Urinary Retention, Acute

Presentation

Urinary retention is a common problem encountered in the emergency department. Acute urinary retention (AUR) presents as a sudden inability to voluntarily void.

The patient, usually male, may complain of increasing dull, low abdominal discomfort or pain and the urge to urinate, without having been able to urinate for many hours. Lower abdominal pain may become severe. Urinary hesitancy, sensation of incomplete voiding, an interrupted or decreased urinary stream, and straining to void are other typical symptoms of obstruction. Flank pain may accompany obstruction that leads to hydroureter and hydronephrosis.

Elderly and debilitated patients may be asymptomatic or have vague discomfort with urinary frequency but small volumes, overflow, or stress incontinence.

A firm, distended bladder can often be palpated between the symphysis pubis and umbilicus, although this can sometimes be masked by body habitus. Rectal examination may reveal an enlarged or tender prostate or suspected tumor, although a prostate that is of normal size and consistency by palpation can still be the cause of urethral obstruction.