What to Do If You Can't Urinate After Surgery

The complete inability to urinate after surgery, a condition called urinary retention, is considered an emergency if you are no longer in the hospital and you are unable to produce any urine. It can occur for a variety of reasons.

It is important that you seek treatment immediately, from either your surgeon or an emergency medical facility. If the bladder is not emptied serious damage can be done to both your bladder and kidneys.

• A noticeably full bladder; may be visible as abdominal swelling in thin people
• The discomfort or pain of a full bladder
• Inability to urinate, despite feeling the urge
• Lower abdominal pain, particularly below the belly button

A really full bladder can be quite painful, but most people aren't familiar with what bladder pain feels like and may not be able to identify the cause of the pain, just that it is present.  Aside from the pain, when the bladder can hold no more urine, the fluid backs up into the kidneys, which can cause damage if the pressure is not relieved quickly. In extreme cases, the bladder can actually rupture when it can hold no more urine.

The inability to urinate after surgery is usually caused by a condition called neurogenic bladder, a type of bladder dysfunction that interferes with the nerve impulses from the brain to the bladder. The bladder does not receive the signal to empty, and will continue to fill despite any pain or trauma that may occur.

For patients with no history of difficulty urinating prior to surgery, the problem is often attributed to a combination of risk factors that include abdominal surgery, general anesthesia, pain medications, and fluids given by IV during surgery.

In rare circumstances, a surgical error, such as accidentally severing one of the tubes that transport urine, may be causing the problem. This complication is very rare and is typically detected prior to leaving the hospital.

Other Less Common Causes

• Prostate Enlargement—Can cause chronic urinary retention because the enlarged prostate interferes with the movement of urine from the bladder to the outside of the body.
• “Droopy” bladder—The bladder may slip lower into abdomen (most commonly in women who have had multiple children) creating problems with the movement of urine from the bladder to the outside of the body.
• Anti-anxiety medications
• Nerve damage to bladder due to surgery, trauma, childbirth
• Antidepressant medications
• Anticholinergic medications (commonly used for overactive bladder)
• Antihistamine medications
• Spinal cord injuries and defects
• Blockage of the urethra, the tube that removes urine from the bladder, by blockage or compression such as bladder stones or constipation.

The treatment for a full bladder that does not respond to repeated attempts to urinate is a urinary catheter, a sterile tube that is inserted through the urethra into the bladder in order to drain the urine out of the bladder. The problem can be acute, a short term but serious complication, or it can be chronic, an ongoing problem that persists for weeks, months or longer.

Patients who experience urinary retention may be instructed in methods to self-catheterize by medical staff, so the bladder can be drained as needed should the problem occur repeatedly.

A less serious form of urinary retention that can happen after surgery can cause a delay in getting started urinating, or it may feel as though the bladder is still full after a successful trip to the bathroom. This is not an emergency, but it should be discussed with your surgeon, especially if it persists.

Some patients are able to urinate, but they feel that their bladder isn't emptying completely. This should also be reported as it can lead to urinary tract infections. A change in medications can often correct bladder problems. 

A dramatic reduction in the amount of urine output should be cause for worry, especially if there is no clear reason. Urine should be produced numerous times a day, and with good hydration, some individuals urinate as frequently as hourly. A dramatic decrease in urine output and frequency can mean dehydration or some type of bladder problem. If no urine output is present, dramatically decreased and/or bladder pain is present, seek medical attention.