Can't Pee? What Causes Urinary Retention & How to Fix It

You don’t know what you’ve got ‘til it’s gone –– including the ability to pee. 

One day, I found myself on the toilet, feeling like I had to pee, but nothing would come out. Panic ensued. What is wrong with me? Why can't I pee?! 

This was a problem I never had before. Nothing had changed with my health except for one thing: I’d recently started a new medication. I Googled the drug’s side effects, and there it was: urinary retention. 

As the days went by, the problem continued. Peeing took way more time and effort than it should. It took a while to start peeing, and then I felt like I had to push to get it all out. Otherwise, it would slowly dribble out for what felt like an eternity. 

If you’re struggling with this same problem, just know you’re not alone! Here’s what you need to know about urinary retention, its causes, treatment, and more. 

What Is Urinary Retention?  

Put most simply, urinary retention means it’s hard to pee. “Urinary retention is when you can’t empty your bladder when you’re trying to,” says pelvic floor physical therapist Dr. Ashley Rawlins, PT, DPT. 

Urinary retention falls into two main categories: acute and chronic. 

Acute Urinary Retention 

Acute urinary retention refers to trouble urinating that happens suddenly, and it’s very obvious, Dr. Rawlins says. If you can’t pee at all out of nowhere, this is potentially a medical emergency.

Other acute urinary retention symptoms are:

• Feeling a strong need to urinate, but you can’t
• Pain or discomfort in your lower abdomen and lower back
• Bloating 
• Low back pain

Chronic Urinary Retention 

Chronic urinary retention develops over time. Since it comes on gradually, it might not be something you’re even aware of at first, Dr. Rawlins says. Some chronic urinary retention symptoms that may build up slowly include:

• Trouble starting your urine flow 
• Having a slow or weak stream — or one that starts and stops 
• Frequently feeling the urge to pee (more than once every 2 hours)
• Having a strong urge to pee but only a little comes out
• Feeling like you have to pee right after you just went
• Feeling like your bladder is not fully empty
• Bladder leakage (urinary incontinence)
• Peeing multiple times (more than once) throughout the night (nocturia)

What Causes Urinary Retention for Women?

Urinary retention can have many different causes, and it’s important to determine the underlying factors so that you can get treatment and avoid complications. Here are some common causes of urinary retention for those assigned female at birth.

Some common causes of urinary retention in females include:

Urinary Retention with a UTI

A UTI or urinary tract infection is one of the most common causes of acute urinary retention, Dr. Rawlins says. UTIs happen when bacteria get into your urinary tract, causing infection. These infections may cause swelling in your urethra (the tube that allows pee to move from your bladder out of your body), making it hard to pee. 

Urinary Retention as a Medication Side Effect

Certain medications can result in difficulty urinating. Common culprits include:

• Tricyclic antidepressants
• Antipsychotics
• Anticholinergics
• Muscle relaxants

Post Surgery Urinary Retention 

Can’t pee after surgery? If you were under anesthesia for surgery, this may temporarily cause urinary retention, Dr. Rawlins says. A number of factors could be to blame, including: 

• Post-anesthesia effects
• Medication side-effects
• Direct irritation to your bladder or urethra from surgery (like can occur during abdominal or pelvic surgery)
• Side effects from catheter use

Postpartum Urinary Retention

There are a couple of different ways that childbirth can impact your bladder function and potentially lead to urinary retention: 

• Catheter-related trauma: Catheters used during epidurals or cesarean births can cause swelling and irritation that can take some time to resolve after removing it, making peeing tricky in the meantime, said Dr. Rawlins. 
• Anesthesia effects: It can take a while for your anesthesia to fully wear off. The lingering effects of an epidural or other anesthesia can temporarily impact your bladder and your ability to pee.
• Cesarean birth complications: Thank goodness for cesarean births! But the surgical process can impact nearby nerves, muscles, and even the bladder itself, temporarily disrupting your bladder control after surgery.
• Vaginal birth trauma: The physical stress of a vaginal delivery can also impact your ability to pee after birth. As the baby moves down the birth canal it can cause bruising to your bladder and/or urethra, and injure the muscles and nerves of the pelvic floor.

While these things can contribute to postpartum urinary retention, in most cases it will resolve as your body heals.

Urinary Retention Related to Neurological conditions

Peeing isn’t just about your bladder. The process also includes your brain and spinal cord communicating with your bladder, according to Dr. Rawlins. Different medication conditions can disrupt this process including:

• Multiple sclerosis (MS)
• Parkinson’s disease
• Spinal cord injury
• Cauda Equina (acutely this is a medical emergency)
• Diabetes

Urinary Retention Due to Urethra Abnormalities

A blockage or other structural abnormality in your urethra could cause trouble peeing. This could be related to scar tissue in the urethra, blood clots, or kidney stones, for example.

Urinary Retention with Pelvic Organ Prolapse

When you have pelvic organ prolapse, your pelvic floor muscles are damaged or too weak to support your organs. If you have a prolapsed bladder or prolapsed urethra, this can make it more difficult to empty your bladder, especially if the change in organ position disrupts the path of urine flow, says Dr. Rawlins. 

