What are the treatment options for urinary retention in females?

From the Guidelines

To treat urinary retention in women, intermittent catheterization is generally recommended for initial management, as it provides immediate relief and helps to prevent complications such as kidney damage or urinary tract infections. This approach is supported by the American Heart Association/American Stroke Association, which suggests that people with stroke should be observed for voiding after presentation to the hospital and those found to have urinary retention should undergo screening via bladder scan or straight catheterization, followed by intermittent catheterization for initial management 1.

When considering the treatment of urinary retention in women, it's essential to identify the underlying cause, as this will guide the most appropriate management strategy. For instance:

• If the retention is caused by medication side effects, stopping or changing the medication may resolve the issue.
• For cases related to pelvic floor dysfunction, physical therapy focusing on pelvic floor exercises can be effective.
• When urinary retention stems from neurological conditions, clean intermittent catheterization may be necessary, performed 4-6 times daily using sterile technique.
• Pharmacological treatments, such as alpha-blockers like tamsulosin, may be considered to relax the urethral sphincter, but the use of such medications should be based on the most recent and highest quality evidence available.

In the context of treating urinary retention in women, the focus should always be on minimizing morbidity, mortality, and improving quality of life. Therefore, the most recent and relevant guidelines should be consulted to ensure that the management strategy is evidence-based and tailored to the individual patient's needs. The use of alpha-blockers, for example, may be considered in certain cases, but this should be done with caution and careful consideration of the potential risks and benefits, as outlined in previous guidelines 1.

Key considerations in the management of urinary retention in women include:

• The need for prompt relief of urinary retention to prevent complications
• The importance of identifying and addressing the underlying cause of the retention
• The role of intermittent catheterization in initial management
• The potential benefits and risks of pharmacological treatments, such as alpha-blockers
• The importance of individualizing the management strategy to the patient's specific needs and circumstances.

From the FDA Drug Label

Bethanechol Chloride Tablets, USP are indicated for the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention and for neurogenic atony of the urinary bladder with retention. To treat urinary retention in women, bethanechol chloride can be used, as it is indicated for the treatment of acute postoperative and postpartum nonobstructive (functional) urinary retention 2.

• The drug increases the tone of the detrusor urinae muscle, producing a contraction sufficiently strong to initiate micturition and empty the bladder 2.
• It is essential to note that if the sphincter fails to relax as bethanechol chloride contracts the bladder, urine may be forced up the ureter into the kidney pelvis, potentially causing reflux infection if there is bacteriuria 2.

From the Research

Treatment of Urinary Retention in Women

• The treatment of urinary retention in women typically involves bladder catheterization with prompt and complete decompression 3.
• Obstructive causes in women often involve the pelvic organs, and a thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases 3.
• Initial management includes assessment of urethral patency with prompt and complete bladder decompression by catheterization, and suprapubic catheters may improve patient comfort and decrease bacteriuria and the need for recatheterization in the short term 4.
• Further management is decided by determining the cause and chronicity of the urinary retention and can include initiation of alpha blockers with voiding trials, although the evidence for this is primarily based on studies in men 4, 5.
• Patients with urinary retention related to an underlying neurologic cause should be monitored in conjunction with neurology and urology subspecialists 4.
• Clean, intermittent self-catheterization may be an option for women with chronic urinary retention from neurogenic bladder, and low-friction catheters have shown benefit in these patients 3.
• Muscarinic antagonists may be used to treat overactive bladder, while muscarinic agonists have been used to treat hypoactive bladder, although the evidence for these treatments is not specific to urinary retention in women 6.