Overview
Urinary tract obstruction is a blockage that inhibits the flow of urine through its normal path, which includes the kidneys, ureters, bladder, and urethra. This obstruction can occur at any point along the urinary tract and can be partial or complete, affecting one or both sides of the urinary system. When urine cannot drain properly, it backs up, potentially causing kidney damage, infections, and other serious complications.
The condition can develop suddenly (acute) or gradually over time (chronic). Acute obstructions often cause severe symptoms and require immediate medical attention, while chronic obstructions may develop slowly with milder symptoms that worsen over time. The severity and location of the obstruction determine the symptoms and potential complications.
If left untreated, urinary tract obstruction can lead to permanent kidney damage, chronic kidney disease, and life-threatening infections. Early detection and treatment are crucial for preventing these complications and preserving kidney function.
Symptoms
The symptoms of urinary tract obstruction vary depending on the location, degree, and duration of the blockage. Some people may have no symptoms, especially with partial or slowly developing obstructions.
Common Symptoms
- Retention of urine - Inability to empty the bladder completely
- Suprapubic pain - Pain in the lower abdomen above the pubic bone
- Painful urination - Burning or discomfort during urination
- Frequent urination - Need to urinate more often than normal
- Blood in urine - Pink, red, or cola-colored urine
- Excessive urination at night - Waking multiple times to urinate
Additional Symptoms
- Sharp abdominal pain - Severe pain in the abdomen
- Back pain - Pain in the lower back or flank area
- Side pain - Pain on one or both sides of the body
- Symptoms of prostate - In men, prostate-related symptoms
Severity Indicators
Symptoms may vary based on whether the obstruction is:
- Complete or partial: Complete blockage causes more severe symptoms
- Unilateral or bilateral: Blockage of both kidneys is more serious
- Upper or lower tract: Location affects symptom presentation
- Acute or chronic: Sudden onset versus gradual development
Causes
Urinary tract obstruction can result from various conditions that block or compress any part of the urinary system:
Common Causes in Men
- Benign prostatic hyperplasia (BPH): Enlarged prostate gland
- Prostate cancer: Malignant growth blocking the urethra
- Urethral stricture: Narrowing of the urethra
- Prostatitis: Inflammation of the prostate
Common Causes in Women
- Pelvic organ prolapse: Organs dropping into the vagina
- Pregnancy: Enlarged uterus compressing ureters
- Uterine fibroids: Benign tumors pressing on urinary tract
- Ovarian cysts: Large cysts compressing ureters
Causes in Both Sexes
- Kidney stones: Crystallized minerals blocking ureters
- Blood clots: Clots in the urinary tract
- Tumors: Cancers of the bladder, kidney, or ureter
- Neurological disorders: Conditions affecting bladder control
- Scar tissue: From surgery or radiation therapy
- Congenital abnormalities: Birth defects of the urinary system
Risk Factors
Several factors increase the risk of developing urinary tract obstruction:
Age and Gender
- Men over 50: Increased risk due to prostate enlargement
- Postmenopausal women: Higher risk of pelvic organ prolapse
- Infants: Congenital abnormalities more common
Medical Conditions
- History of kidney stones: Recurrent stone formation
- Previous urinary tract surgeries: Risk of scar tissue
- Neurological conditions: Multiple sclerosis, spinal cord injury
- Diabetes: Nerve damage affecting bladder function
- Cancer: Tumors in or near the urinary tract
Lifestyle Factors
- Dehydration: Concentrated urine increases stone risk
- High-sodium diet: Promotes kidney stone formation
- Sedentary lifestyle: May contribute to stone formation
- Certain medications: Some drugs increase obstruction risk
Diagnosis
Diagnosing urinary tract obstruction involves various tests to identify the location and cause of the blockage:
Initial Assessment
- Medical history: Symptoms, duration, and risk factors
- Physical examination: Abdominal and pelvic exam
- Digital rectal exam: In men to assess prostate
- Bladder scan: Measures post-void residual urine
Laboratory Tests
- Urinalysis: Checks for infection, blood, or crystals
- Blood tests: Kidney function (creatinine, BUN)
- PSA test: Prostate-specific antigen in men
- Urine culture: Identifies bacterial infections
Imaging Studies
- Ultrasound: Non-invasive view of kidneys and bladder
- CT scan: Detailed images of the entire urinary tract
- MRI: For soft tissue evaluation
- Voiding cystourethrogram: X-ray during urination
- Renal scan: Assesses kidney function
Specialized Tests
- Cystoscopy: Direct visualization of bladder and urethra
- Urodynamic studies: Measures bladder pressure and flow
- Retrograde pyelogram: X-ray with contrast dye
Treatment Options
Treatment for urinary tract obstruction depends on the cause, location, and severity of the blockage:
Emergency Treatment
Immediate Relief
- Catheterization: Tube to drain urine from bladder
- Nephrostomy: Tube through skin to drain kidney
- Suprapubic catheter: Through abdomen into bladder
Medical Management
Medications
- Alpha-blockers: Relax prostate and bladder neck muscles
- 5-alpha reductase inhibitors: Shrink enlarged prostate
- Antibiotics: Treat or prevent infections
- Pain relievers: Manage discomfort
- Stone dissolution therapy: For certain types of stones
Minimally Invasive Procedures
- Ureteral stent: Tube to keep ureter open
- Lithotripsy: Shock waves to break up stones
- Ureteroscopy: Remove stones with scope
- Percutaneous nephrolithotomy: Remove large kidney stones
Surgical Options
- TURP: Transurethral resection of prostate
- Open surgery: For complex obstructions
- Laparoscopic surgery: Minimally invasive approach
- Robotic surgery: Precise surgical intervention
- Urinary diversion: Reroute urine flow in severe cases
Prevention
While not all cases of urinary tract obstruction can be prevented, certain measures can reduce your risk:
Lifestyle Modifications
- Drink plenty of water (8-10 glasses daily)
- Limit sodium and animal protein intake
- Maintain a healthy weight
- Stay physically active
- Practice good bathroom habits
Medical Management
- Regular prostate exams for men over 50
- Manage chronic conditions (diabetes, hypertension)
- Take prescribed medications as directed
- Address urinary symptoms promptly
- Follow up after urinary tract procedures
Stone Prevention
- Increase citrus fruit intake
- Limit oxalate-rich foods if prone to stones
- Reduce salt consumption
- Consider preventive medications if high risk
When to See a Doctor
Seek immediate medical attention for these emergency symptoms:
Emergency Warning Signs
- Complete inability to urinate
- Severe abdominal or back pain
- High fever with urinary symptoms
- Nausea and vomiting with urinary problems
- Blood clots in urine
- Signs of kidney failure (swelling, confusion)
Schedule an Appointment If You Have:
- Difficulty starting or maintaining urine stream
- Frequent urination, especially at night
- Persistent feeling of incomplete bladder emptying
- Recurring urinary tract infections
- New onset of bedwetting in adults
- Unexplained lower abdominal pain
References
- Selius BA, Subedi R. Urinary Retention in Adults: Diagnosis and Initial Management. Am Fam Physician. 2008;77(5):643-650.
- National Institute of Diabetes and Digestive and Kidney Diseases. Urinary Retention. Updated July 2021.
- Stoffel JT. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies. Transl Androl Urol. 2016;5(1):127-135.
- Kaplan SA, Wein AJ, Staskin DR, Roehrborn CG, Steers WD. Urinary retention and post-void residual urine in men. Rev Urol. 2008;10(4):279-289.
- Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function. Neurourol Urodyn. 2002;21(2):167-178.