Urinary retention, or incomplete emptying of the bladder, can occur with a variety of medical conditions. Interference with nerve control of the bladder and structural abnormalities of the bladder or nearby organs can lead to incomplete bladder emptying. Urinary retention may cause discomfort and incontinence and can be complicated by conditions such as bladder stones and infections. Determining the cause of incomplete bladder emptying guides appropriate medical treatment to improve or restore bladder function.
Benign Prostatic Hyperplasia
Benign prostatic hyperplasia, more commonly known as BPH, is a common condition experienced by many men as they age. The National Institute of Diabetes and Digestive and Kidney Diseases explains that in the presence of male sex hormones, the prostate typically grows slowly during adult life; overgrowth of prostatic tissue is termed hyperplasia.
The prostate surrounds the bladder neck, the funnel-shaped area of the bladder through which urine flows into the urethra as it passes from the body. BPH can encroach on the bladder neck, impeding urine flow from the bladder during urination. This commonly results in incomplete bladder emptying. Medications to reduce the size of the prostate or prostate reduction surgery can alleviate urinary flow obstruction.
Neurogenic Bladder
Bladder control involves complex, multistage signaling between the brain and urinary structures. Interference with the nerve pathways involved in bladder function, or neurogenic bladder, can lead to incomplete bladder emptying. The bladder wall contains muscle cells that contract during urination. A hypotonic neurogenic bladder has poor muscle function due to nerve damage or interference.
Penn State College of Medicine's Milton S. Hershey Medical Center notes that possible causes of hypotonic neurogenic bladder include congenital spinal cord conditions, spinal cord injuries, a ruptured disk, multiple sclerosis, diabetes mellitus, syphilis, pelvic nerve injuries and amyotrophic lateral sclerosis.
Cystocele
In women, the urinary bladder rests in front of the vagina, suspended above the urethra by ligaments and held in place by pelvic muscles. Weakness of the support structures of the female urinary bladder due to pregnancy, childbirth, obesity or prior pelvic surgery can lead to drooping of the bladder into the vagina. This condition, termed cystocele, can cause incomplete bladder emptying, as the bladder is no longer properly aligned over the urethra. The degree of urinary retention correlates with the severity of the cystocele.
The American College of Obstetricians and Gynecologists advises that pelvic floor exercises, or Kegel exercises, may strengthen the muscles sufficiently to correct small cytoceles. A pessary, a vaginal device similar to a contraceptive diaphragm, can also be used to hold the bladder in place. Large cystoceles that bulge through the vaginal entrance typically require corrective surgery.
References
- National Institute of Diabetes and Digestive and Kidney Diseases: Prostate Enlargement--Benign Prostatic Hyperplasia
- Penn State College of Medicine Milton S. Hershey Medical Center: Neurogenic Bladder
- American Congress of Obstetricians and Gynecologists: Pelvic Support Problems
- University of Pittsburgh Medical Center: Cystocele and Rectocele Repair
- National Institute of Diabetes and Digestive and Kidney Diseases: What Causes Urinary Retention?
