What to Do If You Can't Urinate After Surgery

The complete inability to urinate—called urinary retention—is always a medical emergency. In people who have had surgery, the type of procedure, anesthesia used, and post-operative medications can all contribute to urinary retention. In most cases, it usually gets better in a few weeks.

If you can't pee at all, it is important to seek treatment right away to avoid damage to your bladder and kidneys. Similarly, talk to your healthcare provider if you are able to pee but feel like you still have urine in your bladder afterward.

If the bladder is left full, urine can back up into the kidneys. This can lead to additional pressure in the kidney, which can cause damage. In extreme cases, the bladder can actually rupture when it gets too full.

The article outlines what can cause an inability to urinate after surgery, symptoms of urinary retention, and how the condition can be treated.

Symptoms

If you are unable to pee, you may have acute (sudden and serious) or chronic (ongoing) retention. Both types of retention can occur after surgery.

Acute Retention

Signs of acute retention include:

• Being unable to pee, even when you feel you need to
• A noticeably full bladder (in thin people, this may look like abdominal swelling)
• Discomfort or pain in the bladder region
• Lower abdominal pain, particularly below the belly button

Not all patients who have had surgery experience these symptoms. If you've had surgery, it's important that you pay attention to whether you need to pee, and how often.

Chronic Retention

Unlike acute retention, which means you cannot empty your bladder at all, chronic retention refers to other types of problems you may have. Symptoms of chronic retention include:

• Trouble starting to pee
• A weak or stuttering urine stream
• A feeling that your bladder is not completely emptied

This type of retention is not a medical emergency. However, patients who retain urine even after peeing (called post-void residual urine) are at a greater risk of urinary tract infections, which can cause serious complications.

Causes

It may seem like a simple process, but emptying your bladder (called "micturition") is complicated. Our muscles, nerves and spinal cord all work together to help us pee. Sometimes, major surgery can temporarily impact one or more parts of the process. In fact, having trouble urinating after an operation is fairly common.

How quickly you can pee after surgery is usually based on a few things:

• Type of anesthesia used: During major procedures, an anesthesiologist uses a combination of medicines to help you sleep during the procedure. These drugs also paralyze the muscles to prevent you from moving during the procedure. Longer surgeries require greater doses of these drugs, which can take time to clear your system and let your muscles fully "wake up." Nerves may take a little longer.
• Type of surgery performed: Surgeries to the abdomen or pelvis can have an impact on the surrounding tissues, nerves, and organs, including the bladder. This can cause temporary swelling that can impact your ability to pee. Likewise, procedures that involve the spinal cord or that require spinal anesthesia can interfere with the nerves that control urination.
• Types of post-surgery medicines given: Patients who are given opioid medications after surgery have a greater risk of developing post-operative urinary retention. They can also cause constipation, which can put pressure on the urethra and make it hard for the bladder to empty. Non-steroidal anti-inflammatory drugs (NSAIDs) are less likely to impact a patient's ability to pee.

It's extremely rare, but sometimes a surgical error—such as accidentally cutting one of the tubes that transport urine—may be the reason you can't pee. This complication is typically detected before you leave the hospital.

Talk to your healthcare provider before your surgery about medications you are taking and whether you have any existing conditions that impact your ability to pee. If you have an enlarged prostate, for instance, surgery could make your symptoms worse. Certain medications—like antidepressants, antihistamines, anti-anxiety drugs, and anticholinergic medications—can affect your bladder function.

Treatment

During surgery, a urinary catheter may be inserted to allow the bladder to fill and drain normally. Depending on the type of procedure performed and how long you're expected to be in the hospital, you may still have the catheter in place when you wake up. Not all patients will have a catheter during surgery.

However, if you can't pee after surgery, a urinary catheter is the best treatment for a full bladder that does not respond to repeated attempts to urinate. Your healthcare provider may recommend a catheter, even if you didn't need one during your procedure. This will help you avoid the damage to your bladder and kidneys that an overly full bladder can cause.

You healthcare provider may also start you on medication to relax your urethra to make it easier for your bladder to empty. This medication, called an alpha blocker, is often given to men to relax their prostates. It can also be given for a short time period to men and women to help them urinate after surgery.

Some patients will need short-term catheterization in the hospital, but others may need to use a catheter for a while after they go home. These patients may be taught by medical staff how to self-catheterize so the bladder can be drained as needed should the problem occur repeatedly.

Summary

Not being able to pee normally after surgery is common. It varies from person to person, but most people resume normal urinary function within a few weeks of surgery. If urinary retention persists beyond the recovery period, your surgeon or family healthcare provider may order additional tests to determine what is causing the problem and the best course of treatment.

A Word From Verywell

There are many details to monitor as you recover from surgery, and bladder function is one that shouldn't be ignored. You should be emptying your bladder numerous times a day. Any dramatic reduction in urine output should be a cause for worry, especially if you feel your bladder is full but can't pee. Even if you don't have bladder pain, if you suspect you're retaining urine, talk to your healthcare provider right away to avoid damage to your urinary tract.