From the Guidelines
Urinary retention in females is primarily caused by impaired detrusor muscle contraction or increased outlet resistance, which can be due to various factors such as neurological conditions, medication side effects, pelvic organ prolapse, or urethral obstruction. The causes of urinary retention in females can be categorized into several key areas, including:
- Neurological conditions, such as spinal cord injury, stroke, Parkinson’s disease, multiple sclerosis, or diabetic neuropathy, which can lead to neurogenic bladder 1
- Medication side effects, including anticholinergics and antidepressants, which can impair detrusor muscle contraction
- Pelvic organ prolapse, which can cause urethral obstruction
- Urethral obstruction due to infection, metastases, or congenital abnormalities
- Refractory bladder, which can be caused by various factors, including urethral obstruction or impaired detrusor muscle contraction
In terms of management, catheterization is a common intervention for urinary retention in females, with intermittent self-catheterization being a preferred method for patients with urinary retention. The choice of catheter material and method, such as hydrophilic, gel reservoir, or non-coated catheters, can depend on various factors, including patient preference and the risk of catheter-associated UTIs 1. It is essential to address the underlying causes of urinary retention and to provide patients with instruction on how to manage their condition, including voiding regularly, avoiding excessive fluid intake before bedtime, and performing double voiding. If retention recurs after initial management, urodynamic testing and specialist referral are warranted.
From the Research
Causes of Urinary Retention in Females
- Obstructive causes, such as pelvic organ abnormalities 2
- Infectious and inflammatory causes, including cystitis, urethritis, and vulvovaginitis 2
- Pharmacologic causes, including medications in the anticholinergic and alpha-adrenergic agonist classes 2
- Neurologic causes, such as cortical, spinal, or peripheral nerve lesions 2
- Weakened power of the detrusor muscle 3
- Other causes, including medical, surgical, and gynaecological conditions 4
- Infective, pharmacological, neurological, anatomical, myopathic, and functional causes 5
Specific Causes and Management
- Detrusor failure is often an underlying factor that complicates interpretation 5
- Initial management includes bladder drainage (intermittent or indwelling catheterization) if the woman is symptomatic or at risk of complications, and correcting likely causes 5
- Investigations should be focused on identifying the underlying etiology and any reversible factor 5
- Urodynamic tests are required in specific situations 5
- Urethral dilatation has a limited role, but it should be considered if there is urethral stenosis 5
- Definitive management requires correction of cause where possible and symptom management where no correctable cause is detected 5
- Clean intermittent catheterization with or without pharmacological treatment can achieve a success rate of over 85% in managing urinary retention in females 4