Peeing has always been so simple. In the past, you could be in and out of the bathroom in less than a commercial break. But now it seems like a show can start and end before you’re able to get your flow going. And when you’re finally able to manage a dribble, your bladder still feels full (probably because it is).
If you’re unable to pee – or have difficultly emptying your bladder completely —it may be because there’s something blocking urine flow or there are problems with how your bladder muscle works.
Below, we share reasons why you may have trouble peeing, what causes urinary retention, when to see a doctor and treatment options.
Urinary retention is when you have difficulty urinating
Urinary retention (sometimes called bladder retention) is the medical term for when you can’t pee or completely empty your bladder.
Pee is what’s produced after your urinary system filters waste and extra fluids from your blood stream. If you can’t pee, it means something is preventing urine from moving through your urinary system. Your kidneys, bladder, ureters (tubes that connect the kidneys to the bladder) and urethra (the tube that urine passes through to exit your body) make up your urinary system.
Problems with urination can happen suddenly or get worse over time. You’ll likely need treatment in both situations, but you’ll want to get immediate medical attention if you’ve been trying to pee for 6-7 hours and nothing comes out.
Acute urinary retention starts suddenly
This occurs when the flow of urine is suddenly cut off – absolutely no urine comes out, no matter how hard you try. Acute urinary retention can become an emergency situation.
Here’s why it’s dangerous: if you’re not able to empty your bladder, it will continue to fill, putting pressure on the surrounding nerves and tissues. You should head to urgent care if you have urinary retention that comes on suddenly and makes it so you can’t pee at all.
Chronic urinary retention doesn’t go away
For most people, urinary retention is a problem that gets worse over time and doesn’t go away. With chronic urinary retention, you’ll still be able to pee but won’t be able to completely empty your bladder.
Even if your symptoms don’t seem that bad and they’re manageable, it’s still best to make an appointment with a primary care doctor. This condition can get worse over time and, if left untreated, may cause damage to your kidneys and bladder.
Urinary retention symptoms: Changes in how you pee
Urinary retention affects how much and how often you pee. It can also cause discomfort and pain. Possible symptoms include:
- Difficulty starting peeing (urinary hesitancy) – If you have urinary retention, it can be difficult to start a stream of urine. You may have to try for several minutes before any pee comes out.
- A weak or interrupted stream – With urinary retention, it’s common to have the urge to pee but little comes out. Your urine stream may seem very slow, or it may stop before you feel like you’re finished.
- A bladder that feels full all the time – This is because urinary retention makes it difficult for you to fully empty your bladder.
- Needing to pee many times during the day – There are many reasons for frequent urination in women and men. When it’s caused by urinary retention, you may need to pee immediately after your last bathroom visit. There are ways to manage urinary frequency, so let your doctor know if you’re going more than eight times a day, even if you don’t have other signs of urinary retention.
- Waking multiple times at night because you need to pee (nocturia) – As you get older, it’s common to wake up once during the night to pee. However, peeing more often can be a sign of urinary retention or another condition.
- Leaking urine – If you are unable to empty your bladder, it may become too full, and urine may leak out throughout the day. Overflow incontinence is common in men with urinary retention.
- Difficulty holding in your urine – People with urinary retention may also have urge incontinence, a condition where you feel the sudden need to pee but aren’t able to hold it.
- You can’t tell if your bladder is full – If there are problems with the nerves that control bladder function, you may not know when you need to urinate or be able to go when you try.
- Discomfort or pain in your stomach – You may have discomfort or pain in your lower abdomen. The pain can be especially bad if you have acute urinary retention.
- Swelling in your stomach – If urine builds up in the bladder, your abdomen can swell outwards and downwards. This usually only happens with acute urinary retention.
Reasons you’re more likely to get urinary retention include gender and age
You’re most likely to get urinary retention if you’re an older adult and have male anatomy, but people of all ages and genders can have acute or chronic urinary retention.
Why males are more likely to get urinary retention
The reason why men are more likely to get urinary retention comes down to two key differences in anatomy:
- The urethra is longer in males – The urethra is the tube that carries urine from the bladder to outside the body. In females, the urethra is about 1.5 inches, but in males it goes from the bladder all the way to the tip of the penis. Since urine needs to travel farther to exit the body, there are more opportunities for problems as the urine flows out. And, since the penis is on the outside of the body, it can get hurt in a way that causes the urethra to swell.
- Males have a prostate – In male anatomy, the prostate surrounds the top of the urethra. It’s common for the prostate to get bigger, and it can get so big that it blocks urine flow. According to research, prostate problems cause urinary retention in men more than 50% of the time.
Why the chance of urinary retention increases with age
Urinary retention is caused by conditions that are more common in older age, such as an enlarged prostate. People who are older are also more likely to take medications that can cause urinary retention or make it worse.
Why can’t I pee? Causes of urinary retention
There are many causes of urinary retention, but they can be broken down into a few main categories – blockages, swelling, nerve problems, medication and surgery. More rarely, it can be caused by cancer.
