Urinary Retention

Urinary retention is described as being a "state in which an individual experiences incomplete emptying of the bladder" (Glanze, 1990).  It occurs when urine is produced normally but is not excreted.  If this is the case then the bladder continues to fill.

Symptoms of urinary retention include bladder distension, small infrequent voiding, or absence of voiding.  The patient may express a sensation of bladder fullness, dribbling, residual urine, dysuria, and overflow incontinence.  Under normal conditions the adult bladder usually holds 250 to 450 ml of urine when the micturition reflex is triggered.  In retention the bladder may expand to hold 3000 to 4000 ml of urine.  As with Bob many patients experience retention overflow.  Although they have lower abdomin discomfort and a palpable bladder, they are only able to void small amounts.  The nurse should not mistake this for normal functioning.

Urinary retention is usually diagnosed by the symptoms experienced and palpation and percussion above the symphysis pubis.  The abdomen swells as the bladder rises and the height of the bladder can be determined by palpating with light pressure on the abdomen.  Other diagnostic equipment such as the ultrasound scan Bob experienced can help to confirm the diagnosis and to determine the extent of the retention.

There are many potential causes for urinary retention these include, post surgery, mechanical obstruction, enlarged prostate in men, psychic causes, certain disease processes, or injury to the spinal cord.

In the surgical patient urinary retention is more common following surgery on the rectum, vagina, herniorrhapies, surgery on the lower abdomen, or surgery where ambulation is delayed.  It is thought in these instances to be caused by a spasm of the bladder sphincter.

Assessment of someone in urinary retention or with the potential of urinary retention includes, a strict fluid balance record, noted complaints of pain in the pubic area.   Notation of swelling, urinary urgency, frequency and dysuria.

Often patients have difficulty voiding while lying in bed.  If sitting or standing are not contraindicated, it is recommended that the patient be sat up, or for a male patient stood beside the bed to use the urinal.  For some patients this will be all that is needed.  Nursing consideration needs to be given to the patients needs, some people cannot void in the presence of others.  Maintaining patient privacy and safety, warming the bedpan or urinal, offering warm drinks, giving prescribed analgesia pre- urination if pain is related.  Sometimes the sound of running water relaxes the spasm of the bladder sphincter.

If other efforts fail catheterisation may be required.  Catheterisation is avoided if possible due to the risk of bladder infection, also research indicates that once catheterisation has taken place, subsequent catheterisations are sometimes needed.   Retention however is often a temporary problem.

(Smeltzer & Bare, 1996;  Taylor, Lillis & LeMone, 1997).

Summary

Urinary retention has be outlined as a condition in which individuals experience incomplete emptying of the bladder.  Symptoms of bladder distention, small infrequent voiding or absence of voiding have been identified.  Patient experiences have been expressed as a sensation of bladder fullness, dribbling, residual urine, dysuria and overflow incontinence.  It has been suggested that patients such as Bob can experience retention overflow, allowing them to pass only small amounts of urine.  Diagnosis of urinary retention has been outlined as being by symptoms presented with and abdominal examination, and the possible use of other equipment such as ultrasound scan.   Potential causes for urinary retention include, post surgery, mechanical obstruction, enlarged prostate in men, some disease processes and spinal cord injury.   Helping patients into a more natural position, maintaining privacy, offering warm drinks, warming the bedpan or urinal, running the tape, and administering analgesia pre urination were all identified as nursing considerations which may help the patient achieve micturition.  Assessment of the urinary retention patient was outlined, and retention was described as being often a temporary condition.