Urinary retention (bladder not emptying)Urinary retention (masana khali na hona)

Urinary retention kya hai

Aap ka masana peshab ko jama rakhta hai jab tak aap usay karne ke liye tayyar na hon. Jab aap peshab karte hain, to masanay ka muscle sikurta hai aur nikasi ka rasta dheela ho kar khul jata hai, aur peshab peshab ki nali (urethra) se bahar nikal jata hai. Mardon mein urethra prostate se guzarti hai, jo masanay ke bilkul neechay aik chhoti gilti (gland) hai.

Urinary retention ka matlab hai ke khali hone ka yeh amal theek kaam nahi karta. Ya to nikasi ka rasta band ya tang ho jata hai, ya masanay ka muscle kamzor hota hai ya us ke nerves ke signals theek kaam nahi karte, is liye peshab masanay mein reh jata hai. Is ki do aham qismein hain:

• Acute retention achanak shuru hoti hai. Aap peshab bilkul nahi kar patay, ya sirf chand qatray aatay hain, halankeh hajat shadeed hoti hai. Pait ka nichla hissa sooj jata hai aur dard karta hai. Yeh medical emergency hai.
• Chronic retention hafton ya mahinon mein aahista aahista barhti hai. Masana kabhi poori tarah khali nahi hota, lekin aksar dard kam ya bilkul nahi hota, is liye lambay arsay tak pata nahi chalta. Phir bhi bacha hua peshab infection aur pathri ka sabab ban sakta hai, aur dabao se gurdon ko aahista aahista nuqsan pohanch sakta hai.

Retention ka matlab yeh nahi ke gurday bohat kam peshab bana rahe hain. Retention mein peshab ban raha hota hai lekin masanay mein phans jata hai, is liye pait ka nichla hissa aam tor par bhara hua aur takleef wala hota hai. Agar aap kam peshab kar rahe hain aur pait normal lag raha hai, to yeh doosra masla hai, aur usi din doctor ko dikhayein.

Yeh kitna aam hai

Urinary retention auraton ke muqablay mein mardon mein kaheen zyada aam hai, aur umar ke saath is ka imkaan barhta hai, zyada tar is liye ke prostate barhne lagta hai. Acute retention mardon mein urology ki sab se aam emergencies mein se aik hai.

Auratein bhi is ka shikar ho sakti hain, lekin kam. Yeh kisi bhi umar mein operation ya anaesthetic ke baad, shadeed qabz ya beemari mein, ya kuch dawaon ki wajah se bhi ho sakta hai.

Aam alamaat

Acute retention

• Peshab na kar pana, ya sirf qatray aana, halankeh shadeed hajat ho.
• Pait ke nichlay hissay mein dard aur sooj, pubic bone ke oopar.
• Bechaini aur takleef jo masana jitni der bhara rahe utni barhti hai.

Chronic retention

• Kamzor ya sust dhaar, ya zor lagana parna.
• Yeh mehsoos hona ke masana khali nahi hua, ya thori der baad dobara jana parna.
• Thora thora peshab baar baar aana, raat ko bhi.
• Achanak boondain tapakna ya peshab nikal jana, kyunke bhara hua masana chalak jata hai.
• Pait ka nichla hissa phoola hua aur baar baar peshab ka infection.
• Kuch logon mein koi alamat nahi hoti, sirf scan ya khoon ke test se pata chalta hai.

Peshab ka nikal jana hamesha yeh nahi batata ke masana khali hai. Chronic retention mein peshab ka rissna is baat ki alamat ho sakta hai ke masana zaroorat se zyada bhara hua hai. Jin logon ke nerves ka masla ho, jaise reedh ki haddi ki chot ke baad ya bohat purani sugar (diabetes) ke saath, un mein masana bhara hone ke bawajood zyada dard nahi hota.

Aam wajuhaat

Retention ki kayi wajuhaat hain. Aksar aik se zyada cheezein mil kar kaam karti hain, maslan barha hua prostate ke saath qabz ya nazla ki koi dawa.

Koi cheez nikasi ka rasta rokti hai

• Barha hua prostate mardon mein sab se aam wajah hai. Hamari barhay hue prostate ki guide mein is ki tafseel hai.
• Peshab ki nali ka tang hona (stricture), aksar purani chot, infection ya catheter ki wajah se.
• Pathri masanay ya urethra mein, ya masanay mein khoon ka lothra (clot).
• Kam aam tor par, koi ganth (growth) prostate ya masanay mein.
• Auraton mein, prolapse, jis mein masana ya rehm neechay khisak jata hai, ya pelvis mein koi gilti, urethra par dabao daal sakti hai.

