What Causes Urinary Retention in Women?

Urinary retention is the inability to urinate or empty the bladder. Retention may be related to the bladder or other conditions.

Causes related to the bladder:

Detrusor Sphincter Dyssynergia (DSD) or neurogenic bladder, caused by neurological disorders including multiple sclerosis, stroke or spinal cord injury. In instances of DSD, the signal from the brain to the bladder that normally functions to coordinate the bladder muscle and urethral sphincter becomes uncoordinated resulting in an improper tightening of the urethral sphincter preventing bladder emptying.

Iatrogenic (caused by medical treatment or a procedure), usually from scarring or injury to the bladder can result in urinary retention or inhibited bladder function.

Damage to the bladder such as trauma from childbirth or injury could also result in urinary retention.

Causes related to other conditions:

Variations in anatomy, such as prolapse or cystocele, uterine prolapse or enterocele can result in urinary retention or difficulty emptying the bladder. Incomplete bladder emptying secondary to prolapse occurs because the bladder has dropped into the vagina resulting in stagnant urine staying in the bladder instead of emptying out of the bladder during urination.

A less common cause for urinary retention is uterine fibroids. Fibroids can distort the uterus or cervix resulting in obstruction of the urethra preventing the passage of urine.

Other causes for urinary retention or incomplete bladder emptying include spinal cord injury or other conditions affecting the spinal cord, obstruction such as a tumor or bladder stone. Medications used for overactive bladder (OAB) can also cause incomplete bladder emptying.

Treatment:

Treatment for urinary retention depends on the underlying cause for symptoms. In cases of prolapse, surgical repair such as vaginal prolapse repair or da vinci sacrocolpopexy may be done to restore the anatomy to its proper position. Non-surgical candidates may use a pessary to lift the bladder and improve bladder emptying. Fibroids may be removed by myomectomy or in more advanced cases, a hysterectomy may be recommended. Medication for OAB can be changed to a newer class of medication, Myrbetriq, without this side effect or in some cases, InterStim may be recommended. Treatment for causes related to the bladder such as DSD, iatrogenic or injury may be more difficult to treat and treatment is based on the patient’s history, physical finding and often urodynamics.