Management of Bladder Irritation and Urinary Retention
For patients with bladder irritation and urinary retention, treatment should proceed from conservative therapies to more invasive options, with surgical interventions reserved for cases where other treatments have failed or when quality of life is significantly impacted by symptoms. 1
Assessment and Initial Management
- Bladder irritation and urinary retention affect approximately 25-50% of stroke survivors and can significantly impact rehabilitation, physical health, and quality of life 1
- Urinary retention should be confirmed through bladder scanning or straight catheterization to quantify residual volume 2
- For acute urinary retention, immediate bladder decompression via urethral catheterization should be performed for symptom relief 2
- Indwelling catheters should be removed within 48 hours to minimize urinary tract infection risk 1
- Silver alloy-coated urinary catheters are recommended when catheterization is necessary to reduce infection risk 1
Management of Bladder Irritation
First-line Treatments
Behavioral modifications should be implemented first, including 1:
- Altering urine concentration through fluid management (restriction or additional hydration)
- Application of local heat or cold over the bladder or perineum
- Avoiding common bladder irritants such as caffeine, citrus products, and spicy foods
- Using elimination diets to identify specific food triggers
- Implementing relaxation techniques for flare management
Recent evidence suggests that caffeinated, carbonated, and citrus beverages as well as high-acid foods may be associated with urgency urinary incontinence symptoms 3, 4
Second-line Treatments
Oral medications that may be administered include 1:
- Amitriptyline
- Cimetidine
- Hydroxyzine
- Pentosan polysulfate
Intravesical treatments that may be considered include 1:
- Dimethyl sulfoxide
- Heparin
- Lidocaine
Management of Urinary Retention
Conservative Management
Implement a stepwise approach beginning with a behavioral bladder-training program 1:
- Offer the commode, bedpan, or urinal every 2 hours while awake and every 4 hours at night
- Limit fluids in early evening
- Progress to medication only when needed
For post-stroke urinary retention, prompted voiding techniques are recommended for patients with urinary incontinence 1, 2
Pharmacological Management
- For BPH-related retention, administer alpha blockers (tamsulosin or alfuzosin) prior to attempting catheter removal to improve chances of successful voiding trial 2, 5
- Finasteride may be beneficial for long-term management of BPH-related retention, with studies showing a 57% reduction in risk of acute urinary retention compared to placebo 6
Catheterization Approaches
- Intermittent catheterization is generally preferred over indwelling catheters when possible 2, 7
- For patients requiring long-term catheterization, regular follow-up is essential to assess for complications such as UTI, bladder stones, and renal function deterioration 2
Surgical Management
- Surgery should be considered for patients with refractory retention who have failed at least one attempt at catheter removal 2
- Transurethral resection of the prostate (TURP) remains the benchmark surgical treatment for BPH-related urinary retention 2
- For patients with interstitial cystitis/bladder pain syndrome, surgical treatments (other than fulguration of Hunner's lesions) should only be considered after other treatment alternatives have been exhausted 1
Special Considerations
- For patients with neurological causes of urinary retention (stroke, multiple sclerosis, Parkinson's disease), a multidisciplinary approach is recommended 8
- Medications with anticholinergic properties should be used with extreme caution in patients with history of urinary retention 8, 9
- Constipation can contribute to urinary retention and should be addressed with appropriate fiber intake, fluid management, and laxatives if necessary 1
Monitoring and Follow-up
- Regular assessment of bladder function should continue throughout the rehabilitation process 1
- Patients who successfully void after catheter removal should be informed that they remain at increased risk for recurrent urinary retention 2
- Multimodal pain management approaches should be initiated for patients with bladder pain 1
Pitfalls to Avoid
- Prolonged use of indwelling catheters increases infection risk and should be avoided when possible 1, 7
- Blind catheter passage should be avoided if urethral injury is suspected 2
- Avoid delaying surgical intervention in patients with refractory retention, as this can lead to bladder decompensation and chronic retention 2
- Regularly changing catheters as a preventive measure against infection is not recommended 1