How blockages can cause urinary retention
A blockage is anything that gets in the way when pee tries to leave your body. When a blockage decreases urine flow, it can lead to chronic urinary retention. If something completely blocks urine flow, it can cause sudden and severe symptoms. Possible obstructions include:
Enlarged prostate
Benign prostatic hyperplasia (BPH) is the term for an enlarged prostate. This condition is extremely common and becomes more likely with age. It’s estimated that more than 70% of men in their 60s have BPH symptoms. By the time you’re in your 80s, there’s a 90% chance that you’ll have an enlarged prostate. An enlarged prostate can put pressure on the urethra, blocking urine flow and making it harder to pee. BPH can also cause blood in urine.
Urinary tract stones
You can get crystals in your bladder, kidneys or in the tubes (ureters) that connect these organs together. These crystals are caused by minerals in urine and, over time, can become hard stones.
Bladder and kidney stones can block urine flow and make it difficult to pee. Stones can also cause pain and bleeding when your body tries to pass them through the urinary tract, especially if they get stuck.
Constipation
If you go a long time without a bowel movement, it’s possible for stool to collect in your rectum (the lower part of the bowel) and push down on your bladder near where it connects to the urethra. If backed-up stool is the cause of urinary retention, your symptoms should go away when you treat the constipation.
Narrowed urethra (urethral stricture)
A narrowed urethra can make it more difficult for urine to get through and make it painful to pee. Scar tissue is usually the reason for the narrowing. Scar tissue in the urethra can be the result of trauma, prostate problems, certain types of cancers, radiation therapy or if you’ve had a procedure where a tube called a catheter was inserted into your urethra. Urethral stricture is more common in men than women.
Pelvic organ prolapse
A pelvic organ prolapse can happen if the muscles and supporting tissues in the pelvis aren’t strong enough to fully support the bladder, bowel or uterus. Instead, these organs start to sag and push against other organs. In more severe cases, the organs can sag into the vagina or out of the rectum.
Anyone can experience pelvic organ prolapse but they’re more common in women and those assigned female at birth. This condition can cause problems such as urinary retention, and both urinary and fecal incontinence.
Stuck foreskin on the penis (paraphimosis)
It’s possible for the foreskin to get pulled back behind the penis and get stuck there. This sometimes happens if you try to clean under the foreskin or if you’ve had a medical procedure on your penis.
If the foreskin is trapped, it can tighten like a ring around the penis, making it so pee can’t get through. Other symptoms of this condition include penis swelling and discomfort or pain in the lower abdomen. This condition is rare among uncircumcised males – it occurs in about 1% of those aged 16 years and older, and even more rarely in younger boys.
This condition is a medical emergency, so head to urgent care or call 911 if you think a stuck foreskin is causing urinary retention and other symptoms.
How swelling can cause urinary retention
Infections and trauma can cause swelling that partially or completely blocks urine flow. Some examples include:
Lower urinary tract infections
Infections in the lower urinary tract can lead to urinary retention if there’s swelling or inflammation that makes it difficult for the urine to get through. If you have a urinary tract infection (UTI) in your bladder or urethra, you’ll likely have other symptoms like blood in urine or pain when urinating.
You can develop a UTI if bacteria get in the body from the outside and multiply in the bladder or urethra. UTIs are common and more frequently occur in women. They’re easily treated, usually with an antibiotic. One of the fastest ways to get treated for a UTI is to start a Virtuwell visit – no appointment is needed.
Inflammation of the vagina (vulvovaginitis)
Vulvovaginitis is inflammation or infection of the external part of the vagina (vulva) and vaginal canal. Swelling in this area can make it difficult and painful to pee, and symptoms can quickly get worse.
Inflammation of the prostate (prostatitis)
When the prostate swells, it pushes down on the urethra, making it difficult and painful to urinate. A bacterial infection is the usual cause, though there are other reasons.
Trauma to genitals
Trauma to the genitals can cause swelling that pushes against the urethra or other parts of the lower urinary tract, blocking urine from coming out. If you’re not able to pee at all or you’re in a lot of pain, make sure you get immediate medical attention.
If you’ve been the victim of assault or forced sexual activity, it’s important to talk to someone. Your primary care doctor can be a resource for you, or you can call 800-656-HOPE (4673) to talk to someone at the National Sexual Assault (RAINN) Hotline.
How nerve problems can cause urinary retention
Your brain and nervous system play an important role in urination. When you need to pee, your brain tells the bladder muscle to squeeze the bladder. Then, the brain tells the muscles at the opening of the bladder to relax and open, allowing pee to flow through the urethra and out of the body.
Problems with the nerves that control the bladder can cause urinary retention and other urinary conditions. Bladder nerve problems can result from:
Nerve injury
If there’s an injury to the brain, spinal cord or nervous system, it can affect the nerves that control the bladder.
Medical conditions that affect nerves that control bladder function
Neurological disorders such as multiple sclerosis, Parkinson’s disease or a stroke can affect nerve signaling between the brain and bladder. Nerve damage can also be a complication of uncontrolled diabetes and other medical conditions.
How medications can cause urinary retention
If you’re having difficulty peeing, there’s a chance that your medications might have something to do with it. Some medications change how the bladder muscle works, and other medications have bladder control problems as a possible side effect.
