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Acute urinary retention

  1. Acute urinary retention is defined as an accumulation of urine in the bladder due to an inability to empty the bladder.

    Causes.
    - Any process that causes increased bladder-outlet resistance or decreases bladder contractility
    - Benign prostatic hyperplasia
    - Side effects of drugs
    - Fecal impaction
    - Prostatic cancer
    - Acute prostatitis
    - Neurogenic bladder
    - Urethral stricture or stone
    - Impingement on sacral nerves by protruding intervertebral disk
    - Spinal cord injury

    History.
    - Strong urge to void but inability to do so
    - Suprapubic fullness and pain
    - Voiding habits before retention (hesitancy, dribbling, daytime frequency, nocturia)
    - Bowel habits, last bowel movement and its consistency
    - Drugs (alcohol, sedatives, decongestants in over-the-counter cold remedies, anticholinergics, antipsychotics and antidepressants).

    Physical findings
    - Pulse may be elevated
    - Client may appear in moderate-to-acute distress (but there may be no evidence of distress with a neurogenic bladder)
    - Client may be restless and sweaty
    - Bladder distension may be noted on abdominal inspection
    - Tender, distended bladder may be felt above symphysis, often reaching umbilicus (neurogenic bladder is distended but nontender)
    - Rectal examination: fecal impaction, enlargement of prostate, nodular or rocky hard prostate, decreased anal tone or absent perineal sensation may be present

    Reference: Clinical Practice Guidelines for Nurses in Primary Care. Urinary System. Internet. Accessed August 31, 2009. Available at http://www.hc-sc.gc.ca/fniah-spnia/pubs/services/_nursing-infirm/2000_clin-guide/chap_06b-eng.php#_6-14


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