Difficulty Urinating After Surgery
What is difficulty urinating after surgery?
Difficulty urinating after surgery is a condition called postoperative urinary retention (POUR). POUR is the inability to voluntarily urinate after surgery despite the bladder being full. It occurs when surgery interferes with normal bladder function. Bladder control involves both the voluntary and involuntary nervous systems. There are also two phases of bladder control—filling and voiding.
When the bladder is filling, smooth muscles stay relaxed. The strong sphincter muscles contract during filling to keep urine in the bladder. When nerve signals tell the brain the bladder is full, you become aware of the need to urinate. Voiding—or releasing urine from the bladder—is the part you can control voluntarily. You decide when you will urinate. Once you are ready, the smooth muscles around the bladder contract to squeeze it and you relax the sphincter muscles to let urine flow. Surgery can interfere with the smooth muscle function, the nerve signals, or your ability to voluntarily relax the sphincter muscle.
Difficult urination after surgery is very common. Up to 70% of people having surgery will experience it to some degree. The risk is higher in men, people older than 50 years, and people with certain medical conditions, such as diabetes. It is also more common with certain types of surgery, such as pelvic surgery, and with anesthesia medicines. The amount of time under anesthesia can also contribute to postoperative urinary retention.
Your postoperative care team will monitor your ability to urinate after surgery. It’s important to tell your team if you are having problems urinating. They will need to evaluate your bladder and may need to empty your bladder with a catheter. After some surgeries, you will already have a urinary catheter in place when you wake up.
If you go home after surgery, your team will give you instructions about when to call for a problem with urination. In general, you should call your doctor or seek prompt medical care for the following urinary symptoms:
- Difficulty starting to void
- Dribbling or leaking urine
- Feeling like your bladder isn’t empty after voiding
- Only being able to void small amounts
Seek immediate medical care (call 911) if you are unable to urinate at all.
What other symptoms might occur with difficulty urinating after surgery?
Symptoms that occur along with difficulty urinating after surgery are usually related to the urinary system. However, some people have no symptoms at all.
Urinary-related symptoms that may occur along with difficulty urinating after surgery
Most symptoms are related to the bladder and urinary system including:
- Feeling of incomplete emptying after urinating
- Frequent need to urinate through the night
- Inability to voluntarily start a urine stream or straining to start one
- Leaking urine or dribbling urine after urinating
- Pelvic fullness
- Urinating small amounts even though the bladder feels full
Other symptoms that may occur along with difficulty urinating after surgery
The other symptoms that can occur along with difficult urination depend on the type of surgery and medications you are receiving. Other symptoms may include:
- Sleepiness or drowsiness
Symptoms that might indicate a serious condition
Postoperative urinary retention can lead to complications, including permanent bladder damage. Tell your care team if you are struggling in any way to urinate after surgery. You should also let them know if you don’t have urinary symptoms, but have a feeling of discomfort or fullness in your pelvis or abdomen.
What causes difficulty urinating after surgery?
There are several factors that can contribute to postoperative urinary retention.
Surgical causes of difficulty urinating after surgery
The type of surgery can have an influence on the development of postoperative urinary retention (POUR). Surgery can alter the nerve pathways to and from the bladder and cause localized swelling in the area. These effects are usually temporary, but permanent nerve problems are possible.
Urinary retention is more common with the following types of pelvic, abdominal and lower extreme surgery:
- Colon, rectal or anal surgery
- Gynecologic surgery
- Hernia repair
- Knee or hip replacement
- Pelvic surgery
- Spinal surgery
But, even people having cataract surgery can experience POUR due to anesthesia and other medications.
Medication causes of difficulty urinating after surgery
Anesthesia and other medications can also contribute to POUR. With difficulty urinating after anesthesia, the longer the duration of anesthesia, the greater the risk of POUR. Drugs that can lead to urinary retention include:
- Anticholinergic drugs and other drugs doctors may use during surgery, which can lead to decreased bladder activity
- General anesthetics, which relax smooth muscles and lead to decreased bladder tone. General anesthesia also interferes with voluntary control over the sphincter muscle.
- Opioid pain relievers, which can reduce the sensation of bladder fullness and make it harder to relax the bladder sphincter muscle
- Spinal and epidural anesthetics, which interfere with nerve signals traveling to and from the spinal cord. The risk is highest with spinal anesthesia, followed by epidural anesthesia and general anesthesia.
Other causes and risk factors for difficulty urinating after surgery
Other contributors to developing POUR include:
- Age: The risk is higher in people older than 50 years.
- Duration of surgery: Longer surgeries require more time under anesthesia.
- IV (intravenous) fluids: Without a urinary catheter in place, prolonged administration of IV fluid during surgery increases the risk of POUR.
- Medical conditions: POUR is more likely in people with diabetes, multiple sclerosis, cerebral palsy, spinal injury, and stroke. A pre-existing problem with urinary retention for other reason can also make POUR more likely.
- Sex: Men tend to have a higher incidence of POUR than women.
When should you see a doctor for difficulty urinating after surgery?
Your care team will monitor your ability to urinate after surgery. In some cases, you will have a urinary catheter in place for a period of time after surgery. It will be important to monitor your ability to urinate once the catheter is out. If you stay in the hospital, you need to call your nurse for any urinary symptoms or problems you may have. If you go home, you need to call your provider or seek prompt medical care for urinary problems.
- Being able to urinate, but feeling like your bladder is still full afterwards
- Difficulty starting to urinate or having to strain to start urinating
- Dribbling or leaking urine
- Having a feeling of fullness in your pelvis or lower abdomen
- Urinating frequently, but only voiding small amounts
- Waking often during the night to urinate
Call 911 or go to your nearest emergency room if you are completely unable to urinate.
How is the cause of difficulty urinating after surgery diagnosed?
Since symptoms of urinary retention are not always present, the postoperative care team will monitor your ability to urinate. You may have a urine collection pan in the toilet you use to measure how much you are voiding. In general, you should not go for longer than 6 to 7 hours without urinating. If you are unable to urinate, a physical exam may reveal a distended bladder. Sometimes, the care team may use ultrasound to view the bladder. Using a catheter to drain the bladder and measure its contents is useful for both diagnosing and treating POUR.
What are the treatments for difficulty urinating after surgery?
Difficulty urinating after surgery treatment involves draining the bladder and allowing it to reset. A nurse will use a catheter to empty the bladder. In general, if postoperative urinary retention (POUR) persists, the nurse may repeat the catheterization a second time. If retention continues, an indwelling catheter may be necessary. Some people need to go home after surgery and use self-catheterization while their bladder resets. In some cases, there is also a role for medications, such as tamsulosin (Flomax). These drugs relax the bladder muscles.
Home remedies for difficulty urinating after surgery
Here are some tips to help yourself urinate and deal with urinary retention:
- Try to urinate every 2 to 3 hours instead of holding urine for long periods, even if you don’t feel the urge.
- Begin walking as soon as your doctor allows it. Walking early and often can help prevent POUR.
- Run water in the sink and listen to the sound of water running.
- Smell peppermint oil or put some in the toilet water.
- Rinse your perineum with warm water.
What are the potential complications of difficulty urinating after surgery?
The main complication of postoperative urinary retention (POUR) is overfilling the bladder, which can stretch the bladder muscles too much. This injures the bladder muscles. In most cases, the damage is temporary, but it can be permanent. There are also potential complications of catheterization, including bladder infection.
Recovering from POUR can take time. Most people will regain the ability to urinate within 1 to 3 days. It usually resolves once the effects of surgery and other contributors wear off.