Causes of Urinary Retention
The urinary bladder, located in the lower abdomen just below the navel, is very similar to a balloon. Its purpose is to expand and collect urine output from the kidneys and contract on urination as it empties. Urinary retention occurs when the bladder cannot empty completely. When this happens the condition can be either acute, where urination is suddenly impossible, or chronic, where the person cannot empty the bladder completely. Chronic urinary retention often causes kidney damage.
There are two main causes for the condition: a weak bladder muscle that is unable to contract strongly enough to empty, and a partial or complete blockage of the urethra that channels the flow of urine out of the body. The latter cause is the most common and is typically associated with aging men who also have benign prostate hypertrophy (BPH).
For many men, aging results in an enlargement of the prostate gland, but while aging is surely a risk for BPH, hormone imbalances, poor diet, and especially excess estrogen levels can also cause it. A man suffering from BPH is well advised to have a home salivary hormone test that measures several of his sex steroid hormones before starting any medical or natural treatment to resolve BPH.
With BPH, a man typically suffers a decrease in urinary flow as his growing prostate compresses and narrows the tube that passes urine from his urinary bladder (the urethra). As long as the decreased flow is not significant, it is usually not a problem. However, when the blockage seriously affects the flow of urine, it causes urine to accumulate in the bladder beyond the normal level of 50 to 100 ml. The danger of urinary retention is that it can cause backpressure into the man’s kidneys due to the full bladder. This backpressure can damage the kidneys.
Urinary retention in older men is almost always caused by an enlarged prostate gland (BPH). When a man has BPH, any disturbance that causes a temporary swelling or inflammation of the prostate can result in a temporary inability to urinate. This acute urinary retention is a situation requiring immediate treatment to avoid kidney damage. It can occur suddenly without an obvious trigger or can be due to physical activity or a prostate infection (prostatitis).
Treating Urinary Retention
Acute urinary retention typically occurs to a man during the night time hours, and he usually winds up in the emergency room, painfully waiting for someone to catheterize him to alleviate the over-pressure situation in his bladder. A catheter (called a Foley) is typically inserted in the ER by a nurse, immediately relieving the acute stress on the kidneys and the bladder. When the man is released from the ER (with the catheter and a collection bag in place), he is told to make a follow-up appointment with a urologist.
A Foley catheter is typically used in the hospital or urologist environment. It consists of a pair of thin, plastic tubes inserted through the penile urethra into the bladder. A small balloon at the bladder end is inflated with sterile water after the catheter is threaded into the bladder. This balloon, when inflated, keeps the catheter from slipping out. The second and larger tube is used to transport urine out of the bladder and into a plastic collection bag. Thus, a Foley catheter can be left in place for a period of time. However, the longer it is in place, the higher the risk of a bladder infection.
For many men, this is where a downward roller coaster slide begins. The lucky guy keeps the catheter in for a few days to a week or so, then goes to the urologist, gets it removed and is able to urinate normally again. The unlucky guy gets the catheter removed, still can’t urinate, and shortly afterward gets it put back in, often the same day.
What About Having a TURP?
What many guys don’t realize is that even if you are in the unlucky group, urinary function will likely return to normal, it just may take a little longer. However, it is at this time that the man is most vulnerable to falling towards that downward slide mentioned above. An unscrupulous doctor might insist that the problem can be fixed by a procedure called a Trans-Urethral-Prostatectomy (TURP), and that the procedure should be done immediately.
A TURP removes part of the prostate gland through an instrument passed through the penile urethra. The instrument holds a cutting tool (knife or laser), a viewing instrument (cystoscope) with an associate light (and possibly a camera) so the surgeon can view the internal area. Excess prostate tissue is removed through the tube and discarded. Hopefully, after the man heals, his urinary stream will be much improved.
Above I mentioned the “downward roller coaster slide.” This is the point at which the unwary guy gets talked into having a TURP procedure long before he has investigated or exhausted other, more simple or natural techniques.
Will Drugs and Supplements Work to Help?
Chronic urinary retention caused by BPH can often be resolved by using prescription drugs like Flomax or using natural remedies that contain combinations of saw palmetto and pygeum. While Flomax is well-tested for relieving urinary retention, it is also known to have negative sexual side effects that include abnormal ejaculation, inability to ejaculate, decreased ejaculate and retrograde ejaculation (little or no semen expelled from the penis on orgasm).
On the other hand, herbal products are at the mercy of the manufacturer. While they may contain the right ingredients, they may not contain a therapeutic dose, may be inefficiently extracted, or may contain the wrong form of the herb. That said, a quality prostate-support product is as effective (or even more effective) than a drug like Flomax and has fewer side effects. Selecting a quality herbal product usually means consulting an expert with extensive experience and knowledge or buying from a well-known and regarded source.
Many products on the market (usually tagged with words like male support or male enhancement) contain little of the active ingredients that actually support a healthy prostate. Most of these products are geared to improve sexual stamina or libido and may have a deleterious effect on proper prostate functioning. If you are also having sexual difficulties, it is wise to give healing your prostate first priority. Improving prostate and overall health may restore poor sexual function. Stay away from products containing herbs touted to increase libido such as tongkat ali, yohimbe, Tribulus and maca unless your prostate is already healthy and you are strictly looking to improve libido and sexual performance. These herbs are valuable in that sense, and they often find their way into many over-the-counter male formulas, but they do little to enhance prostate health.
What is the Role of Hormones?
Hormone levels also play a strong role in the development of BPH and subsequent urinary retention. It is well known that excess estrogen levels can trigger prostate growth, BPH and even prostate cancer. A salivary hormone test is simply done in the privacy of your home and measures both androgen and estrogen levels. It can help your provider isolate a hormonal imbalance that can then be corrected naturally with either diet modifications or bio-identical hormones.
If All Else Fails
If all else fails, you may need to use a catheter for a while unti your prostate returns to some semblance of normal. There are generally three types of catheters.
1) An in-dwelling or Foley catheter which is typically used in a hospital or urologist’s office in response to an acute urinary blockage and connected to a collection bag.
2) A condom catheter, which is typically used for temporary incontinence and is also connected to a collection bag.
3) A simple catheter typically used while the prostate is healing after an acute incident, or used by older men that do not want to risk TURP surgery. This type of catheter is used as needed and removed after draining the bladder. It can be used several times per day, and men who have disturbed sleep because of frequent nighttime urination often self-catheterize at bedtime for a better night’s sleep.
The bottom line is that there are many ways to alleviate the urinary retention issues associated with BPH. Any man who has such issues would be wise to see a natural health professional while these issues are just mildly annoying before he finds himself in a medical emergency situation, rushing to the ER at 3 a.m. with a painfully full urinary bladder, or undergoing a surgical procedure.