Sunday, December 17, 2017

Stoppage of water

Urinary retention


Mark Fraser

Does this sound familiar? Your bladder is full and you are desperately in need of a toilet or some private area to pass your urine and you can’t find one. As time passes, and you are still unable to relieve yourself, you start becoming increasingly tense and impatient and for some, “a cold sweat takes you”. Finally, an opportunity to empty your bladder presents itself. Many of us have experienced this urgency and I am sure you remember the feeling of relief when it was over. What if you could not empty your bladder?

Acute Urinary Retention (AUR) is a sudden inability to pass urine and its causes are numerous. Reports indicate that about 10 per cent of cases are caused by medications with a larger number of cases caused by BPH (enlarged prostate) (previous article). Acute Urinary Retention is painful and requires immediate attention involving the placement of a catheter (narrow tube) into your bladder. Mortality in men admitted to the hospital with AUR is high and increases strongly with age.

More and more men today at risk for urinary retention are being taught intermittent self-catheterisation, a procedure that allows men to empty their bladders themselves, avoiding a trip to the emergency department and reducing the above described anxiety. Men are generally concerned about possible discomfort from the procedure, as well as whether they can actually do it. The majority are surprised at how easy it is to do and what a huge difference it makes if you are the one in retention.

Basically you will gather a few things (supplies) and wash your hands with soap and water before starting. The procedure involves putting some “numbing gel” (freezing that comes in a tube with a tip for easy insertion) into the tip of the penis and allowing it some time to “numb” the urethra (previous article).

A catheter (silicone/rubber/plastic tube) is then lubricated a few inches for the insertion and gently introduced into the tip of the penis, gradually making its way to the bladder. The male urethra averages 18-20cm (roughly 7 to 8 inches) in length. You know you have reached the bladder when urine starts flowing out of the catheter (into a collection container you would have prepared in advance to catch it). You allow the urine to continue to flow out until it stops, and then gently remove the catheter, stopping each time urine begins to drain again. The catheter can be then cleaned and re-used.

As a member of the Prostate Brachytherapy (early prostate cancer treatment) Team at the Princess Margaret Hospital in Canada, I was responsible for inserting indwelling catheters (they stay in for a longer period of time) as well as performing and teaching intermittent catheterisation (the catheter removed once urine has emptied). Yes, men at risk for or experiencing urinary retention can be taught how to do “self catheterisation”. Episodes of Acute Urinary Retention (AUR) impact heavily on the patient as well as the healthcare system. To see a video on intermittent self-catheterisation send a blank e-mail to

Intermittent self-catheterisation is a simple procedure. One report states “even children as young as seven or eight years old can be trained to handle catheterisation on their own. Being prepared for a potential problem can greatly influence the outcome if it arises and many doctors support intermittent self-catheterisation for men at risk for AUR.

Medscape reports, “Intermittent self-catheterisation requires education and support, particularly during initial teaching and follow up. A knowledgeable and experienced clinician, in most cases a nurse, is an important component for successful self-catheterisation teaching”.