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What causes difficulty urinating?

Oct 31, 2021 Source: Cainiu Health
Dr. Li Mingchuan
Introduction
1. Organic lesions: Mechanical obstruction of the urethra or bladder outlet caused by various organic pathologies, such as urethral inflammation. 2. Dynamic obstruction: Obstruction resulting from impaired voiding dynamics; common causes include central and peripheral nervous system disorders. 3. Prostatic diseases: Such as benign prostatic hyperplasia, acute prostatitis, prostatic abscess, and prostatic tumors.

Inability to urinate—commonly referred to as urinary retention—describes a condition in which a patient’s bladder contains a large volume of urine but the patient is unable to void spontaneously. This often necessitates catheterization or suprapubic cystostomy (i.e., needle puncture into the bladder through the lower abdominal wall) to drain the urine. Urinary retention is generally classified as either acute or chronic. So, what causes inability to urinate? The following section addresses this question.

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Causes of Inability to Urinate

1. Organic (Structural) Disorders

Mechanical obstruction of the urethra or bladder outlet resulting from various organic pathologies includes urethral conditions such as inflammation, foreign bodies, calculi (stones), tumors, trauma, strictures, and congenital urethral anomalies. Bladder neck obstruction may arise from bladder neck contracture or fibrosis, bladder neck tumors, acute prostatitis or prostatic abscess, benign prostatic hyperplasia (BPH), or prostate cancer. Additionally, pelvic tumors and uterine enlargement during pregnancy may also cause urinary retention.

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2. Dynamic (Functional) Obstruction

Dynamic obstruction results from impaired detrusor contractility or sphincter dysfunction. Common underlying causes involve central or peripheral nervous system disorders—for example, spinal cord or cauda equina injury or tumor, pelvic surgery damaging nerves innervating the bladder, or diabetes mellitus—leading to neurogenic bladder dysfunction. Certain medications—including anticholinergics such as atropine, propantheline, and scopolamine—that relax smooth muscle may occasionally precipitate urinary retention. Therefore, vigilance regarding medication use is advisable.

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3. Prostate-Related Disorders

Conditions such as benign prostatic hyperplasia (BPH), acute prostatitis, prostatic abscess, and prostate cancer—as well as pelvic fracture, rectal tumors, cervical cancer, uterine leiomyoma (fibroids), phimosis, paraphimosis, priapism, urethritis, urethral tumors, urethral calculi, bladder stones, spinal cord injury, multiple sclerosis, epidural abscess, epidural hematoma, central disc herniation, diabetes mellitus, herpes simplex infection, and hypokalemia—can all contribute to urinary retention.

The above outlines the potential causes of urinary retention. We hope this information is helpful to you.

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