Sudden Inability to Pass Urine: Reversible Causes, and Why It Cannot Wait

শেষ আপডেট: ২৯ আগস্ট, ২০১৬

• ওয়ার্ডপ্রেস
• লিঙ্কডইন
• মেইল

If you cannot pass urine right now

Go to hospital today. A bladder that cannot empty is painful, it does not resolve by waiting, and prolonged obstruction damages the kidneys. Drainage with a catheter relieves it within minutes, and everything else on this page — working out why it happened — comes afterwards.

An earlier version of this article discussed reversible causes at length without saying this anywhere. In an emergency in Thailand, call 1669.

• ইউরোলজি সেন্টার ব্যাংকক হাসপাতাল থাইল্যান্ড অনলাইনে বুক করুন 02-310-3009 bhquro@bdms.co.th
• সামিটেজ শ্রীরাচা হাসপাতাল চোনবুড়ি 088-022-1445

Why finding the trigger matters

In men, the background cause is usually a prostate that has been gradually obstructing for years — see স্বাভাবিক প্রোস্টেট বৃদ্ধি. But a prostate that has been slowly enlarging for a decade does not suddenly stop working on a Tuesday. Something usually tips it over, and that something is often correctable.

This matters practically. Where a clear trigger is found and removed, many men pass urine normally after the catheter comes out and need nothing further. Where no trigger is found, retention is more likely to recur and the underlying obstruction usually needs treating. The fuller account of the causes themselves is in acute urinary retention in men.

The correctable triggers

Medicines — the commonest, and the most avoidable

• Cold and flu remedies containing a decongestant such as pseudoephedrine or phenylephrine. These tighten the bladder outlet, and in a man with an enlarged prostate they are a classic precipitant of a first episode of retention. This was missing from the earlier version of this article entirely, and it is the one worth knowing about, because these are bought without a prescription by men who have no idea they carry the risk.
• Antihistamines, particularly the older sedating type found in the same cold remedies — they relax the bladder muscle.
• Anticholinergic drugs, including bladder medicines for an overactive bladder, some drugs for nausea and vertigo, and some for Parkinson’s disease.
• Opioid painkillers, and anaesthesia — retention after an operation is common enough to be routine.
• Tricyclic antidepressants and some other psychiatric medicines.
• A heavy episode of alcohol, which fills the bladder quickly while blunting the reflex to empty it.

Two corrections here. The earlier version listed antihypertensives এবং NSAIDs among the causes; neither is a well-established precipitant of retention, and both have been removed. Decongestants, antihistamines and anticholinergics — the ones that genuinely matter — were largely absent.

কোষ্ঠকাঠিন্য

A loaded rectum presses on the bladder outlet, and clearing it sometimes resolves the retention on its own. Easily missed, easily fixed, and worth asking about in anyone who is immobile or on opioids — both of which cause constipation and retention at the same time.

Infection and inflammation

প্রোস্টাটাইটিস in particular can cause retention outright, and any urinary infection can tip a marginal bladder over. Fever with retention needs urgent attention rather than a routine appointment.

Being unwell, immobile, or recently operated on

Bed rest, a general anaesthetic, post-operative pain relief and an unfamiliar environment combine, which is why retention is so common in hospital. It is also why the episode that happens in hospital does not always mean the prostate needs treating.

The checklist used in clinic: DIAPPERS

To make sure none of the above is missed, the reversible contributors are worked through as a checklist using the mnemonic ডায়াপার. It comes originally from the assessment of transient urinary অসংযম, and it is used here in the same spirit — as a systematic sweep for the reversible things that tip a marginal bladder over, so that none is overlooked in a patient who is uncomfortable and being dealt with quickly.

What happens after the catheter goes in

• The volume drained is recorded. A very large volume suggests the bladder had been struggling for a long time rather than failing suddenly — but it is worth knowing that there is no agreed volume above which retention counts as chronic. The formal definitions use the urine left after passing water rather than what comes out through the first catheter, and even those differ between guidelines: one uses more than 300 ml on at least two occasions over six months, another sets the mark at a litre. Kidney function, whether the kidneys are swollen on a scan, and repeated infections predict how things go better than the drainage figure does.
• Kidney function is checked, since obstruction affects it.
• Occasionally the kidneys produce a great deal of urine for a day or two afterwards. This is post-obstructive diuresis, usually defined as more than 200 ml an hour for two hours running, or more than three litres in a day. In most men it settles within about 24 hours and needs only watching. Beyond about 48 hours it becomes a problem in itself, because losing that much fluid and salt can drop the blood pressure and disturb the body’s chemistry — which is a legitimate reason to be kept in on fluids and blood tests rather than sent home with a bag. The heaviest diuresis generally happens only when both kidneys, or a single functioning kidney, were completely obstructed.
• A medication to relax the outlet is usually started before the catheter is removed, and it makes a measurable difference: pooled trial data show roughly 60% of men pass urine successfully after the catheter comes out when an alpha-blocker has been given, against roughly 38% without one, and it also reduces the chance of going back into retention afterwards. It is one of the better-supported small interventions in urology, and reasonable to ask about if nobody has mentioned it.
• The catheter is removed after a few days and you are watched to see whether you can void. If that fails, it is repeated later or the underlying obstruction is treated — see জলীয় বাষ্প থেরাপি and the other options for an obstructing prostate.

One caution worth stating, because it is the reason assessment matters more than the choice of treatment: a weak or underactive bladder produces the same picture as an obstructed outlet, and operating on the prostate of a man whose bladder is the real problem does not help him. That distinction is made on flow testing and, where it matters, pressure studies.

