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Dr. Andrew Rynne

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What is the cause and treatment for urinary retention?

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General & Family Physician
Practicing since : 2005
Answered : 2639 Questions
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I am a 39 yo female who has had difficulty initiating a urine stream for about three weeks. Over the past two days, it has gotten so bad that I had to get catheterized at the hospital once. Following that, I was ok for almost a day, and then it started again. I don't want to be catheterized again, so I have been squeezing it out forcefully (I'm afraid I'm going to give myself an aneurysm or something, I have to squeeze so hard).

I am on several medications, but the only changes in recent weeks was to change my antidepressant from Paxil to Cymbalta. This past week Neurontin was added, which was stopped yesterday and I started lyrica today. My doctor is trying to see which one works better for my pain so that I can get off of the narcotics. I do take OTC medications (multi-vitamins, probiotics, stool softener), as well as klonopin, Hydrocodon, and Mobic; but I've been taking them for several months.

I have severe jaw problems and will be having jaw replacement surgery. We are just waiting for the prosthetic to arrive. This has been going on since October, and the pain continues to increase, which is the reason my doctors are playing around with the medications.

Knowing all of this, does anything stand out as to the sudden cause of this condition about three weeks ago?

What can I do to initiate a urine stream without pushing so forcefully (and that just makes me void a little. I have to take a breath and push again to void more, and continue repeating this until I feel done.).

I have not yet tried a warm bath or hearing pad, but I read they may help.

How long will this condition continue? Do I need to see someone or will it resolve on its own?

I had a little pain on my right side yesterday, but it's now gone. It does not hurt to go and all urine tests were fine at the hospital - they just showed signs of slight dehydration. Of course, I am trying to drink more to resolve the dehydration. I'm usually a very big water drinker, but have stopped with not feeling well. I've been drinking chocolate milk or chocolate protein shakes and Arizona Iced Tea. I do drink an occasional cola, but not often. I even do kegels, but stopped doing them on a regular basis in XXXXXXX (I was doing them as part of my regular exercise routine. Unfortunately, I stopped everything at the end of XXXXXXX for vacation and have not restarted; though I do occasionally remember to do them.)

If you can please assist me with this, I would be greatly appreciative. I believe I provided all the relevant information, but please let me know if you have any further questions. Thank you very much.

Sincerely,
Unable to Go
Thu, 28 Aug 2014 in Urinary and Bladder Problems
 
 
Answered by Dr. Prasad 7 hours later
Brief Answer:
Perhaps it is drug induced...

Detailed Answer:
Hi,

From what you describe seems like urine retention to me. Since you are able to void some amount forcefully, it is not like complete obstruction that presents for emergency management at my hospital, so you can wait and watch to consult an urologist.

As you continue to wait for urologist appointment, there are couple of things I will want you to do:
1. Most common cause of urine outflow obstruction is an infection. With negative urine test, it seems to be ruled out. But if you have other symptoms such as burning or vaginal discharge, this condition needs to be reconsidered.
2. Some class of antidepressants especially cymbalta is listed to cause urine retention. These antidepressants affect autonomic functions of the bladder sphincter leading to retention. You can call your treating doctor and get them changed.
Lyrica barely causes retention. We can keep this.
3. Besides antidepressants and lyrica, I am not sure what other pain medicines you are on. Other drugs including opioids are listed to cause difficulty in passing urine.
4. Finally we also need an ultrasound scan / uroflometry / endoscopic procedures to rule out other causes of retention. These are however procedures that are ordered by urologist.

In short words, the current action plans that I suggest are:
1. Call your doctors and discuss if your medicines are causing it. I strongly believe they do. Drug changes is warranted.
2. Watch out for fresh symptoms of infection. Get the tests repeated whenever needed.
3. Talk to your GP if he/she can expedite urology consultation.
4. Continue warm compresses.

Hope this helps. Let me know if you need clarifications.

Regards
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