Treatment of Urinary Retention Caused by Constipation

Understanding the Connection

Constipation can lead to urinary retention through mechanical obstruction, where fecal impaction in the rectum can directly compress the urethra and bladder neck, creating physical obstruction to urine outflow, particularly significant in children but also affects adults 1, 3

Assess for urinary retention using bladder scanner or in-and-out catheterization to determine residual volume, and insert urinary catheter for immediate relief if significant retention is present, using silver alloy-coated urinary catheters to reduce infection risk, and remove catheter as soon as possible, ideally within 48 hours to minimize urinary tract infection risk 3
Digital fragmentation and extraction of stool if impaction is present, may require manual disimpaction following pre-medication with analgesic and/or anxiolytic, and glycerine suppository or mineral oil retention enema may facilitate disimpaction 2, 4

Osmotic laxatives such as polyethylene glycol (PEG), lactulose, and magnesium salts, and stimulant laxatives such as bisacodyl and senna, can be used for constipation management, with the option to escalate to more aggressive regimens if initial treatment fails 2, 4
Tap water enemas until clear can be used for severe impaction, but are contraindicated in patients with neutropenia, thrombocytopenia, intestinal obstruction, or recent colorectal surgery 2, 4

Increase fluid intake, dietary fiber, and physical activity, and establish regular toileting schedule aligned with patient's previous bowel habits, and consider abdominal massage to improve bowel efficiency 2, 3, 4
Consider implementing an individualized bladder-training program, and use prompted voiding techniques for patients with urinary incontinence, and monitor for resolution of urinary symptoms as constipation improves 3

For elderly patients, ensure access to toilets, provide dietetic support, optimize toileting, and use PEG (17 g/day) as an efficacious and tolerable solution with good safety profile, and avoid liquid paraffin due to aspiration risk, and use caution with magnesium-based laxatives in patients with renal impairment 4
For opioid-induced constipation, all patients receiving opioid analgesics should be prescribed concomitant laxatives, with osmotic or stimulant laxatives generally preferred, and consider methylnaltrexone for opioid-induced constipation (0.15 mg/kg subcutaneously every other day) 2, 4

Regular reassessment of bowel function, monitor for recurrence of constipation, and continue maintenance bowel regimen to prevent recurrence of constipation and subsequent urinary retention 2, 4