From the Guidelines
The treatment for urinary retention due to holding in urine typically involves immediate bladder drainage through catheterization, followed by the administration of an alpha-blocker, such as tamsulosin or alfuzosin, prior to attempted catheter removal, as recommended by the American Urological Association 1. When treating urinary retention caused by habitually holding urine, it is crucial to address the issue promptly to prevent further complications. The initial step involves relieving the immediate retention through catheterization. Following this, the focus shifts to preventing recurrence, which may include the use of medications like alpha-blockers to relax the bladder neck and prostate, making urination easier 1. Key considerations in the management of urinary retention include:
- Establishing regular bathroom schedules every 3-4 hours, even without the urge to urinate
- Avoiding excessive fluid intake before bedtime
- Limiting caffeine and alcohol, which can irritate the bladder
- Practicing double voiding (urinating, waiting a few minutes, then trying again)
- Pelvic floor physical therapy to strengthen muscles involved in urination It is essential to note that the use of alpha-blockers, such as tamsulosin or alfuzosin, prior to a trial of catheter removal may be preferable, as stated in the AUA guideline 1, but this should be approached with caution in patients with a history of alpha-blocker side effects or unstable medical comorbidities. Overall, the goal of treatment is to restore normal urination patterns, prevent recurrence, and improve the patient's quality of life, while minimizing the risk of complications associated with urinary retention 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for Urinary Retention due to Holding in Urine
The treatment for urinary retention due to holding in urine involves several steps, including:
- Assessment of urethral patency with prompt and complete bladder decompression by catheterization 2, 3
- Use of alpha blockers to relax prostatic smooth muscle cells and decrease resistance to urinary flow 4, 5
- Suprapubic catheterization, which may be superior to urethral catheterization for short-term management 2, 3
- Clean, intermittent self-catheterization for patients with chronic urinary retention from neurogenic bladder 2
Management of Urinary Retention
The management of urinary retention depends on the cause and chronicity of the condition. It may include:
- Initiation of alpha blockers with voiding trials 3, 4
- Monitoring in conjunction with neurology and urology subspecialists for patients with urinary retention related to an underlying neurologic cause 3
- Surgical and medical treatments, depending on the etiology of the condition 2
Use of Alpha Blockers
Alpha blockers have been shown to increase the success rates of trial without catheter (TWOC) and reduce the incidence of recurrent acute urinary retention 4, 5. However, the evidence is of moderate quality, and more randomised clinical trials are needed to address the issues of cost effectiveness and recommended duration of alpha blocker treatment after successful TWOC 4, 5.
Catheterization
Catheterization is an effective way to relieve the obstruction and mitigate the underlying cause of retention 2, 3, 6. Suprapubic catheterization may be superior to urethral catheterization for short-term management, and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection 2, 3.