Picture this: it’s a cold winter morning and you’ve stumbled into the bathroom, desperate to relieve yourself. Everything seems ready to go, but then… nothing happens. You feel the urge, your bladder feels full, yet the urine simply won’t come out.

Most of us have experienced holding our urine at some point - that uncomfortable sensation when your bladder is painfully full and feels like it might burst. But there’s a different problem that’s far more frustrating: wanting to pee but physically being unable to do so.

If you’ve experienced any of these scenarios, pay attention:

You feel a strong urge to urinate, but only manage a few drops when you try
Your brain receives the signal that you need to go, but nothing comes out no matter how long you wait
You make multiple trips to the toilet, each time managing only a tiny amount
Even after urinating, you still feel like your bladder isn’t empty

When this happens repeatedly, you may be dealing with urinary retention - a condition where urine gets “stuck” and cannot be properly expelled from the bladder.

What Exactly is Urinary Retention?

Urine is essentially filtered waste from your blood. After your kidneys process it, the urine travels to your bladder where it’s stored until you’re ready to empty it through the urethra. Urinary retention occurs when this final step fails - the urine accumulates in the bladder but cannot be discharged normally.

According to the NHS, urinary retention can affect anyone but becomes increasingly common with age, particularly in men over 50 1.

There are two main types:

Acute Urinary Retention

This is a medical emergency. Your bladder suddenly becomes unable to empty despite being completely full, causing severe distension and pain. Acute retention is roughly 13 times more common in men than women, and the risk increases significantly with age. If this happens to you, seek immediate medical attention - this is not something to wait out.

Chronic Urinary Retention

Unlike the acute form, chronic urinary retention develops gradually. Your bladder function slowly deteriorates over time, leaving progressively larger amounts of residual urine after each trip to the toilet. Many people don’t realise they have this condition until it’s quite advanced because the symptoms creep up slowly.

Recognising the Symptoms

Acute Urinary Retention Symptoms

The signs are hard to miss:

Complete inability to urinate despite a full bladder
Severe pain or discomfort in your lower abdomen
Visible swelling or distension of the lower belly
An urgent, overwhelming need to urinate with no relief

Chronic Urinary Retention Symptoms

These are trickier to spot because they develop gradually:

Difficulty starting urination (hesitancy)
A weak or interrupted urine stream
Feeling that your bladder isn’t completely empty after urinating
Needing to urinate frequently but producing less each time
Mild but persistent discomfort in the lower abdomen
Urinary incontinence or unexpected leakage
Waking multiple times at night to urinate (nocturia)

How Doctors Diagnose Urinary Retention

If you’re experiencing these symptoms, your doctor has several diagnostic tools available:

Bladder ultrasound scan: A non-invasive test that measures how much urine remains in your bladder after you’ve tried to empty it (called post-void residual volume). It can also detect stones or abnormal growths.

Cystoscopy: When imaging alone isn’t conclusive, doctors may use a thin tube with a tiny camera to look directly inside your bladder and urethra. It sounds uncomfortable, but it provides valuable information about blockages or structural problems.

Urodynamic testing: This involves placing small catheters to measure the pressures inside your bladder during filling and emptying. It helps doctors understand the dynamic relationship between your bladder muscle and your sphincter.

Electromyography (EMG): Sensors measure the electrical activity of your bladder muscles and the nerves controlling them. This helps identify neurological causes of retention.

What Causes Urinary Retention?

The causes vary between men and women, but several conditions can affect either sex.

In Men

Benign prostatic hyperplasia (BPH): This is the most common cause in older men. As the prostate gland enlarges with age, it can squeeze the urethra shut or press against the bladder neck. A study published in European Urology found that BPH-related acute urinary retention affects approximately 2.2 per 1,000 person-years in men over 40, increasing substantially with age 2. Symptoms often include slow urine flow, straining to urinate, a weak stream, and dribbling at the end. Learn more about benign prostatic hyperplasia.

Prostatitis: Inflammation of the prostate (whether from infection or other causes) leads to swelling that can compress the urethra. This often comes with pain during urination, pelvic discomfort, and sometimes fever if infection is present.

In Both Men and Women

Urinary tract stones: Stones can form in the kidneys, ureters, or bladder. If a stone lodges in the urethra or blocks the bladder outlet, it physically prevents urine from passing. Besides retention, stones typically cause significant pain and sometimes blood in the urine. See our article on kidney stones for more information.

Diabetes: Between 25% and 87% of diabetic patients eventually develop some form of bladder dysfunction, according to research in the journal Diabetes Care 3. High blood sugar damages the nerves that control bladder contraction (a condition called diabetic cystopathy), leading to weak bladder contractions and incomplete emptying.

Neurological conditions: Any disease affecting the nerves between your brain and bladder can cause retention. This includes multiple sclerosis, Parkinson’s disease, stroke, and spinal cord injuries. See our page on neurogenic bladder for details.

Medications: Certain drugs can interfere with bladder function, including antihistamines, decongestants, some antidepressants, opioid pain medications, and drugs used for Parkinson’s disease.

Psychological factors: Some people experience difficulty urinating when they feel anxious or observed (a condition called paruresis or “shy bladder”). In stressful situations, the bladder muscle may contract weakly while the urethral sphincter tightens, making urination difficult or impossible.

