From the Guidelines
The best medication for acute urine retention in females is typically an alpha-blocker, such as tamsulosin (Flomax) at a dose of 0.4 mg once daily. While the provided evidence primarily focuses on benign prostatic hyperplasia in males, the principle of using alpha-blockers to relax the smooth muscle in the bladder neck and urethra can be applied to females with acute urine retention as well, considering the lack of gender-specific guidelines in the provided evidence 1.
Key Considerations
- The use of alpha-blockers like tamsulosin may facilitate urination by relaxing the smooth muscle in the bladder neck and urethra.
- It's crucial to identify and address the underlying cause of urinary retention, which could include obstruction, neurological disorders, medication side effects, or pelvic organ prolapse.
- Treatment with alpha-blockers should be approached with caution in patients with a history of alpha-blocker side effects or unstable medical comorbidities, such as orthostatic hypertension or cerebral vascular disease 1.
Additional Therapies
- For cases where urinary retention is due to pelvic floor spasm, a muscle relaxant like baclofen may be beneficial.
- If an infection is the cause, appropriate antibiotics based on urine culture should be prescribed.
- Other medications like bethanechol may be considered for stimulating bladder contraction, though their efficacy can be variable.
Clinical Approach
- Catheterization is often the immediate intervention needed to relieve acute urine retention.
- The duration of medication treatment depends on the underlying cause of the retention, with some patients requiring only short-term therapy while others may need longer management.
- Given the potential risks and the need for individualized care, the choice of medication and treatment approach should be guided by the most recent and highest quality evidence available, prioritizing patient safety and quality of life 1.
From the Research
Causes of Acute Urine Retention in Females
- The causes of urinary retention in females can be classified as obstructive, infectious and inflammatory, pharmacologic, neurologic, or other 2
- Detrusor failure is often an underlying abnormality in female acute urinary retention (AUR), rather than outlet obstruction 3
- Numerous causes are recognized in women, including infective, pharmacological, neurological, anatomical, myopathic, and functional factors 4
Management of Acute Urine Retention in Females
- Initial management includes bladder drainage (intermittent or indwelling catheterization) if the woman is symptomatic or at risk of complications, and correcting likely causes 4
- Alpha-blockers are no better than placebo in the treatment of female AUR 3
- There is no role for urethral dilatation in the treatment of female AUR, except in cases of urethral stenosis 4
- Patients who fail to void after catheter removal should be taught clean intermittent self-catheterization (ISC) 3