Masanay ka muscle ya us ke nerves theek kaam nahi karte

• Diabetes jis ne kayi saal mein nerves ko mutasir kiya ho.
• Reedh ki haddi ya dimagh ke masail, jaise slipped disc, reedh ki chot, stroke, Parkinson's disease ya multiple sclerosis.
• Operation ke baad, pelvis, kamar ya aanton ke, ya reedh ke anaesthetic ke baad.

Woh cheezein jo retention shuru kar sakti hain

• Qabz, jo bohat aam hai aur aksar nazar-andaz ho jata hai. Bhari hui aant masanay ki nikasi par dabao daalti hai.
• Kuch qism ki dawaein, jin mein nazla, khansi aur allergy ki kuch goliyan, masanay ki jaldi ke liye kuch dawaein, depression ya bechaini ki kuch dawaein, kuch tez dard ki dawaein aur kuch muscle dheela karne wali dawaein shamil hain.
• Infection ya soojan, jaise prostate ya peshab ka infection.
• Alcohol ka zyada istemal, ya bohat der tak peshab rokna, maslan safar ya kaam ke dauran, jis se masana had se zyada khich sakta hai.
• Beemar hona, shadeed dard mein hona, ya hil na sakna, maslan operation ke baad hospital mein.

Koi regular dawa khud se band na karein. Agar aap ko lagta hai ke koi dawa is mein shamil ho sakti hai, to apne doctor ko batayein aur unhein faisla karne dein.

Tashkhees kaise hoti hai

Doctor aap se alamaat, aap ki dawaon aur aap ke paikhane ki aadat ke baare mein poochein ge aur aap ke pait ke nichlay hissay ko chhoo kar dekhein ge. Mardon mein prostate ka muaina aam tor par pichhli sharamgah ke raaste kiya jata hai. Auraton mein pelvis ka muaina zaroori ho sakta hai. Aam tests yeh hain:

• Bladder scan, aik jaldi hone wala, bedard ultrasound jo dikhata hai ke masanay mein kitna peshab hai, ya peshab karne ke baad kitna reh gaya.
• Peshab ke tests, infection ya khoon dekhne ke liye.
• Khoon ke tests, yeh dekhne ke liye ke gurday kitna theek kaam kar rahe hain, aur infection ki alamaat ke liye.
• Gurdon aur masanay ka ultrasound, yeh dekhne ke liye ke peshab peechay ruk kar gurdon ko soojaa to nahi chuka, aur pathri dekhne ke liye.

Wajah ke mutabiq, aap ke urologist yeh bhi tajweez kar saktay hain:

• Peshab ki raftaar ka test (uroflowmetry), jis mein aap khaas machine mein peshab karte hain jo dhaar ko napti hai, aam tor par bladder scan ke saath.
• Cystoscopy, patli camera se urethra aur masanay ke andar dekhna.
• Masanay ke dabao ke tests (urodynamics), agar nerves ya muscle ke masle ka shak ho.

Kabhi kabhi PSA khoon ka test bhi zaroori hota hai, lekin retention, catheter aur infection teeno PSA ko waqti tor par barha saktay hain. Aap ke urologist us ke liye sahi waqt chunein ge.

Ilaaj ke tareeqay

Ilaaj ke do maqsad hain: masanay ko abhi mehfooz tareeqay se khali karna, aur wajah dhoond kar us ka ilaaj karna taake dobara na ho. Aham tareeqay yeh hain:

Aap ke liye sahi ilaaj ka faisla aap ke urologist karein ge. Apni dawaein khud se shuru, band ya tabdeel na karein.

Catheter ke saath zindagi

Zyada tar log catheter ki aadat ho jane ke baad achhi tarah guzara kar lete hain. Aap ki nurse ya doctor aap ko sikhayein ge ke is ka khayal kaise rakhna hai. Aam tor par:

• Bag ko masanay ki satah se neechay rakhein, aur farsh par na rakhein. Is se peshab neechay behta hai aur jaraseem waapis oopar nahi jatay.
• Haath dhoyein catheter ya bag ko chhoone se pehle aur baad.
• Bag ko bohat bharne se pehle khali kar dein. Neechay wali tap istemal karein, aur bag ko alag na karein jab tak aap ko tareeqa na sikhaya gaya ho.
• Catheter ko apni raan se bandh kar rakhein taake kheenche na, aur dekhte rahein ke nali mur ya dab na gayi ho.
• Catheter ke aas paas ki jild ko din mein aik dafa sabun aur pani se narmi se saaf karein. Aap aam tarah shower le saktay hain.
• Din bhar kaafi pani piyein, khaas tor par garmi mein, taake peshab ka rang halka rahe. Is se nizam saaf rehta hai aur rukawat aur infection ka imkaan kam hota hai.
• Qabz se bachein. Bhari hui aant catheter ko theek se behne se rok sakti hai.
• Catheter badalne ya nikalne ki tareekh yaad rakhein. Catheter ko baghair jaiza liye hamesha ke liye nahi rakha jata.