Post-surgical retention: Urinary retention is a common complication after surgery, particularly procedures involving the pelvis, spine, or when general or spinal anaesthesia is used. It usually resolves within a few days but sometimes requires temporary catheterisation.

Why You Shouldn’t Ignore Urinary Retention

Left untreated, urinary retention sets up a destructive cycle. The residual urine constantly triggers your bladder’s stretch receptors, signalling the need to urinate. But when you try, your weakened bladder muscle can’t generate enough force to empty properly. This leads to further muscle fatigue and even more residual urine - a vicious circle that progressively worsens.

The consequences can be serious:

Urinary tract infections: Stagnant urine is a perfect breeding ground for bacteria. Once your residual volume exceeds about 50ml, infection risk increases substantially. Repeated UTIs can become a chronic problem.
Bladder damage: Chronic overdistension can permanently weaken the bladder wall, reducing its ability to contract effectively.
Kidney damage: If pressure builds up enough, urine can back up into the ureters and kidneys (hydronephrosis), potentially causing irreversible kidney damage or even kidney failure if severe.
Physical discomfort: A constantly heavy bladder often causes lower back pain and general pelvic discomfort.

Treatment Options

Treatment depends on whether you’re dealing with acute or chronic retention, and what’s causing it.

Immediate Relief

Catheterisation: For acute retention, the immediate priority is draining the bladder. This is done by inserting a thin, flexible tube (catheter) through the urethra into the bladder. Sometimes a suprapubic catheter (inserted through the lower abdomen) is used instead. Relief is usually immediate and dramatic.

Medications

Urinary smooth muscle agents: Bethanechol chloride stimulates the parasympathetic nervous system, increasing bladder muscle tone and promoting more effective contractions.

Alpha-blockers: These drugs (like tamsulosin or alfuzosin) relax the smooth muscle in the prostate and bladder neck, making it easier for urine to flow. They’re particularly effective for BPH-related retention. Research shows that using alpha-blockers before attempting catheter removal significantly improves the chances of successful voiding 2.

5-alpha reductase inhibitors: For men with BPH, medications like finasteride or dutasteride can shrink the prostate over time, though they take several months to show full effect.

Antibiotics: When infection is contributing to retention, targeted antibiotic therapy addresses the underlying cause.

Self-Catheterisation

For people with chronic retention, learning to catheterise yourself can be genuinely life-changing. Clean intermittent self-catheterisation (CISC) allows you to empty your bladder completely several times daily without needing to carry a urine bag. Done properly, it actually reduces UTI risk compared to leaving a permanent catheter in place.

Surgery

When conservative measures fail, surgical options include:

Prostate surgery (TURP or similar procedures) for BPH
Stone removal procedures
Urethral stricture repair
In severe cases, long-term suprapubic catheter placement

Prevention Strategies

For Women

Prevention centres largely on avoiding cystitis and maintaining pelvic floor health:

Keep the perineal area clean, particularly during menstruation and around sexual activity
Urinate shortly after intercourse to flush out any bacteria
For post-menopausal women, topical oestrogen creams can help maintain healthy vaginal tissue and reduce infection risk
Pelvic floor exercises (Kegels): Strengthening these muscles supports bladder function and helps prevent both retention and incontinence. To perform: squeeze the muscles you’d use to stop urinating mid-stream, hold for a few seconds, then relax. Repeat 10-15 times, several times daily.

For Men

Prostate health is key:

Stay well hydrated - concentrated urine irritates the prostate and bladder
Don’t delay when you feel the urge to urinate - habitual holding weakens the bladder
Maintain regular sexual activity, which helps keep the prostate healthy
Limit alcohol and caffeine, which can irritate the bladder
Get regular prostate check-ups, especially after age 50

For Everyone

Bladder training: Drink water regularly throughout the day (about 200ml per hour) and gradually extend the time between toilet visits. This can help improve bladder capacity and control.
Stay active: Regular exercise promotes good circulation, including to your urinary system.
Strengthen your pelvic floor: Both men and women benefit from pelvic floor exercises.
Manage stress: Chronic tension can affect bladder function. Find healthy ways to relax.
Avoid bladder irritants: Reduce intake of alcohol, caffeine, artificial sweeteners, and spicy foods.
Don’t strain: If you have difficulty urinating, don’t push hard - this can worsen the problem over time.

When to See a Doctor

Don’t wait if you experience:

Sudden inability to urinate (this is an emergency)
Persistent difficulty starting or maintaining urination
Feeling that your bladder never fully empties
Frequent urinary tract infections
Any blood in your urine

The sensation of incomplete bladder emptying is one of the most common signals of urological problems. If you’re experiencing these symptoms regularly, visiting a urologist for proper investigation is the sensible next step. Early diagnosis means simpler treatment and better outcomes.

References

NHS. Urinary retention. https://www.nhs.uk/conditions/urinary-retention/
Fitzpatrick JM, Desgrandchamps F, Adjali K, et al. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2012;109(1):88-95. https://pubmed.ncbi.nlm.nih.gov/18350762/
Kirby MG, Wagg A, Cardozo L, et al. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. BJU Int. 2011;108(10):1540-1551. https://pubmed.ncbi.nlm.nih.gov/22117624/