term, obstruction of the urinary tract may cause:

Bladder stones
Atrophy of the detrusor muscle (atonic bladder is an extreme form)

Hydronephrosis (congestion of the kidneys)
Hypertrophy of the detrusor muscle (the muscle that squeezes the bladder to empty it during urination)

Diverticula (formation of pouches) in the bladder wall (which can lead to stones and infection)

Treatment
In acute urinary retention, urinary catheterization, placement of a prostatic stent or suprapubic cystostomy relieves the retention. In the longer term, treatment depends on the cause. BPH may respond to alpha blocker and 5-alpha-reductase inhibitor therapy, or surgically with prostatectomy or transurethral resection of the prostate (TURP). Older patients with ongoing problems may require continued intermittent self catheterization. 5-alpha-reductase inhibitor increase the chance of normal urination following catheter removal. In case, if catheter can't be negotiated, suprapubic puncture can be done with lumbar puncture needle.

Medication
Some people with BPH are treated with medications. These include tamsulosin to relax smooth muscles in the bladder neck, and finasteride and dutasteride to decrease prostate enlargement. The drugs only work for mild cases of BPH but also have mild side effects. Some of the medications decrease libido and may cause dizziness, fatigue and lightheadedness.

Catheter
Acute urinary retention is treated by placement of a urinary catheter (small thin flexible tube) into the bladder. This can be either an intermittent catheter or a Foley catheter that is placed with a small inflatable bulb that holds the catheter in place.

Intermittent catheterization can be done by a health care professional or by the person themselves (clean intermittent self catheterization). Intermittent catheterization performed at the hospital is a sterile technique. Patients can be taught to use a self-catheterization technique in one simple demonstration, and that reduces the rate of infection from long-term Foley catheters. Self catheterization requires doing the procedure every 3 or 4 hours 4-6 times a day.

For acute urinary retention, treatment requires urgent placement of a urinary catheter. A permanent urinary catheter may cause discomfort and pain that can last several days.

Surgery
The chronic form of urinary retention may require some type of surgical procedure. While both procedures are relatively safe, complications can occur.

In most patients with benign prostate hyperplasia (BPH), a procedure known as transurethral resection of the prostate (TURP) may be performed to relieve bladder obstruction. Surgical complications from TURP include a bladder infection, bleeding from the prostate, scar formation, inability to hold urine, and inability to have an erection. The majority of these complications are short lived, and most individuals recover fully within 6–12 months.[6]

Sitting voiding position
A meta-analysis on the influence of voiding position on urodynamics in healthy males and males with LUTS showed that in the sitting position, the residual urine in the bladder was significantly reduced. The other parameters, namely the maximum urinary flow and the voiding time were increased and decreased respectively. For healthy males, no influence was found on these parameters, meaning that they can urinate in either position

Whatever you consumed caused your prostate to swell even more, shutting your urethra down. In some cases, sitting for a very long period of time and holding it in can cause additional trauma to your prostate and trigger the reaction.

Prevention will be very useful to avoid this condition again.

But two things are important here:
you must find out about the condition of your bladder and prostate;

and if it is your prostate, then most likely it is an enlarged prostate symptom or what is known as BPH, for Benign Prostatic Hyperplasia.

What to do about acute urinary retention...
If you are reading this and experiencing this awful feeling and can't go, then you must get to an emergency room so they can insert a catheter and release the urine.

It sounds worse than it is. An experienced doctor or nurse will know how to insert the catheter competently and the release will be immediate. The male catheter allows the bladder to empty through the tube.

Most likely, they will want to test you for a bladder condition to rule that out. Next, they will try to determine the condition of your prostate. They'll probably want to keep the catheter in place for a few days while they have an urologist figure out what happened.

If it is an enlarged prostate, they will no doubt want to schedule surgery as soon as they can. Now you have to decide if that is the course of action to take.

Do not rush this decision unless they claim you are still in an emergency situation. According to one patient experience, once the urine escapes, he was fine. he always removed the catheter after emptying and was able to go afterwards. The extra swollen prostate slowly subsides and you'll be OK. You will still have other enlarged prostate symptoms like frequency and hesitancy.

But the crisis has passed. I always used that stage to find the culprit and avoid it in the future he narrated!

Acute urinary retention is a wakeup call for you to make changes to eliminate the causes or to follow your urologist's advice.

Chronic Urinary Retention is a condition of difficulty urinating... slow to start, weak stream, difficulty emptying your bladder, very frequent urination, dribbling after, and occasional acute urinary retention... all very likely signs of prostate problems in men.

Two Serious Side Effects
It would be great if the recommended medical prostate treatments did not have any after-effects. But they do and they can affect your life greatly. For example:

male urinary incontinence
sexual dysfunction and impotence
Male urinary incontinence means that you cannot fully control your bladder and you leak, requiring the wearing of an external catheter or the use of adult diapers.

Sexual dysfunction and impotence result from damage to the nerve fibers that affect erections. Study the 10 functions of the prostate to understand how crucial the prostate is to the vitality and health of a man.

In some cases retrograde ejaculation results.

Retrograde ejaculation occurs when semen is redirected to the urinary bladder. Normally it would be ejaculated out the penis via the urethra. This happens because the prostate has been damaged from surgery. You basically have a dry orgasm. And, of course, you can no longer impregnate a woman.

Acute urinary retention is the beginning of a journey of change for you. One path will take you down the road of medical intervention (once the acute crisis has passed); the other path, to learning all about your prostate and the causes of how you got here and what to do about it.

Obviously, some men will not know they have an enlarged prostate because they are unaware of these symptoms. Then it comes as a surprise when they have an examination by a doctor.

Some men will not experience any enlarged prostate symptoms at all... until they suddenly find it hard or impossible to go pee. This condition, called acute urinary retention, can be triggered by taking over-the-counter medicines for colds and allergies, excessive drinking, cold temperatures, or prolonged periods of sitting."

I always recommend to men to have a male catheter in your emergency first aid kit, especially if you are traveling in remote places where hospital access is difficult.

Complete blockage can happen to men as young as their mid-30's and up.

Self-catheterization really can be done to deal with a prostate attack. It is far easier than going to the emergency ward and waiting and waiting, while your pain only gets worse.

Ref https://en.wikipedia.org/wiki/Urinary_retention

Dr. Raphael Nyarkotey Obu is a research Professor of Prostate Cancer and Holistic Medicine @ Da Vinci College of Holistic Medicine, Larnaca city, Cyprus. Contact: 0541234556