Understanding Urinary Retention in Pregnancy

pregnant woman that needs to pee

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For many women, making lots of trips to the bathroom is one of the first signs of pregnancy. In fact, during pregnancy, your urinary system undergoes some major changes. For instance, the pregnancy hormones coursing through your system stimulate your kidneys to expand and produce more urine, which helps your body get rid of extra waste more quickly.

Meanwhile, your expanding uterus also presses on your bladder—even when your baby is tiny. This should not surprise you though. After all, your uterus begins as the size of a fist but grows to accommodate a 7 to 10-pound baby. Then as your baby grows, the baby's weight also may press on your bladder making you have to go to the bathroom much more often. But what happens when you cannot pee? Is urinary retention cause for alarm?

What Is Urinary Retention?

Urinary retention, or bladder retention, means that you are not able to completely empty your bladder. In more severe cases, you may not be able to urinate even when you want to. When you go to the bathroom or urinate, this is a complex process involving coordination between the brain, the body's nerves, and your spinal cord.

Sometimes something gets in the way of this process and you are not able to go to the bathroom like you normally would. For instance, an obstruction in the urinary tract or nerve problems can lead to urinary retention.

There are two forms of urinary retention—acute and chronic. Acute urinary retention happens suddenly and can become life-threatening. In this situation, you feel like you need to urinate badly, but you cannot go at all. This condition causes a lot of pain and discomfort in your lower abdomen. If you experience acute urinary retention, you need to get emergency medical care right away to release the build-up of urine.

With chronic urinary retention, the inability to release all the urine in your body occurs over a period of time. You may not even realize this is happening because there are no symptoms at first. You should talk to your doctor if your urine stream is weak or starts and stops; you feel like you have to go again even though you are finished; you experience discomfort, and you cannot tell when your bladder is full.

Causes of Urinary Retention

In simple terms, urinary retention is caused when something interferes with the signals between the brain and the bladder.

If there is a communication error due to nerve problems, certain medications, or a blockage, the bladder can end up retaining urine.

It gets more complicated if your bladder tries to release the urine it contains, but can't due to weak muscles or a blockage. If all the parts of the urinary system are not working together, urine will not be released.

Sometimes urinary retention is caused by an infection or a blockage of the urethra. In some cases, the urethra can become blocked by a blood clot or a bladder stone. And, in very rare cases, urinary retention may be caused by an impacted uterus. Typically, this happens in the first trimester. If you experience an impacted uterus, this is a medical emergency.

When the uterus is impacted, it is trapped inside the pelvic ring. This means that the uterus is not able to ascend into the abdominal cavity like it is supposed to.

Additionally, when the uterus is trapped, it may not be able to enlarge like it is supposed to either. Women with a history of pelvic inflammatory disease or large fibroids are at a greater risk of developing acute urinary retention. What's more, an impacted uterus can lead to miscarriage if it is not addressed immediately.

Treatments of Urinary Retention in Pregnancy

When you are unable to pee, your doctor will need to perform a thorough examination to determine the exact cause of the urinary retention. If you are experiencing acute urinary retention, this is a medical emergency. You need to see a doctor right away. Here is an overview of some of the treatment options.

Using Catheters

For immediate and short-term relief, catheters are often used to empty the bladder. During this procedure, the catheter is inserted into the urethra, which allows the urine to drain out. In addition to alleviating pain, this initial treatment also prevents permanent bladder damage. What's more, emptying your bladder will make you feel better right away and help prevent complications.

Suggesting Double Voiding

Sometimes bladder retraining and pelvic muscle exercises are needed to help the nerves and muscles in your urinary system work better. As a result, doctors sometimes recommend waiting a short time after your first urination to try and go again. They also may recommend that you do kegel exercises to strengthen your pelvic floor muscles.

Addressing Medications

Some prescription medications can help with bladder retention. Depending on your symptoms, your doctor might give you a prescription to help manage your condition. Meanwhile, there are a number of medications that can cause urinary retention as a side effect. Consequently, your doctor may need to adjust your current medications or end them altogether if you experience bladder retention.

Using Manual Correction

When acute urinary retention is caused by an impacted uterus, your doctor may try to manually correct the situation. What this means, is that he or she will manually place the uterus in the anterior position where it is supposed to be. If this doesn't work, your condition may require surgery.

Risks Associated with Urinary Retention

Aside from being bothersome and inconvenient, there are a number of risks associated with urinary retention. For instance, not being able to pee when you need to can cause a great deal of discomfort. What's more, you'll likely experience a full sensation and maybe even pain in the pelvic area.

Bladder Infection

You also are at an increased risk for bladder infections. This occurs because the urine is retained in your bladder for too long. This kind of infection is called a urinary tract infection (UTI). And, if the infection spreads and involves the kidneys, it can become very serious.

UTIs can cause fevers, chills, and even blood in the urine. What's more this infection can spread throughout the body and potentially harm you and your baby. For instance, UTIs can cause premature birth or a low birth weight baby. Usually, UTIs do not resolve on their own and require a prescription-strength antibiotic.

Miscarriage

Likewise, when the acute urinary retention is caused by an impacted uterus, you are at risk for a miscarriage. So, if you are not able to pee, you need to see a doctor right away. Do not delay in getting medical attention.

A Word From Verywell

It is important to speak with your doctor immediately if you are experiencing any difficulties urinating. Urinary retention in pregnancy is a rare problem, but one that needs to be addressed right away. Ignoring the issue or hoping it will go away could lead to miscarriage or other complications.

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