Kya aam hai

• Pehle chand dinon mein peshab mein halka khoon.
• Yeh mehsoos hona ke peshab aana hai, ya halki maroor, khaas tor par shuru mein.
• Mard ke aagay ke hissay ki nok par ya catheter ke aas paas halki takleef.

Kya aam nahi hai, aur tawajjo maangta hai

• Peshab behna band ho jaye aur pait tang ya dardnak ho jaye.
• Catheter ke aas paas se bohat peshab rissna, ya catheter ka nikal jana.
• Gaarha khoon ya clots.
• Bukhaar, kanpkanpi, ya tabiyat bohat kharab hona.

Catheter wale zyada tar log chal phir saktay hain, kaam kar saktay hain aur safar kar saktay hain. Catheter ke saath namaz aur paaki ke sawalaat ke liye apne doctor se, aur kisi mo'tabar aalim se poochein.

Follow-up

• Catheter ke baghair trial ya catheter badalne ki appointment zaroor rakhein. Sirf is liye na chhorein ke aap aaraam mehsoos kar rahe hain.
• Catheter nikalne ke baad, aam tarah pani piyein aur baqi din dekhte rahein ke peshab kaise aa raha hai. Agar peshab na aaye, ya sirf thora aur dard ke saath aaye, to usi din hospital wapas jayein.
• Prostate ya masanay ki jo dawaein di gayi hon woh jari rakhein jab tak doctor kuch aur na kahein.
• Jo tests bataye jayen woh zaroor karwayein, jaise dobara scan, peshab ki raftaar ka test ya PSA khoon ka test.
• Agar dobara ho jaye, ya kamzor dhaar, zor lagana ya rissna mehsoos ho, to wapas jayein. Baar baar hone wale retention ka muaina urologist ko karna chahiye.
• Apne hospital ke kaghazat mehfooz rakhein, jin mein yeh bhi ho ke kitna peshab nikala gaya, aur har visit par saath layein.

Aam sawalaat

What urinary retention is

Your bladder stores urine until you are ready to pass it. When you go, the bladder muscle squeezes while the outlet relaxes and opens, and the urine flows out through the urethra. In men, the urethra passes through the prostate, a small gland just below the bladder.

Urinary retention means this emptying does not work properly. Either the outlet is blocked or narrowed, or the bladder muscle is too weak or its nerve signals are not working, so urine stays behind in the bladder. There are two main types:

• Acute retention comes on suddenly. You cannot pass urine at all, or only a few drops, even though the need is strong. The lower tummy becomes swollen and painful. This is a medical emergency.
• Chronic retention builds up slowly over weeks or months. The bladder never empties fully, but there is often little or no pain, so it can go unnoticed for a long time. Even so, the leftover urine can cause infections and stones, and the pressure can slowly damage the kidneys.

Retention is not the same as the kidneys making very little urine. In retention, urine is being made but is stuck in the bladder, so the lower tummy is usually full and uncomfortable. If you are passing little urine and your tummy feels normal, that is a different problem, and you should see a doctor the same day.

How common it is

Urinary retention is much more common in men than in women, and it becomes more likely with age, mostly because the prostate tends to enlarge. Acute retention is one of the most common urological emergencies in men.

Women can get it too, but less often. It can also happen at any age after an operation or an anaesthetic, when a person is very constipated or unwell, or because of certain medicines.

Common symptoms

Acute retention

• Being unable to pass urine, or passing only drops, despite a strong urge.
• Pain and swelling in the lower tummy, above the pubic bone.
• Restlessness and discomfort that gets worse the longer the bladder stays full.

Chronic retention

• A weak or slow stream, or having to strain.
• Feeling that the bladder has not emptied, or going again soon after.
• Passing small amounts often, including at night.
• Dribbling or leaking without warning, because the over-full bladder overflows.
• A swollen lower tummy and repeated urine infections.
• No symptoms at all in some people, found only on a scan or blood test.

Leaking urine does not always mean the bladder is empty. In chronic retention, leaking can be a sign that the bladder is too full. In people with nerve problems, such as after a spinal injury or with long-standing diabetes, the bladder may be full without much pain.

Common causes

Retention has many causes. Often more than one thing is working together, for example an enlarged prostate together with constipation or a cold medicine.