Urinary Retention Caused by Pelvic Floor Dysfunction

“One of the lesser known, sneaky causes of urinary retention is pelvic floor dysfunction,” Dr. Rawlins says. This is when your pelvic floor muscles are not working properly. “When we develop urinary retention, more often than not, it’s related to pelvic floor muscle overactivity and tightness, so those pelvic floor muscles are having a hard time relaxing all of the way.” 

In some cases, it’s also possible for weak pelvic floor muscles to result in trouble urinating — like when they are contributing to pelvic organ prolapse for example.

How is Urinary Retention Diagnosed?

If you go to your doctor and tell them you’re having trouble urinating, they’ll likely conduct tests to determine the cause. Some of these tests include:

• Urinalysis: A urinalysis analyzes a sample of your urine. Dr. Rawlins says this is a simple way for your provider to determine if there’s blood or bacteria in your pee, that could indicate a UTI.
• Uroflowmetry: Uroflowmetry is a test where you pee into a device that measures the volume of your urine, how quickly it was released, and how long it took in total. This helps assess bladder function. 
• Bladder scan: A bladder scan uses an ultrasound device to view your bladder and determine how much urine is in your bladder before or after you pee (post-void residual),  Dr. Rawlins says.
• Cystoscopy: A cystoscopy is a more invasive test involving inserting a camera tool through your urethra and into your bladder. This allows your doctor to see your bladder clearly and check for abnormalities or blockages.
• Pelvic floor muscle assessment: To assess the pelvic floor muscles, a provider will conduct an internal and external pelvic floor muscle exam. Dr. Rawlins says your provider might ask you to contract and relax your muscles so they can see what the muscles are doing in real-time, assessing if they’re too tight or too weak.
• MRI: If your doctor suspects a neurological issue could be causing your urine retention, they may order an MRI of your brain. “An MRI can check for things that are obstructing or affecting your urinary system in some way, like lesions in your central nervous system or spinal cord, or masses that could impact your bladder function,” says Dr. Rawlins. An MRI can also check for other neurological issues. 

Your doctor may order a combination of these tests to get the most comprehensive view of your health and determine the cause of your symptoms.  

What Is the Treatment for Urinary Retention?

Since the causes of urinary retention vary, the course of treatment depends on the specific cause. 

Urinary retention treatment options include:

• Pelvic floor physical therapy: If pelvic floor dysfunction is to blame, or if you’ve developed pelvic floor dysfunction related to other causes, pelvic floor PT can help. A pelvic floor physical therapist will teach you relaxation techniques, stretches, and other exercises to improve muscle function, and your ability to get the pee out. They may also provide you with pelvic floor massage. 
• Catheterization: If you have acute urinary retention and you can’t pee at all, you might need a catheter to drain your bladder, which will bring you sweet relief! Depending on your circumstances, this may be a one-and-done situation, or you may need to use a catheter until the condition improves.
• Antibiotics: If your urinary retention is caused by an infection, such as a UTI, antibiotics will help to clear this up, Dr. Rawlins says. 
• Adjustments to medications: If a medication is the culprit, your prescribing doctor may adjust the dose of the medication or switch you to a different medication that doesn’t have the side effect of urinary retention. (Never stop or change your dose of a prescription without direct instructions from your doctor).
• Pessaries: A pessary is a device you can insert into your vaginal to help with pelvic organ prolapse. It will help support the prolapsed organ and improve your symptoms. These are magic!
• Surgical procedures: Depending on the specific cause of urinary retention, surgical procedures can help. Surgery can help fix any abnormalities or blockages that are contributing to your symptoms. 

What Not to Do if You Have Urinary Retention

First things first: if you feel like have to pee but can't get urine flowing, you should NOT push to pee! “Pushing is not a normal function of how we pee,” Dr. Rawlins says. “You shouldn't have to push to pee. That often is a bad habit that we develop because of things like hovering to pee, or rushing because your toddler suddenly got really quiet.” Over time, pushing to pee will mess with your pelvic floor muscles, especially if you do it often and long-term. Pushing can actually cause your pelvic floor muscles to contract when what you really want is to relax your pelvic floor muscles when you urinate. Instead of thinking about how to pee faster, focus on relaxing. 

Second: “It is totally normal to have some amount of urine in your bladder after you pee,” says Dr. Rawlins. Generally, it’s normal to have up to 100 milliliters of post-void residual. “A lot of times, people will kind of stress that if they push, they can get a little bit more out, so emotionally, it feels like they haven't fully emptied their bladder,” she adds. However, it’s okay to have a little bit of urine in your bladder after you pee, as long as it’s not lining up with other bladder symptoms that could indicate a bladder issue. 

Get Back to Peeing Normally with Pelvic Floor Physical Therapy

Dealing with urinary retention is super frustrating. Feeling like you can’t pee can range from annoying to scary. If you think that pelvic floor dysfunction is playing a role in your urinary retention struggles, Origin can help provide treatment to get your pelvic floor muscles in tip-top shape. 

Origin’s compassionate pelvic floor physical therapists can evaluate you for a tight or weak pelvic floor, and then come up with a treatment plan to improve your symptoms so you can pee normally again –– because peeing shouldn’t have to be hard!