Urinary Retention
Print Friendly, PDF & Email

almostadoctor app banner for android and iOS almostadoctor iPhone, iPad and android apps almostadoctor iOS app almostadoctor android app


This is the inability to micturated, and it can either be chronic or acute



This is a sudden inability to micturate in the presence of a painful bladder. The bladder may be slightly distended, and there will be a sensation of bladder fullness.
  • In children – abdominal pain, drugs
  • In young people – drugs, surgery,UTI, trauma, haematuria
  • In the elderly – surgery, tumour, BPH


This is the presence of a large, full painless bladder that may or may not be accompanied by the inability to micturate. Overflow incontinence is an example of chronic urinary retention, and it is often accompanied by a secondary UTI. The symptoms will be those of bladder irritation – frequency, small volume, and dysuria.
  • Retention is particularly common in old men as a result of prostate pathology.


  • Children – congenital abnormalities
  • Young people – surgery, trauma
  • Elderly – BPH, strictures, prostatic carcinoma


This will cause chronic retention as a result of:
  • Upper motor neurone diseases – leading to chronic retention with reflux incontinence
  • Lower motor neurone diseases – leading to chronic retention with overflow incontinence
Retention is particularly common in young adults, and requires investigation to rule out a serious underlying cause.


Differential diagnoses will basically be any sort of UTI obstruction.
These can be divided into:

Obstructions within the lumen – this can be the lumen of the ureter, bladder, or urethra.

  • Calculus – a stone that forms in an organ or duct of the body. This may present with acute pain in the penis or glans if it is in the urethra.
  • Blood clot
  • Sloughing renal papillae (the point where the pyramid empties into the collecting ducts)
  • Tumour of renal pelvis or ureter
  • Bladder tumour
  • Congenital valves (rare) – may present in neonates, or later in life with men, and later in life in anyone with recurrent UTI’s
  • Foreign body (rare)

Obstructions in the wall of the lumen

  • BPH
  • Tumour
  • Stricture – may present with a history of trauma or serious infection. There will be gradual onset of poor stream if in urethra. Can also be caused by TB or calculus
  • Trauma
  • Congenital defects – Pelviureteric neuromuscular dysfunction, Ureterovesicual stricture

Pressure from outside

  • Tumours (colonic, retroperitoneal growths and tumours, pelvic tumours (e.g. cervical cancer)
  • Pancreatitis
  • Prostatic disease
  • Crohn’s disease
  • Phimosis
  • Diverticulitis
  • Fibroids (benign tumours that grow in the wall of the uterus)
  • Pregnancy
  • Ovarian cyst
  • Faecal impactation


  • U+E – this will asses renal function
  • MSU – associated infection, may also detect tumour cells if requested (and if present!)
  • Cystography – visualisation of the bladder after injection of a radio-opaque substance – will show urethral valves and strictures
  • Intravenous urography – an investigation of the kidneys, ureters and bladder after injection of a radio-opaque substance – renal / bladder stones
  • Cystoscopy
  • Urodynamics – allows analysis of neurological problems and BPH.


Read more about our sources

Related Articles

Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

Leave a Reply