Urology treats urinary tract diseases in all genders and male reproductive issues, covering the kidneys, bladder, prostate, urethra, from infections to complex cancers.
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The symptoms of urinary retention vary depending on whether the condition is Acute or Chronic. Understanding this duality is critical for early recognition and appropriate triage. The presentation depends on whether the sensory nerves of the bladder are intact and whether the bladder wall has had time to adapt (stretch) to the increasing volume.
The presentation is dramatic, distressing, and unmistakable. It is one of the most painful conditions in medicine.
The presentation is insidious, often developing slowly over years. Patients frequently adapt to their symptoms and may not report them until complications arise.
Urinary retention is rarely idiopathic; it is almost always secondary to another pathological process involving obstruction, muscle failure, or nerve damage.
Obstructive Risk Factors (The “Pipe” Problem)
Many common medications inhibit bladder function or increase outlet resistance.
Anesthesia: General and spinal anesthesia temporarily paralyze the bladder (Post-Operative Urinary Retention – POUR).
While rare, retention in young women can be caused by Fowler’s Syndrome. This is a condition of the external urethral sphincter, often associated with Polycystic Ovary Syndrome (PCOS). The sphincter fails to relax due to abnormal electromyographic (EMG) activity (decelerating bursts), effectively locking the bladder closed. It is non-obstructive in a mechanical sense but functional.
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This is called “intermittency.” It usually indicates that the bladder muscle (detrusor) is struggling to overcome an obstruction (like an enlarged prostate). The muscle pushes, gets exhausted, stops to rest for a second (to recover ATP), and goes again. It is a sign of a decompensating bladder that is losing its reserve power.
Yes. This is the paradox of “Overflow.” Because your bladder is full (e.g., holding 1000 mL), there is no room for new urine from the kidneys. So, every time the kidneys secrete 50 mL, 50 mL spills out. You feel like you are peeing constantly, but you are never actually emptying the tank. This is a dangerous state often mistaken for incontinence.
Cold and flu medicines often contain decongestants like pseudoephedrine. This drug works by constricting blood vessels in the nose to stop a runny nose. However, it also strongly stimulates the Alpha-1 receptors on the smooth muscle sphincter at the neck of the bladder. If you already have a slightly enlarged prostate, this extra tightening can be enough to block the urine flow completely.
It can be. Rapid emptying of a chronically distended bladder (e.g., after putting in a catheter) can cause “Decompression Hematuria” because the blood vessels in the bladder wall burst when the pressure drops suddenly. However, spontaneous blood in the urine (hematuria) should always be investigated to rule out bladder cancer, stones, or infection.
Sertraline, also known as Zoloft, is a common SSRI for treating depression and anxiety. But, it can cause a serious side effect: urinary retention. This
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