Feel like I have to pee but nothing comes out (Urine Retention)

Having an urgent need to pee then nothing comes out when you finally get the chance to pee can be very frustrating and can feel like a waste of time. You ask yourself what the fuss was all about. This is medically referred to as urine retention.

This is something that happens to both men and women and there is a wide range of health conditions that can cause this. 

Not all of these conditions make it very difficult for you to pee or make nothing come out when you want to pee. Some are serious and some are minor. UTIs, pregnancy, enlarged prostate, overactive bladder are just a few conditions that can make you feel like you have to pee but eventually, nothing comes out in the end. 

In this article, you will get to know the possible causes, treatment, diagnostic methods, and prevention tricks. Let’s get into them.

What causes the inability to urinate after having the urge

A number of things including some medical conditions have been identified to contribute or be the cause of the inability to urinate after feeling the urge to. Some of these conditions include:  

• UTIs, 
• Pregnancy, 
• Enlarged prostate, 
• Overactive bladder 
• Cancers
• Medications
• Nerve damage
• Infections
• Trauma

Let’s take each of these causes one after the other and discuss how they cause urine retention and what you can do to prevent or protect yourself.

Urinary tract infections (UTI)

Urinary tract infections are a common cause of a frequent urge to pee. They often occur in the bladder. They are mostly present in females. In fact, UTIs have been found to occur in the ratio of 8:1 in women as compared to men (source). 

When bacteria enter the urinary tract. With UTIs, they can make you feel the urge to pee but in the end, little or nothing at all comes out. 

Burning sensation during urination, low body temperature, cloudy urine, bloody urine, cramps in the lower abdomen or groin are all symptoms of urinary tract infections. 

Drinking plenty of fluids, urinating before sex, avoiding wearing underwear that can trap moisture, cleaning the anus and genitalia every day are all ways you can prevent UTIs.

Overactive bladder

A person with an overactive bladder may feel the urge to urinate even when there is nothing or at least a little urine in the bladder. Having an overactive bladder causes the bladder muscles to squeeze too often.

This can lead to the frequent urge or need to urinate.

Enlarged prostate

The prostate is a gland near the bladder that produces semen and is present in only males. As males age, their prostate becomes larger. 

When the prostate grows, it can put pressure on the bladder. This can mean that a man may feel the need to urinate more often, even if there is little to no urine in the bladder. 

If someone has an enlarged prostate, it can also block their urethra. This is the tube that carries urine and semen through the penis. 

Other symptoms of an enlarged prostate can include 

• difficulty starting urinating, 
• a weak stream of urine, 
• dribbling at the end of urinating, 
• pain after ejaculating or while urinating.

Obstruction leading to urine retention

An obstruction happens when something gets in the way of urine going out through your bladder.

When something suddenly gets in the way and blocks your urine, it causes acute urinary retention. If the obstruction happens slowly over time and still allows some urine out, this results in chronic urinary retention. 

Some possible causes of obstructions include 

• swelling in the urethra 
• a formation of the urethra that makes it difficult for urine to pass out 
• an object blocking the urethra 
• constipation 
• stones from the kidney or other part of the urinary tract
• a tumour or other mass in the gut or hip area that’s constricting the urinary tract
• a clot from blood in the urethra

Cancer 

If a person frequently needs to pee but little comes out, it could be a sign of cancer. Cancers that can affect peeing include 

• bladder cancer 
• prostate cancer 
• ovarian cancer 

The symptoms for all these cancers can be similar to other urinary tract conditions. Thus, it is very important to speak to a medical professional if urination issues occur.

Medications that may cause urine retention

Certain drugs can result in urinary retention due to muscle weakness or symptoms affecting your internal sphincter. These medications include 

• pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs) 
• muscle relaxers 
• urinary incontinence medications 
• pseudoephedrine 
• some antidepressants 
• medication for Parkinson’s disease 
• some antipsychotics
• amphetamines
• opioids (such as morphine)

Nerve damage leading to urine retention

Damage to or disruption of the nerves near your urinary tract can lead to urination issues. Problems with these nerves make it more difficult for nerve signals to be sent to your brain and back to your body. 

This is needed to help stimulate the urge to urinate. Injury to the nerves can also retract the muscles preventing urine from passing out. 

Some possible causes of nerve problems that can lead to urinary retention include 

• diabetes complications
• injury to the brain or spine 
• vaginal birth 
• multiple sclerosis 
• Parkinson’s disease 
• stroke

Trauma 

Hurting the sexual organs (penis or vagina) can cause swelling that blocks the urethra or other internal parts of the lower urinary tract, blocking urine from coming out.

Infection

An infection called vulvovaginitis affects the external part of your vagina and can result in urinary retention. Bladder infections and urinary tract infections can also cause urinary retention.

How is urine retention diagnosed?

Your medical history will be used to check and determine your symptoms before a physical exam is conducted by a doctor or qualified health personnel.

The physical exam will include an examination of your genitals and rectum to look for any symptoms affecting those areas that may also affect the urinary tract.

Some other tests that may be used to confirm a diagnosis include

• Urine samples
• Blood tests
• Urodynamic tests that measure the quantity of urine that your bladder can hold
• Post-void residual (PVR)
• Cystoscopy
• Electromyography
• CT scan
• Ultrasound

How is urine retention treated?

When it comes to the treatment of urine retention, it depends on the type of urine retention suffered by the individual.

For acute urine retention, immediate treatment is required. A catheter (a tube that carries urine from the bladder to the outside of the body) may be passed to augment drainage of the bladder. 

Sometimes, the healthcare provider will insert a catheter into your bladder through a small hole in your belly or will be passed into your urethra to help quickly drain the urine. 

Local anesthesia will be used to make sure you don’t feel pain or discomfort from the insertion of the catheter. 

For chronic urine retention, long-term consistent treatment will be required. Medications like antibiotics in cases of infections can help treat urine retention. 

Lifestyle changes are also another fix for urine retention. This includes consciously urinating as soon as you feel the urge to and not holding urine on you for long.

Surgery may be done if the medications and lifestyle changes prove to be ineffective.

The takeaway from this article

When you feel like you want to pee and nothing comes out eventually, there may be several possible causes of which some may usually not be serious. 

However, there may be some serious or potentially serious causes that require medical attention.

It must also be noted that not being able to pee after having the urge is something that can happen to either males or females altogether.