Urinary retention - what to do?

[RealLifeClanger]

I've been struggling with bladder emptying for a while on and off. Usually it seems to be a phase, made worse by constipation or something but this time it's being more stubborn and I'm getting worried. I am still weeing fairly regularly but there is very little urge and I have trouble starting to wee. The stream is also weak, slow and stop/starts. Definitely not emptying as much as it should. It always seems to get worse as the day goes on then in the morning it improves somewhat but still not totally normal. I keep finding I need to lie down with a heat pack over my bladder to get things moving. I'm not sure if I have a prolapse or not but I do know I have a weak and overtight pelvic floor. What can I do to fix this quickly? I will make a gp appointment but at what point would I need to seek urgent care? Not weeing at all?

Might be worth giving 111 a call for advice

Might be worth giving 111 a call for advice

I have a cyctocele (and rectocele...thanks kids!) and often have a problem. Mine's the other way round... I struggle to wee in the mornings or when my bladder is full..weak stream and slow start and stops. I usually can only get a little out and then have to walk around for a bit before trying again.
On the three occasions I've had a general anaesthetic I'm completely unable to wee for many many hours (and have had to be catheterised).

Not gone into complete retention yet but I suspect I will eventually. It's crap, and in my case defo related to my bladder cytocele and yes constipation always makes it worse.

I'd say defo go to the GP...they can refer you for dynamic studies where they can check your wee flow (it's done very sensitively and is not half as embarrassing as you might imagine!)

@Sonolanona has given good advice.
See your GP for referral for urodynamics but if you can’t empty , then you need seek medical advice from urgent care or Emergency for catheterisation.
Retention of urine can increase your risk of UTI’s and possible kidney issues

Ask for referral (or our GP allows self referral) to your local hospital continence clinic.

Would second the suggestion to ask to be referred to the continence service. They are very good at listening and diagnosing, though treatment options are somewhat limited if you have good control of your pelvic floor. I have minor prolapses of most things after three vaginal births and I find that I can often wee better if I stand up and lean forward, like when you "hover" over a toilet you would rather not sit on (and as we are all told never to do!).

I've had one episode of "proper" urinary retention a few years ago when I was in unbearable pain and literally unable to wee. I also passed some blood, from my bladder I think, which was strange. They did a CT at A&E but whatever had caused it was no longer there. I suspect a stone or potentially an ovarian cyst that had ruptured. Still no idea.

Currently awaiting cystoscopy for persistent invisible haematuria, which showed up in tests for persistent uti symptoms that come and go. Hoping that's just menopause related but would be interesting if it was bladder stones. And obviously in my case there's the possibility of malignancy. But I suspect your issue is something benign that they can help you with.

I hope you get some answers soon.

Thanks for the advice everyone. Bit of an update, the gp saw blood on the dip when I went in so sent me away with nitrofurantoin and sent the sample to the lab. This came back clear and I had a terrible reaction to the nitro so stopped it after just 12hrs. Bizarrely the one day of nitro seems to have helped the flow but I've had another sample sent off to lab that still shows blood but no infection so they've referred me to urology.

However, I'm terrified of having a cystoscopy as both times I've been catheterised after my c sections I've ended up with a urine infection, one of which was resistant to most antibiotics (ESBL infection) and required IV gentamicin and a hospital admission :(

The lab didn't culture my sample both times though, the results said 'no evidence of infection on microscopy' so I'm suspicious that they've actually missed something. Going back to the gp on Monday and will discuss as my last confirmed infection was in October and was an unusual bacteria. Given my complex history of uti's and unusual bacteria I want them to take this seriously and just culture the damn wee!

@JeanieK you sound similar to me apart from I've had 2 c-sections and I'm wondering if the scars are adhered to my bladder or something. I have an over tight pelvic floor as well, which is causing issues but do often get sensations of heaviness and pressure which makes me wonder if there's some sort of prolapse somewhere.

Hi @RealLifeClanger I'm so sorry for the delay in answering. I wonder if it could be related to that, though I had vaginal births so I don't have any experience with c-sections.

How did you get on with the GP?

One thing, when you mention catheters, as far as I'm aware you don't need to have a catheter when it's an outpatient cystoscopy as it will probably be a flexible one. It's meant to take about 10 minutes and then you go home. It's only the "rigid" 🙀one where they might use a catheter, I think. So while I understand fully your concern about infection, I think this is less likely with no catheter required. The thought of IV antibiotics scares me too as I had a horrible infection once from antibiotics so try to avoid them at all costs.

Interesting what you say about the lab results. Having scrutinised a bunch of these late last year, I suspect what it means is that they didn't find white cells in the sample (sometimes called pyuria) and so there was no need to culture it. Don't worry about that, the lab would have done so if there was any sign of infection.
My first lab report showed a high level of pyuria (possibly contamination when I did the sample, can be caused by vaginal discharge etc) but the only bacteria they managed to culture was a weird one that rarely causes infection, and was resistant to almost every antibiotic, I was given cipro but it didn't agree with me so I stopped it after two doses. The following two or three samples showed no white cells so I think it was contamination.

The only reason I've been referred for cystoscopy is that they still showed red cells, ie non-visible blood, so that has to be investigated but I'm hoping it's caused by low estrogen making everything sore down there. I'm in late perimenopause so that's a factor.

I really hope you get some answers soon. I will be thinking of you. I've been referred on the two-week pathway as I'm over 45, though I think the GP got muddled up as the NICE guidelines say that's for visible haematuria. So I'm accidentally jumping the queue 😇 but it's still a bit scary.

Oh just realised you are seeing GP tomorrow... sorry have lost track of time! Let us know how you get on.

@JeanieK thank you, I've got a huge list of things to talk with the gp about tomorrow!

With the catheter thing, I'm worried about anything going up there now as it seems to be quite common to get an infection after cystoscopy as well. A previous doctor said because the bacteria live on your skin, things like catheter / cystoscopy can cause them to be introduced to the bladder, causing infection. It's something I'm going to chat to the urologist about because of my quite complex history, I don't want to take any chances. I'm hoping they'll be able to do something else non invasive like a scan or something.

Interesting you mention low oestrogen as I'm on the mini pill and have had a lot of dryness everywhere since going on it. Might have to change to a coil like my gynae suggested 😬

Good luck! They did a scan first with me but I hadn't managed to drink enough so they couldn't. Definitely worth asking in your case. I understand about the catheter/camera risk, of course. Slightly scared myself now you mention that! I hope GP listens 🙏

Yeah I'm due an ultrasound scan at the end of the month but that's at gp request rather than urology.

Sorry to have scared you about the camera, hopefully you don't have the same issues as me so you'll be ok. I can't take several of the usual antibiotics anymore because I've become allergic or have adverse reactions to loads of them!