Treatment for Urinary Retention in Females

Not being able to empty your bladder is uncomfortable at best and an emergency at worst. In women it is also easy to miss, because it is far less common than in men and doctors may not think of it first.

Treatment for urinary retention in females depends on two things: whether it came on suddenly or slowly, and what is causing it. Here is how each type is treated, where pelvic floor training fits, and when to get help straight away.

What Urinary Retention Is

The NIDDK defines urinary retention as being unable to empty all the urine from your bladder. It is not a disease in itself but a sign of another problem, such as a cystocele, where the bladder sags into the vagina.

There are two types:

• Acute retention comes on suddenly. You cannot pee at all, even with a full bladder. It can cause severe pain and can be life threatening.
• Chronic retention builds up over time. You can pee, but you cannot empty the bladder fully. Many people with it do not know they have it.

It is much rarer in women. The NIDDK estimates that about 3 in 100,000 women develop acute urinary retention each year, compared with roughly 1 in 10 men over 70 over five years.

Symptoms to Watch For

Acute retention is hard to miss. According to the NIDDK, symptoms include being unable to pee, often severe lower belly pain, an urgent need to go and swelling in the lower belly.

Chronic retention is subtler. Signs can include:

• Peeing often, but only small amounts
• Trouble getting the stream started
• A slow or weak stream
• Feeling like you still need to go right after you finish
• Leaking urine without warning
• Lower belly discomfort

If you often feel you cannot fully empty, our guide to what happens when you hold your pee explains why a bladder that stays too full is worth taking seriously.

What Causes It in Women

The NIDDK groups the causes into two buckets: something blocking the flow of urine, or a bladder that cannot squeeze hard enough to empty.

Blockage or narrowing can come from:

• Pelvic organ prolapse, including cystocele and rectocele
• Constipation
• Pelvic masses such as fibroids or tumors
• Tight pelvic floor muscles
• Infections, including urinary tract infections and sexually transmitted infections
• Scar tissue or narrowing in the urethra

A weak or underactive bladder can come from nerve problems such as multiple sclerosis, diabetes, stroke, spinal cord injury or vaginal birth. It can also follow pregnancy and childbirth, surgery under anesthesia, or a bladder that has been overstretched.

Medicines are a common and overlooked trigger. The NIDDK lists antihistamines and decongestants, antidepressants, opioids, antispasmodics, benzodiazepines and NSAIDs such as ibuprofen among the drugs that can cause retention.

One cause is specific to younger women. A 2021 review in the International Journal of Environmental Research and Public Health describes Fowler syndrome, in which the urethral sphincter does not relax properly. The authors note it is often underdiagnosed.

Medical Treatment Options

The NIDDK treatment guide lays out the main approaches.

Draining the Bladder

With acute retention, a health professional drains the bladder right away with a catheter. This eases the pain and helps protect the bladder and kidneys.

With chronic retention, the first step is to find and treat the cause. A catheter may still be needed if retention continues or gets worse. It can be left in place, or used intermittently, which means you insert it when needed and then remove it. If you need intermittent catheters, a nurse or doctor can teach you how.

Medicines

Many retention drugs target the prostate, so they apply to men. For women, the most relevant medicines are antibiotics for an infection that is causing the problem. If a medicine you take is behind your retention, your doctor may lower the dose or switch it.

Devices and Procedures

• Vaginal pessary. A ring placed in the vagina to support a prolapsed bladder or rectum. Cleveland Clinic lists it among the nonsurgical options for a sagging bladder.
• Urethral dilation. Gently stretching a narrowed urethra caused by scar tissue.
• Cystoscopy. A camera look inside the urethra and bladder to find and remove blockages such as stones.
• Surgery. If simpler options fail, surgery may repair prolapse or a urethral stricture, or remove a mass such as a fibroid.

Sacral Nerve Stimulation

For retention without a blockage, a small device can stimulate the sacral nerves that control the bladder. In a 2008 review in Nature Clinical Practice Urology, Kessler and Fowler noted that women with Fowler syndrome seem to respond particularly well.

The 2021 review found that sacral neuromodulation is currently the only intervention shown to restore normal voiding in Fowler syndrome. Its effectiveness exceeds 70 percent, though more than half of patients needed a revision procedure.

Where Pelvic Floor Therapy Fits

Pelvic floor muscles have to do two jobs. They tighten to hold urine in, and they have to let go fully so you can empty. When they stay tense, they can squeeze the urethra and make emptying hard.

That is why the NIDDK recommends working with a physical therapist who specializes in pelvic floor problems. The therapist works to stretch tight pelvic floor muscles and help you keep them relaxed. The NIDDK adds that Kegel exercises help the nerves and muscles you use to empty your bladder work better.

The key is balance. If your muscles are already too tight, squeezing harder is not the fix. Learning to release fully matters as much as building strength. Our guides on how to relax your pelvic floor muscles and hypertonic pelvic floor explain the difference. A specialist can test which side of the problem you are on. See our guide to pelvic floor physical therapy for what a session involves.

Bladder Habits That Help

The NIDDK suggests a few simple habits alongside medical care:

1. Timed voiding. Pee at set times so your bladder never gets too full.
2. Double voiding. After you pee, wait a short while and try again to empty what is left.
3. Take your time. Give yourself extra time on the toilet so you can relax and empty fully.
4. Sit, do not hover. The NIDDK notes that hovering over a toilet seat stops the pelvic muscles from fully relaxing and can leave urine behind. Sit down or use a full squat.
5. Stay regular. Constipation is one of the listed causes of retention, so ask your doctor about treating it if it is a problem for you.

If you sometimes struggle to get the stream started, our tips on how to make yourself pee can help in the moment.

When to Get Help

If you suddenly cannot pee at all, or you have severe belly pain, get emergency care right away. Acute retention can be life threatening.

See a doctor soon if you notice trouble starting, a weak stream, frequent small trips or leaking. Chronic retention can cause serious health problems even when the symptoms feel mild, and urine left in the bladder can raise the risk of infections. Our guide to incontinence and UTIs explains how bladder problems and infections feed each other.

The Bottom Line

Urinary retention is rare in women, which is exactly why it can be missed. Treatment starts with draining the bladder if needed and finding the cause, whether that is prolapse, a medicine, nerve damage, tight pelvic floor muscles or Fowler syndrome. From there, options range from a pessary or bladder training to pelvic floor therapy and sacral nerve stimulation. Get sudden retention treated as an emergency, and get slow, quiet symptoms checked too.