When You Can't Urinate After a Stroke

As you are recovering from a stroke, you may experience urinary incontinence, an inability to control your urine. Urinary incontinence affects up to 25% of stroke survivors within the first year post-stroke. Up to 15% still experience urinary incontinence one year or later post-stroke.

Urination is a complex process involving coordination between the brain, the spinal cord, and the nerves. Because a stroke can prompt issues with coordination and overall brain function, it follows that an inability to urinate is another potential post-stroke complication. Urinary retention, also referred to as bladder retention, means that you may not be able to completely empty your bladder or you may not be able to urinate when you want to.

Some stroke survivors experience incontinence, some suffer from bladder retention, and some experience a combination of both. In fact, a number of neurological conditions, such as multiple sclerosis, spine disease, and dementia, are also associated with a combination of incontinence and urinary retention.

Problems Associated With Bladder Retention

Urinary retention is bothersome. But beyond being inconvenient, urinary retention can also cause serious health problems, including:

• Discomfort: The most obvious problem with bladder retention is that it is uncomfortable. When you can’t empty your bladder, you may feel a sensation of fullness, discomfort, or even pain in the lower pelvic area. This discomfort might not be relieved until you are finally able to empty your bladder.
• Leaking: After a while, if you cannot empty your bladder when you want to, the buildup of urine inside your bladder may overcome the capacity of your bladder or may place pressure on your muscles. In this instance, urine may finally leak out on its own when you are not ready, causing wetness and embarrassment.
• Bladder infection: Sometimes, if the muscles that help you urinate are weakened because of your stroke, urine may remain in your bladder for so long that you can develop an infection. This kind of infection is called a urinary tract infection (UTI). A UTI is an infection of the bladder or the ureters or the kidneys. If the infection involves the kidneys, this is usually much more serious. UTIs can produce fevers, chills, and blood in the urine, and can even spread to cause an infection throughout the rest of the body. UTIs generally do not resolve on their own and often require prescription-strength antibiotic medication.

Treatment for Bladder Retention

There are a number of effective treatments for bladder retention, and your healthcare provider will assess which of these is most suitable for your situation. Options include:

• Medication: Some prescription medicines can help with bladder retention. Depending on your symptoms, your healthcare provider might give you a prescription to help manage your urinary retention.
• Stopping medications: A number of medications can produce bladder retention as a side effect, so your healthcare provider may need to make some prescription changes if you experience bladder retention.
• Therapy: Many people with bladder retention need a type of physical therapy that is tailored for bladder training. This requires active participation in order to optimize the results.
• Catheter: Sometimes, your nurse or therapist might teach you how to place a catheter to release excess urine from your bladder. While it may seem awkward, sometimes using a catheter is the most effective way to relieve bladder retention.
• Botulinum toxin: Newer methods of treating bladder retention include injection of botulinum toxin. Botulinum toxin has been used as a treatment for muscle stiffness after a stroke for years and is also approved for bladder problems.
• Acupuncture: A 2012 study evaluated electro acupuncture as a possible therapy for bladder retention after a stroke and the results were promising.

A Word From Verywell

After a stroke, decreased control of urination can be a major lifestyle and health problem.

Sometimes, stroke survivors lose control of urine and have to go urgently or frequently or may even wet their pants. Sometimes, bladder retention causes stroke survivors to be unable to urinate when they want to because the urine won't start or won't completely empty. And many stroke survivors experience a combination of both problems.

There are effective treatments for bladder control problems. It is important to speak with your healthcare provider about any problems you have with urination, because you may experience serious complications if the problem goes untreated for too long.