একই দিনে মনোযোগের প্রয়োজন এমন লক্ষণসমূহ

• Being unable to pass urine at all, with a painful full lower abdomen.
• Fever or shaking chills alongside difficulty passing urine.
• Passing only small amounts frequently, with constant dribbling — this can be a full bladder overflowing rather than an improvement, and it is easily mistaken for the opposite problem.
• New leg weakness or numbness, numbness around the buttocks or genitals, or loss of bowel control alongside retention. This suggests pressure on the nerves of the spine and is an emergency measured in hours.
• A catheter that stops draining.

প্রায়শই জিজ্ঞাসিত প্রশ্ন

I cannot pass urine. Can it wait until tomorrow?

No. It is painful, it will not resolve by itself, and prolonged obstruction damages the kidneys. Drainage with a catheter relieves it within minutes. Investigating why it happened comes afterwards.

Which medicines can bring it on?

Decongestants in cold and flu remedies are the classic trigger and are bought without a prescription. Also older antihistamines, anticholinergic drugs including some bladder and anti-nausea medicines, opioid painkillers, anaesthesia, tricyclic antidepressants, and a heavy episode of drinking. If you have an enlarged prostate, check cold remedies before taking them.

Does a medication before the catheter comes out actually help?

Yes, measurably. Pooled trial data show that with an alpha-blocker started before the catheter is removed, roughly 60% of men pass urine successfully, against roughly 38% without one, and it also reduces the chance of going back into retention. It is reasonable to ask about if it has not been mentioned.

They drained a huge amount. Does the number mean it is serious?

Only loosely. A large volume suggests the bladder had been struggling for a while rather than failing suddenly, but there is no agreed volume that makes retention officially chronic. The formal definitions use the residual left after voiding rather than the first drainage, and they differ between guidelines — one uses more than 300 ml on two occasions over six months, another a litre. Kidney function, swelling of the kidneys on imaging and repeated infections tell you more than the drainage figure.

Will I need a prostate operation?

Not necessarily. Where a clear trigger is found and removed — a medicine, constipation, an infection, an operation — many men pass urine normally once the catheter comes out and need nothing further. Where no trigger is found, retention tends to recur and the underlying obstruction usually needs treating.

I am dribbling constantly. Does that mean the blockage has cleared?

Not necessarily, and this catches people out. A very full bladder can overflow, producing constant dribbling that looks like incontinence while the bladder remains obstructed. It needs assessment rather than reassurance.

Does this happen to women?

Much less often, since there is no prostate. When it does, the causes are different — neurological conditions, pelvic surgery, prolapse, medication, or a bladder that has become underactive — and it warrants proper investigation rather than being assumed transient.

একটি পরামর্শের ব্যবস্থা করা হচ্ছে

After an episode of retention, Dr. Soarawee Weerasopone sees patients at ব্যাংকক হসপিটাল সদর দপ্তর এবং চোনবুরির সামিতিভেজ শ্রীরাচা হাসপাতালে 088-022-1445. Bring a list of everything you take, including cold remedies and anything bought without a prescription, and the record of how much was drained if you have it.

ব্যাংকক হসপিটাল টেলিমেডিসিন এমন রোগীদের জন্য উপলব্ধ যারা সশরীরে উপস্থিত হতে পারেন না, যার মধ্যে আন্তর্জাতিক রোগীরাও অন্তর্ভুক্ত — ইউরোলজি বিভাগে ইমেলের মাধ্যমে এটি অগ্রিম ব্যবস্থা করুন bhquro@bdms.co.th. সামিটিভেজ শ্রীরাচা শুধুমাত্র সরাসরি উপস্থিতির মাধ্যমেই সেবা দিয়ে থাকে। খরচের বিষয়ে অনুসন্ধানগুলোর উত্তর এই ওয়েবসাইটের মাধ্যমে দেওয়া হয় না, হাসপাতাল নিজেই দিয়ে থাকে।. If you cannot pass urine now, go to hospital rather than emailing.

তথ্যসূত্র

• Fisher E, Subramonian K, Omar MI. The role of alpha blockers prior to removal of urethral catheter for acute urinary retention in men. Cochrane Database Syst Rev. 2014;(6):CD006744.
• Karavitakis M, Kyriazis I, Omar MI, et al. Management of urinary retention in patients with benign prostatic obstruction: a systematic review and meta-analysis. Eur Urol. 2019;75(5):788–798.
• Stoffel JT, Peterson AC, Sandhu JS, et al. AUA white paper on nonneurogenic chronic urinary retention. J Urol. 2017;198(1):153–160.

দাবি পরিত্যাগ এই বিষয়বস্তু ব্যাঙ্কক হসপিটাল হেডকোয়ার্টার্সের বোর্ড-সার্টিফাইড ইউরোলজিস্ট ড. সোয়ারಾವী উইরাসোপোনে দ্বারা লিখিত ও পর্যালোচিত হয়েছে এবং এটি শুধুমাত্র শিক্ষার উদ্দেশ্যে তৈরি করা হয়েছে। এটি কোনো চিকিৎসা পরামর্শ, রোগ নির্ণয় বা কোনো ব্যক্তির জন্য প্রেসক্রিপশন নয়, এবং ব্যক্তিগত মেসেজিং চ্যানেল বা সোশ্যাল মিডিয়ার মাধ্যমে কোনো পরামর্শ, রোগ নির্ণয় বা প্রেসক্রিপশন দেওয়া হয় না। ড. সোয়ারಾವীর কোনো পাবলিক সোশ্যাল মিডিয়া অ্যাকাউন্ট নেই; তাঁর নামে ব্যক্তিগত পরামর্শ প্রদানকারী যেকোনো অ্যাকাউন্ট প্রতারণামূলক। থাইল্যান্ডে জরুরি অবস্থায় কল করুন 1669.