Urinary retention is the inability to release urine from the bladder completely.  Urinary retention can be acute or chronic.  Acute urinary retention can be a medical emergency, as the person is unable to pass urine at all.  In chronic cases,  the person is able to pass some urine but retains a certain amount in the bladder.  Chronic urinary retention can pose a lot of health problems including bladder stones, kidney problems and infections.

There are various possible causes that can lead to urinary retention.  When dealing with urinary retention, one may feel the urge to urinate but has difficulty fully emptying.   It also causes abdominal pain, discomfort and bloating.

Some of the possible causes of urinary retention are:

*Urinary Tract Infection (UTI)– much more frequent in women then men.

*Obstruction from Bladder stones- The obstruction due to stones in the opening of the urethra will cause abdominal pain during urination as well as possible blood in the urine.

*Pelvic Organ Prolapse- Pelvic organ prolapse is actually very common.  It is generally due to weakness of the pelvic floor muscles and over stretching of the ligaments that support the organs during pregnancy and childbirth.  A cystocele is where the bladder falls (prolapses) into the vagina.  Because the bladder sits right over the front wall of the vagina, it makes it difficult to empty the bladder.  A rectocele is when the rectum prolapses into the back wall of the vagina causing an obstruction.

This condition is easily treated with Myofascial Release and manual therapy techniques.  All women should have a thorough evaluation of their pelvic floor muscles especially after childbirth and around menopause.  Myofascial Release addresses muscle imbalances and allows for appropriate strengthening of the pelvic floor muscles.  It will not only help avoid prolapse but will also help correct prolapses.

*Dysfunctional Voiding- This is generally caused when the muscles around the bladder and the pelvic floor muscles in general, are too tight.  The bladder has to be able to sufficiently contract and urethra has to be able to relax in order to have proper voiding.

Myofascial Release can help correct dysfunctional voiding as it corrects muscle imbalances and helps to normalize muscle tone.

Neurogenic bladder- often called a lazy bladder where the muscles around the bladder do not contract hard enough to empty.

There can be many reasons for this such as: diabetes,pelvic injury, constipation, stroke, spinal cord injuries and infections.   These conditions can cause damage to the nerves that control urine flow.

*Benign Prostatic Hyperplasia (BPH) –  This is where the prostate becomes enlarged and squeezes the urethra and blocks the flow of urine making it harder to urinate.

TREATMENT OPTIONS:

Pelvic floor therapy– with an emphasis on manual therapy and myofascial release are a very important option when considering treatment for urinary retention.  It is very important to address muscle and structural imbalances which could impede proper blood flow and mobility and motility of the pelvic floor organs.  This is an obvious treatment option for pelvic floor organ prolapse and dysfunctional voiding.  Myofascial Release can be done directly to the prostate, increasing tissue mobility and blood flow to the prostate.  Myofascial Release techniques directed toward the spine can also correct spinal alignment which would affect the nerves along those segments.

Catheterization- usually done by the patient.  In acute cases, the catheter is left in until the patient regains the ability to urinate on their own.  In chronic cases, the patient will self catheterize every day, and even several times a day,  in order to fully drain the bladder.  Although easy to do with little discomfort, on going catheterization can cause UTI’s due to the continual insertion of the catheter into the bladder.  This is a readily accepted technique by the medical field.  However, repeated UTI’s causes repeated use of antibiotics which can cause the destruction of beneficial bowel flora.  More on this subject will be written at a later time as it is a topic for discussion on it’s own.

Vaginal Pessary- A device, like a diaphragm, is inserted into the vagina to lift up and support the bladder and allow it to empty.

Surgical Options- InterStim- an FDA approved device implanted under the skin of the upper buttocks.  It is designed to help nerve stimulation to the bladder.

Urinary retention, acute or chronic, can pose many health complications if not treated properly.  The accumulation of urine in the bladder causes bacterial growth which could lead to various infections.  Early detection of pelvic floor muscle imbalances and treatment of dysfunctional voiding patterns with conservative methods, especially Myofascial Release have been shown to have good long term success in restoring proper alignment to the spine, pelvis and pelvic organs.  Urinary retention can be treated conservatively with good success if caught early.  If you are experiencing difficulty emptying your bladder, talk to your doctor.  Request a visit to a pelvic floor Physical Therapist who utilizes manual therapy techniques and is trained in Myofascial Release to properly evaluate your pelvic floor muscles.

 

Jody Hendryx, PT