What you should do if you suddenly can’t pee, according to an expert

By Dr. Jamin Brahmbhatt, CNN

(CNN) — The day after I had kidney stone surgery, I suddenly couldn’t pee. My bladder felt full, but nothing was coming out. I’m a urologist and even I was freaking out: I felt stuck, panicked and helpless. After what felt like five hours — but was really only five minutes — the urine started to flow.

Once I remembered I’m a urologist, I realized the problem wasn’t just my bladder. The problem was constipation from all the medications I had to take the day before surgery. Once that issue was sorted out, my bladder finally relaxed — and the urine flowed just fine.

My case was situational and temporary, and it could be for you, too. But for many people, difficulty urinating is a real quality-of-life issue that won’t go away easily.

What’s happening (or not happening) when you can’t pee

The problem could be urinary retention, when your bladder is full but can’t empty. Or your bladder may be empty but you still feel the urge to go. Either way, the experience is the same — you’re trying to pee and nothing’s coming out.

To understand why, I’ll go over some basic anatomy. Made of muscle fibers, the bladder is a balloon-like structure in the lower abdomen that holds urine. At the bottom is a narrow region called the bladder neck, which opens into the urethra – the tube that carries urine out of the body. In men, the urethra runs through the prostate before reaching the penis; in women, it’s shorter and exits just in front of the vagina.

For urine to flow, the bladder muscle must contract or squeeze while the outlet and urethra relax. If anything interferes with this process — a blockage, weak bladder muscles or poor nerve signals — the urine is unable to flow.

What causes problems with flow

This issue is most common in men older than 50, but women and younger people can experience it too, especially if medications or other health conditions are involved.

In men, the most common cause is an enlarged prostate blocking the flow of urine. In fact, studies show that after age 70, about 1 in 10 men will have developed acute urinary retention within five years, and by the time they reach their 80s, that number rises to nearly 1 in 3.

In women, nerve issues or a cystocele (a type of pelvic organ prolapse, or dropped bladder) can alter flow, but acute urinary retention is much less common, affecting only about 3 in 100,000 women each year. Sorry, guys, this problem is more common in you, thanks to the prostate and longer urethra!

This is not just a condition of being old. Many cases, like mine, come down to something more everyday: constipation. When the bowels back up, they can physically change the angle of the bladder neck, essentially kinking the outlet.

Medications are another significant factor. Think about the pills you might take for allergies or a cold — decongestants and antihistamines are known to slow or even stop urine flow. Some antidepressants, bladder medications and pain pills can have the same effect.

Other causes may include urinary stones, strictures, blood clots and infections that can block the outlet. For those with a neurologic condition such as multiple sclerosis, diabetes, a spinal cord injury or stroke, the nerves that control bladder emptying can be damaged.

Warning signs to watch for

Not all trouble urinating looks the same. A weak stream or stop-and-start flow is one thing — bothersome, but often gradual and not immediately dangerous.

If you cannot urinate at all and your bladder feels painfully full, your belly feels swollen, you’ve tried to relax, you’ve had a bowel movement and still nothing comes out — that’s likely an emergency. Go to the ER right away. You may need to have your bladder drained with a catheter to relieve the pressure, empty your bladder and prevent kidney damage.

Some people have no symptoms at all. In our urology office, we’ll do an ultrasound scan of the bladder and find hundreds of milliliters of urine still inside. This “silent” retention can be just as risky over time, leading to infections or long-term bladder problems if left untreated.

In one hospital-based study of male patients, approximately half presented with acute retention, while about 30% were found to have chronic retention. That’s why it’s important to have routine checkups with your primary care doctor and tell them about any symptoms you may have — sometimes your bladder can be in trouble even if you feel fine.

How urologists figure out your retention problem

The first step is determining whether the issue is proper retention — your bladder is full but can’t empty — or simply having the sensation that you need to go but your bladder is already empty. Those two situations may seem the same, but the treatment is quite different. That’s why we review your medical history and get new, objective data. For example, we check how much urine is left in the bladder after you try to void, test urine and blood for infections, and look at kidney function.

We also have tools that eliminate some of the guesswork. A uroflow machine can measure the strength and pattern of your urine stream. And, if needed, we can put a small camera (cystoscopy) into the urethra and bladder to see what might be blocking the flow.

Just this week, I saw a young man who was having significant trouble urinating — rare for his age. A quick look with the scope showed a urethral stricture, or scar tissue, that was obstructing the flow of urine. As urologists, we see similar issues all the time: Sometimes it’s scar tissue, other times a large prostate pressing on the urethra. In women it could be a dropped bladder. Different causes, same results — urinary flow is blocked, and the bladder cannot empty properly.

In rare, acute cases — when someone is in severe pain and unable to urinate at all — we immediately insert a catheter to drain the bladder. More commonly, however, patients have minor, bothersome symptoms that creep up over time. When caught early, many of these problems can be improved or even fixed before they turn into emergencies.

What you can do to pee

Pay attention to subtle changes, such as a weaker stream, straining or frequent nighttime trips to the bathroom. Don’t brush these off as just getting older. Review your medication list with your doctor and stay hydrated. Most importantly, don’t ignore constipation — it doesn’t just affect your gut; it can affect your urination, too.

Keep an eye on your bathroom habits the way you would your blood pressure or weight. Small changes addressed early can make a big difference.

The bottom (pee) line

Talking about not being able to pee can feel embarrassing or awkward, but it’s important that you tell your doctor if it’s happening to you. After all, having this problem is your body’s way of asking for help. I know firsthand how unsettling it can be since I went through it myself.

In my case, the cause was straightforward, and the symptoms cleared up quickly. In other cases, the cause may be more complex. This is when a doctor can help determine whether the issue is a blockage, a nerve problem, a side effect of medication or something else entirely. Whether the fix is as simple as changing a medication or as involved as having a medical procedure to open the prostate channel, getting checked early makes all the difference.

That’s why I shared my story — it was embarrassing even for me, but I hope it will help you avoid the same issue. Don’t ignore the symptoms if you have them. Just get checked.

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