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Causes
Urinary retention is caused by obstruction of urinary
people are at higher risk for developing drug-induced outflow or failure of the bladder detrusor muscle to
urinary retention, because of existing co-morbidities contract effectively and empty the bladder. Regardless
such as benign prostatic hyperplasia and the use of of the cause, urinary retention occurs and the bladder
other concomitant medication that could reinforce the distends until maximum bladder capacity is reached.
impairing effect on micturition. At this point, urine leaks from the bladder by means of
overflow.
People with urinary retention can present with
complete lack of voiding, incomplete bladder Medications that cause urinary retention include:
emptying, or overflow incontinence. Urinary tract Anticholinergic agents
infection and renal failure are complications of urinary Calcium channel blockers
retention. Non-steroidal anti-inflammatory drugs
(NSAIDs)
Acute urinary retention -adrenergic agonists
People with acute urinary retention cannot urinate at -adrenergic antagonists
all, even though they have a full bladder. Acute urinary Opioids
retention, a potentially life-threatening medical Sedative-hypnotics
condition, requires immediate treatment. It can cause Antipsychotics
great discomfort or pain, and requires catheterisation Antiparkinsonian agents
to provide relief. Anaesthetics
Increased resistance of the urinary flow, interruption The use of ecstasy (3, 4-methylene-
of the sensory innervation of the bladder, weakness dioxymethamphetamine) has also been associated
of the detrusor muscle, and over-distention of the with urinary retention.
bladder may all contribute to acute urinary retention.
The most common cause of infectious acute urinary Anticholinergic agents
retention is acute prostatitis. Research suggests that Anticholinergic agents can contribute to urinary
up to 10% of acute urinary retention is related to retention through interference with cholinergic
medication use. innervation of detrusor muscle of the bladder,
decreasing the force of bladder detrusor contractions.
Acute urinary retention occurs mainly in ageing men
as a consequence of comorbidity and the use of Medications with anticholinergic activity include (but
concomitant medications. not limited to):
Tricyclic antidepressants
Chronic urinary retention Some antipsychotics (olanzapine,
Chronic urinary retention develops over a period of chlorpromazine, clozapine)
time. People with chronic urinary retention can still Antihistamines
urinate; however, they do not completely empty all of Detrusor relaxants (oxybutynin, darifenacin,
the urine from their bladders. It is painless retention of propantheline, solifenacin, tolterodine)
urine associated with an increased volume of residual Inhaled anticholinergics (tiotropium,
urine. ipratropium, glycopyrronium)
Antispasmodics (hyoscine butylbromide)
Complications include storage symptoms (frequency,
nocturia, urgency and urge incontinence), dilatation of Tricyclic antidepressants (amitriptyline, clomipramine,
dothiepin, doxepin, imipramine, nortriptyline,
DRUG-INDUCED URINARY RETENTION
trimipramine) and other antidepressants including occurs soon after commencement of a beta-blocker,
SSRIs, SNRIs, mianserin (Tolvon, Lumin) and reboxetine the medication should be ceased and confirm the
(Edronax) have been associated with urinary retention. cause. Cardioselective beta-blockers (atenolol,
bisoprolol, metoprolol, nebivolol) are less likely to
Antispasmodics such as hyoscine butylbromide cause urinary retention.
(Buscopan) reduce gastrointestinal motility and spasm,
and are used for management of irritable bowel Antiparkinsonian agents
syndrome (IBS). They inhibit contraction of smooth Antiparkinsonian agents shown to cause urinary
muscle cells of the gastrointestinal tract, and also the retention include amantadine (Symmetrel),
bladder detrusor muscle which might result in voiding benztropine (Cogentin), bromocriptine (Parlodel),
difficulties. levodopa (Madopar, Sinemet) and benzhexol (Artane).
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