Unable to urinate after surgery

Urinary retention after surgery

Every surgery has risks and complications and I have written about these in the past.

https://www.tavmd.com/2012/12/13/cosmetic-plastic-surgery-complications-1/

https://www.tavmd.com/2012/12/18/cosmetic-plastic-surgery-complications-2/

Being unable to urinate after surgery is a common cause for apprehension and problems in the first days after surgery. There are a number of causes for patients being unable to urinate after surgery.

1. Anesthesia effects

General anesthesia drugs will have side effects that decrease  or totally block bladder muscle contractions. Effects of these drugs will decrease within a few hours or days depending on each patient’s sensitivity to anesthesia. If your bladder is unable to contract with enough force you may need a urinary catheter to be placed for a few days to get relief!  Catheter is pulled out later by your surgeon. If you are still unable to pee you may need to have a catheter re-inserted.

2. Anatomical reasons

Sometimes bladder muscles have enough strength to initiate a bladder emptying but patients are still unable to pee due to an anatomical barrier in the urethra. For men this typically is an enlarged prostate. Many men suffer form prostate hypertrophy which narrows the urethra. Under normal circumstances the bladder may have enough force to empty through the constriction but with decreased force due to anesthesia it is unable to empty. Women may have a similar anatomy problem due to previous surgery such as bladder suspension surgeries.

3. Medications

A common cause of urinary retention is interaction of pain medication given after surgery with drugs that you may already be taking. Interaction of narcotics and anti-depression medications can be particularly potent in causing urinary retention.

Treatment of Urinary retention                                            urinary catheter

1. Wait and see

If there is no physical pain from the bladder being full, I usually encourage patients to

– get up and walk around the help metabolism of the anesthesia medications

– Try urination while sitting in a warm bath tub. Sometimes that is enough to stimulate bladder emptying.

– Physical pressure can also help to empty the bladder in some cases.

The caveat with this approach is that it is only to be used in the early post operative period. The bladder in some patients will continue to stretch and expand without causing any pain and in the extreme could lead to other serious complications. If there has been no urination after surgery for 4 hours or so its time to go to the ER.

2. Urinary Catheter placement

If there is still inability to urinate after a few hours or if there is pain, a urinary catheter needs to placed. Commonly known as a Foley catheter it is best inserted by a nurse or doctor in the emergency room or office. A rubber catheter with attached bag is placed into the urethra and urine is allowed to drain for a couple of days till the bladder has regained its strength. An antibiotic is usually necessary during the time the catheter is in place to prevent infection.

Although a simple condition to take care of, urinary retention – being unable to pee after surgery is painful and anxiety causing. Not the typical complication one thinks of after surgery but one that both surgeon and patient should be prepared to treat.