Urinary Retention: Treatment Options
There are both non-surgical and surgical treatment options available for urinary retention. The appropriate treatment is dependent on the diagnosis obtained after a detailed urogynecologic evaluation consisting of urodynamic testing and/or cystourethroscopy.
Non-surgical treatment options include:
Pelvic Floor Therapy
Pelvic floor therapy for urinary retention consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor and bladder problems. The physical therapist uses techniques listed below, such as biofeedback, functional electrical stimulation and bladder training to help the nerves and muscles involved in emptying the bladder to function more normally.
Behavioral modification – education on diet, fluid intake and other lifestyle changes to manage various bothersome symptoms.
Biofeedback – an intravaginal device used to train the pelvic floor muscles to contract or relax correctly.
Functional electrical stimulation – a device that can be used intravaginally or externally that delivers a gentle electrical current to activate or relax the nerves and muscles in the pelvis.
Manual therapy – pressure applied to and released from muscles in spasm to relax them and increase blood flow to the area for healing.
Joint and tissue mobilization – gentle manipulation to help calm the muscles and nerves of the pelvis.
A vaginal pessary is a removable diaphragm-like device worn in the vagina. It can hold support a prolapsing anterior vaginal wall, pushing the bladder back into its normal position so that it can be emptied more completely. There are a variety of types and sizes of pessaries available. A pessary fitting includes two or more office visits to find a type and size of pessary that will work for you.
Clean Intermittent Self-Catheterization
Clean intermittent self-catheterization is for women with bothersome urinary retention. A woman inserts a small tube through her urethra into her bladder for a few seconds after she urinates to drain the remaining urine in her bladder.
Surgical treatment options include:
InterStim™ Therapy is an FDA-approved treatment for urinary urgency, frequency, urge incontinence and retention. The InterStim™ is a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally. This is appropriate in patients with non-obstructive urinary retention who fail to respond to the above conservative treatment measures.
Urethrolysis or Sling Release
This procedure is indicated in patients who are in retention due to a prior anti-incontinence procedure. In patients who have had a prior abdominal bladder neck suspension, such as a Burch or MMK, this may be performed through the vagina via a suprameatal urethrolysis or abdominally by releasing the previous sutures. In patients who have had a prior midurethral sling, such as a TVT sling, this is performed through a small vaginal incision to cut or excise a portion of the synthetic tape, with minimal morbidity. Both approaches are performed as outpatient procedures.