Something blocks the outlet

• An enlarged prostate is the most common cause in men. Our enlarged prostate guide explains it.
• A narrowing of the urethra (stricture), often from an old injury, infection or catheter.
• A stone in the bladder or urethra, or a blood clot in the bladder.
• Less often, a growth in the prostate or bladder.
• In women, a prolapse, where the bladder or womb drops down, or a lump in the pelvis, can press on the urethra.

The bladder muscle or its nerves are not working well

• Diabetes that has affected the nerves over many years.
• Problems of the spine or brain, such as a slipped disc, spinal injury, stroke, Parkinson's disease or multiple sclerosis.
• After an operation on the pelvis, back or bowel, or after a spinal anaesthetic.

Things that can tip a person into retention

• Constipation, which is very common and easily missed. A full bowel presses on the bladder outlet.
• Certain types of medicines, including some cold, cough and allergy tablets, some medicines for bladder urgency, some for depression or anxiety, some strong painkillers and some muscle relaxants.
• Infection or inflammation, such as a prostate or urine infection.
• Heavy drinking, or holding urine for a very long time on a journey or at work, which can overstretch the bladder.
• Being unwell, in severe pain, or unable to move, for example in hospital after surgery.

Do not stop a regular medicine on your own. If you think a medicine may be involved, tell your doctor and let them decide.

How it is diagnosed

Your doctor will ask about your symptoms, your medicines and your bowels, and will feel your lower tummy. In men, the prostate is usually examined through the back passage. In women, a pelvic examination may be needed. The usual tests are:

• Bladder scan, a quick, painless ultrasound that shows how much urine is in the bladder, or how much is left behind after you pass urine.
• Urine tests, to look for infection or blood.
• Blood tests, to check how well the kidneys are working, and for signs of infection.
• Ultrasound of the kidneys and bladder, to see whether urine has backed up and swollen the kidneys, and to look for stones.

Depending on the cause, your urologist may also suggest:

• A urine flow test (uroflowmetry), where you pass urine into a special machine that measures the stream, usually combined with a bladder scan.
• Cystoscopy, a look inside the urethra and bladder with a thin camera.
• Bladder pressure tests (urodynamics), if a nerve or muscle problem is suspected.

A PSA blood test is sometimes needed, but retention, a catheter and infection can all push the PSA up temporarily. Your urologist will choose the right time to do it.

Treatment options

Treatment has two aims: to empty the bladder safely now, and to find and treat the cause so it does not happen again. The main options are:

Your urologist will decide the right treatment for you. Do not start, stop or change your medicines on your own.

Living with a catheter

Most people manage well with a catheter once they are used to it. Your nurse or doctor will show you how to look after it. In general:

• Keep the bag below the level of your bladder, and off the floor. This lets urine drain downwards and keeps germs from travelling back up.
• Wash your hands before and after touching the catheter or bag.
• Empty the bag before it becomes too full. Use the outlet tap, and avoid disconnecting the bag unless you have been shown how.
• Keep the catheter secured to your thigh so that it does not pull, and check that the tube is not kinked or squashed.
• Clean the skin around the catheter gently with soap and water once a day. You can shower as normal.
• Drink enough fluids through the day, especially in hot weather, so urine stays pale. This helps flush the system and lowers the chance of blockage and infection.
• Avoid constipation. A full bowel can stop the catheter draining well.
• Keep the date for changing or removing the catheter. A catheter is not meant to stay in forever without review.

What is usual

• A little blood-stained urine in the first few days.
• A feeling that you need to pass urine, or mild cramps, especially early on.
• Some tenderness at the tip of the penis or around the catheter.

What is not usual, and needs attention

• Urine stops draining, and your tummy becomes tight or painful.
• Urine leaking heavily around the catheter, or the catheter falling out.
• Thick blood or clots.
• Fever, shivering, or feeling very unwell.

Most people with a catheter can walk, work and travel. For questions about prayer and cleanliness while wearing a catheter, speak to your doctor, and to a religious scholar you trust.

Follow-up

• Keep your appointment for the trial without catheter, or to have the catheter changed. Do not skip it because you feel comfortable.
• After the catheter comes out, drink normally and watch how you pass urine over the rest of the day. If you cannot pass urine, or only a little with pain, go back to the hospital the same day.
• Continue any medicines you are given for the prostate or bladder unless your doctor says otherwise.
• Have the tests you are asked to have, such as a repeat scan, a flow test or a PSA blood test.
• Return if it happens again, or if you notice a weak stream, straining, or leaking. Repeated retention should be looked into by a urologist.
• Keep your hospital papers, including how much urine was drained, and bring them to every visit.

Common questions