What should I do if I haven't urinated in 2 days?

Emergency Medical Evaluation Required Immediately

If you have not urinated in 2 days, this is a medical emergency requiring immediate evaluation in an emergency department or urgent care facility—you likely have acute urinary retention that needs urgent catheterization to prevent permanent bladder damage. 1

Why This Is Urgent

• Complete absence of urination for 48 hours indicates acute urinary retention, which can cause irreversible bladder damage if not treated promptly 1
• A single episode of bladder overdistention can stretch and permanently damage the detrusor muscle, leading to chronic bladder dysfunction that may not recover even after the bladder is emptied 2
• Acute urinary retention requires immediate medical intervention with urinary catheterization to decompress the bladder 2, 3

What to Expect at the Emergency Department

Immediate Management

• You will likely need urgent bladder catheterization to relieve the retention and prevent permanent damage 2
• The medical team will measure your post-void residual urine volume (though in your case, there is no voiding occurring) 1
• Urinalysis and possibly urine culture will be performed to rule out infection or other abnormalities 1

Diagnostic Evaluation

• Physical examination will assess for a palpable distended bladder, neurological abnormalities, and signs of obstruction 1
• Blood tests may be ordered to check kidney function, as urinary retention can lead to renal complications 1
• Assessment for "red flag" symptoms including pain, fever, recent trauma, neurological symptoms, or history of prostate problems (in men) 1

Common Causes to Consider

In Men

• Benign prostatic hyperplasia (BPH) is the most common cause, particularly in men over 60 years old 1, 3
• Approximately 23% of 60-year-old men will experience acute urinary retention within the next 20 years 3

In Both Men and Women

• Medications with anticholinergic effects (antipsychotics, antidepressants, antihistamines), opioids, alpha-adrenergic agonists, or calcium channel blockers 4
• Recent anesthesia or surgery, as up to 10% of acute retention episodes are attributable to anesthesia 4, 2, 3
• Neurological conditions affecting bladder control 1
• Severe constipation or fecal impaction causing mechanical obstruction 1

Critical Pitfall to Avoid

Do not wait to see if urination returns on its own—the longer the bladder remains overdistended, the greater the risk of permanent damage to the bladder wall and detrusor muscle 2. Seek emergency care immediately.

After Initial Treatment

Once the acute retention is relieved with catheterization:

• The underlying cause must be identified and treated to prevent recurrence 1, 4
• If medication-induced, the offending drug should be discontinued or dose-reduced 4
• Referral to a urologist is indicated for further evaluation, particularly if obstruction or neurological causes are suspected 1
• Some patients may require temporary indwelling catheterization while the underlying cause is addressed 2