Treatment of Urinary Retention in Women
Urinary retention in women requires immediate bladder decompression via catheterization, followed by identification and correction of the underlying cause, which may include obstructive, infectious, pharmacologic, or neurologic etiologies. 1, 2
Immediate Management
- Perform prompt and complete bladder decompression via catheterization as the first-line intervention for symptomatic urinary retention or when complications are imminent 1, 3
- Consider suprapubic catheterization over urethral catheterization for short-term management, as it improves patient comfort and decreases bacteriuria 3
- For chronic retention requiring long-term management, initiate clean intermittent self-catheterization using low-friction catheters 1
Diagnostic Evaluation
- Measure post-void residual (PVR) urine volume; chronic urinary retention is defined as PVR >300 mL on two separate occasions persisting for at least six months 4, 3
- Obtain urinalysis with microscopy and culture to exclude urinary tract infection 4, 2
- Perform focused pelvic examination to identify anatomical causes, particularly pelvic organ prolapse or urethral stenosis 4, 2
- Review all medications, as anticholinergics, opioids, alpha-adrenergic agonists, benzodiazepines, NSAIDs, and calcium channel blockers can cause drug-induced retention 5
- Conduct neurologic examination to identify cortical, spinal, or peripheral nerve lesions 1, 2
- Consider urodynamic testing and urethral sphincter electromyography if Fowler's syndrome is suspected (young women with impaired sphincter relaxation) 2
Definitive Treatment Based on Etiology
Pharmacologic Causes
- Discontinue or reduce the dose of causative medications including anticholinergics, opioids, alpha-agonists, and other implicated drugs 5, 3
- Elderly women are at particularly high risk due to polypharmacy and should have comprehensive medication review 5
Obstructive Causes
- Perform urethral dilatation if urethral stenosis is identified, though this has limited overall efficacy 2
- Address pelvic organ prolapse surgically if it is causing outlet obstruction 2
- Surgical correction may be required for anatomical abnormalities 1
Infectious/Inflammatory Causes
- Treat underlying cystitis, urethritis, or vulvovaginitis with appropriate antimicrobial therapy 1
- Resolution of infection typically restores normal voiding function 2
Neurogenic Causes
- Establish clean intermittent self-catheterization as the primary long-term management strategy for neurogenic bladder 1
- Coordinate care with neurology and urology subspecialists for ongoing monitoring 3
- Avoid labeling symptoms as "psychogenic" without thorough evaluation 2
Important Caveats
Common pitfall: Anticholinergic medications used to treat urge incontinence can paradoxically cause urinary retention, particularly in elderly women 6. This represents a critical adverse effect where treatment for one urinary symptom creates the opposite problem.
Key distinction: The evidence provided primarily addresses urinary incontinence rather than urinary retention in women 6. While these conditions are related, they represent opposite ends of the voiding dysfunction spectrum. Treatments effective for incontinence (such as anticholinergics) may worsen retention 6.
Detrusor failure: This often complicates the clinical picture and makes interpretation of symptoms challenging, requiring urodynamic evaluation for definitive diagnosis 2
Follow-Up Monitoring
- Monitor response to treatment and assess for complications including urinary tract infections and upper tract damage 2
- Reassess PVR volumes after therapeutic interventions to ensure adequate bladder emptying 3
- For women requiring long-term catheterization, silver alloy-impregnated catheters may reduce urinary tract infection risk, though benefits are modest 3