Medications that can make it difficult to urinate include:
- Allergy medications
- Antidepressants and antipsychotics
- Blood pressure-lowering medications
- Hormonal agents
- Medication for Parkinson’s disease
- Muscle relaxers
- Over-the-counter pain relievers (such as aspirin or ibuprofen)
- Opioids (such as morphine)
- Urinary incontinence medications
If you think your medications may be causing problems when you pee, make an appointment to talk to your doctor. Make sure to bring a full list of the medications you’re taking, including over-the-counter vitamins and supplements. And, of course, don’t stop taking any prescriptions until you have your doctor’s approval.
How surgery can cause urinary retention
Anesthesia is commonly used for surgery since it blocks pain signals. And depending on the surgery, you may also need IV fluids to make up for any blood loss. This combination of anesthesia and IV fluids helps increase the safety and comfort of surgery – but anesthesia also affects how nerves work and IV fluids can cause a full bladder.
Usually, the ability to pee returns when the anesthesia wears off, but some people can have urinary retention for days or weeks after surgery. You should talk to your doctor if your symptoms don’t go away within six weeks of surgery or if they get worse.
How cancer can cause urinary retention
Although not as common, cancer can cause urinary retention if a tumor blocks the urinary system or pushes down on the nerves that control your bladder. Urination retention can be a sign of bladder cancer, prostate cancer, uterine cancer, colorectal cancer or neurological cancer.
Cancer doesn’t have a lot of symptoms in the early stages. So, it’s important to get your recommended cancer screenings and talk to your doctor if you have any concerning symptoms.
How doctors diagnose urinary retention: Physical exams and tests
Your doctor will perform a physical exam and ask about your symptoms and the medications you’re taking. They may also do tests to see how well your bladder is working and find out if anything is blocking the flow of urine. Tests may include urinalysis to test your urine, a bladder ultrasound to see how much pee is in your bladder after you urinate, and electromyography to see if your symptoms are caused by nerve problems.
What to do if you can’t pee: Treatments for urinary retention
There are many possible treatments for urinary retention because it depends on the cause. Your doctor will put together a personalized plan based on your situation. Treatments may include:
Draining the bladder
When you go to the doctor for urinary retention, their first priority will be to make sure your bladder isn’t too full. If you’re unable to empty your bladder on your own, your doctor will use a catheter to drain it. Continued catheterization may be recommended as a treatment for some people.
Medications
It’s possible that your doctor may recommend new medications or changes to your current ones. For example, if the retention is cause by an untreated condition (such as an infection or BPH), your doctor may prescribe a new medication. If you’re taking a medication that may be causing urinary retention, your doctor may recommend changing it.
Lifestyle changes
Depending on what’s causing your urinary retention, lifestyle changes may make it more likely that you’re able to completely empty your bladder. Changes may include:
- Pee on a schedule – Your doctor may recommend that you pee every three to four hours. This can help ensure you bladder doesn’t get too full.
- Double void – Before you leave the bathroom, try to pee (void) for a second time. This may help so you don’t need to return to the bathroom right away.
- Stay hydrated – It’s important to drink plenty of fluids, even when it’s difficult to pee. If your urinary system doesn’t get enough fluids, it increases the chance of UTIs, bladder inflammation and kidney problems.
- Strengthen your pelvic floor – Doing pelvic floor exercises (Kegel exercises) can help the nerves and muscles around your bladder work better.
- Avoid constipation – When you’re backed up, it can be hard to pee. You may be able to prevent constipation by eating a colon-healthy diet full of fruits, veggies and whole grains. And getting 30 minutes of exercise most days helps too.
- Don’t squat over the toilet – For a woman, sitting on the toilet is the most relaxing position for the bladder. When you hover over the toilet to avoid touching the seat, you can’t fully relax your muscles, and urine may be left in the bladder.
- Take your time – When in the bathroom, give yourself time to relax and empty the bladder completely.
Medical procedures and devices
Depending on the cause of urinary retention, your doctor may recommend a procedure or device to remove blockages and get urine flowing again. This could be a procedure to shrink an enlarged prostate, increase the diameter of the urethral opening or remove stones.
Surgery
Surgery may be recommended if other treatments don’t work. For example, your doctor may recommend surgery for pelvic organ prolapse or to remove a growth that’s pressing on your urinary system.
What happens if urinary retention isn’t treated?
Untreated urinary retention can cause damage to your bladder, kidneys and surrounding nerves. With chronic urinary retention, the bladder may become so stretched that it can’t work properly. If urine backs up into the kidneys, they can become swollen and press on nearby organs. In some cases, this can lead to chronic kidney disease or kidney failure.
Urinary retention also increases your chance of getting UTIs, kidney stones and other urinary conditions like incontinence.
What to do if you can’t pee or find it difficult to empty your bladder
It’s important to see a doctor if you can’t pee or empty your bladder completely.
Head to urgent care if your bladder feels full and you can’t urinate at all. If you have symptoms of chronic urinary retention, make an appointment with one of our primary care doctors. These doctors are experts at diagnosing and treating hundreds of conditions. If necessary, they’ll refer you to a specialist, like a urologist, for more advanced treatment.