I am a board-certified anesthesiologist in Lake Tahoe, California. I write from the perspective of both a doctor and a patient.
What Is Post-Operative Urinary Retention (POUR)?
Urinating may seem like a simple enough condition to meet before leaving the hospital. Many people, however, find it difficult to empty their bladder after surgery. This frustrating condition is called POUR, post-operative urinary retention, and it is one of the most common side effects of general anesthesia. It usually resolves with only minor interventions, but some cases may result in over-distended bladders, urinary tract infections, and hospital admissions.
Up to 70 percent of patients have minor trouble urinating after surgery. One in 20 people experience more significant bladder-retention problems. Find out whether you may be at risk of experiencing POUR after surgery and learn some strategies to discuss with your doctor.
You can't go home until you pee.
— Hospital recovery room staff around the world
Effect of General Anesthesia on the Bladder Muscles
General anesthesia becomes safer with each passing decade. The medicines used to put a patient under do, however, change how your body works. General anesthesia drugs affect brain function and inhibit the autonomic (involuntary) nervous system that triggers urination. The result is that the detrusor (bladder muscle) contractions are suppressed or decreased. This is an effect of both IV agents and gases used during general anesthesia.
Am I at Risk of Experiencing Urinary Retention?
If you meet most of these criteria, you may be at risk of experiencing urinary retention. Ask your doctor before surgery about whether the medications you are taking (or will take) put you at higher risk.
- Over 50 years of age
- Male (especially with preexisting enlarged prostate)
- Lengthy surgery and anesthesia time
- Undergoing pelvic or hernia repair surgery
- Increased administration of IV fluid (over-stretching the bladder makes it harder to empty after general anesthesia)
- Many types of medications taken or given before, during, or after surgery (beta-blockers, for example)
Managing Urinary Retention During and After Anesthetic
If you have a surgery scheduled and are concerned about urinary retention, talk to your doctor. Be sure to discuss the importance of complete urination before the operation and ask whether any of these strategies may be appropriate for you:
- Bladder ultrasound during surgery. This technique may help operating-room staff monitor whether your bladder is reaching capacity.
- Movement after surgery. Sitting up, standing, and walking as soon as is safe after your operation may help stimulate urination.
- Medication. There are drugs available to counteract the effects of anesthesia on the area of the brain that controls urination.
Healthy Bladder Function
A healthy bladder is a fairly complex, sac-like organ. Composed of a body and a neck, the bladder is made of different types of muscle fibers and nerves that interact to allow micturition, or the passage of urine. Emptying the bladder requires input and action from the bladder, surrounding muscles, spinal cord, brainstem, and brain.
The bladder's body holds the urine. There are stretch receptors in the walls of the bladder body that indicate the level of fullness of the bladder. These special sensors send signals to the brain when the bladder should be emptied. The neck of the bladder has sphincters or valves that open to allow urine to be expelled.
- The internal urethral sphincter, located inside the neck of the bladder, is made of smooth muscle fibers and is not under voluntary control.
- The external urethral sphincter is a ring formed by the pelvic floor muscles (striated muscle) and is under voluntary control.
Read More From Healthproadvice
Emptying the bladder is both voluntary and involuntary. Spinal reflex pathways control urination under the regulation of higher centers in the brain. The brainstem contains a “storage” center and a “micturation” center (pontine storage center and pontine micturation center) that feed information to the spinal pathways that in turn send signals to the bladder.
When the bladder needs to be emptied, the body of the bladder contracts. Then the internal sphincter relaxes, due to input from the parasympathetic nervous system (part of the involuntary nervous system). The brain tells the external sphincter muscles to relax (the voluntary part of the process) and the urine exits through the urethra.
Complications Related to Urinary Retention
More than just an annoyance, bladder retention after general anesthesia can lead to significant consequences.
- Prolonged retention of urine has been linked to urinary tract infections. An overfull bladder is more likely to be incompletely emptied, which is a risk factor for infection. Also, if a catheter has to be used to relieve the retention, this increases the risk of infection, as well.
- Longer-term issues with bladder emptying are possible. There is some evidence that having an over-distended bladder can cause difficulty in emptying the bladder even after leaving the hospital.
- A stretched bladder signals the nerves of the parasympathetic nervous system, which can affect other organs with parasympathetic nerves. This can result in slowed or irregular heartbeat, low or high blood pressure, and nausea/vomiting. These can occasionally be dangerous. Cardiac arrest is an unlikely, but possible, result.
A Resolved Case of Post-Op Urinary Retention
A 75-year-old man arrived in the recovery room after a surgery of about 1.5 hours under general anesthetic.
Upon arrival, the man was agitated and not able to answer questions. His blood pressure was high but his heart rate was low. He was assumed to be in pain, given his agitation, but didn't improve much after medication. He began to sweat and experience ectopy (irregular heartbeats).
The anesthesiologist and recovery nurse realized he had not emptied his bladder before going in for surgery. He had a history of prostate enlargement and had received over a liter of IV fluids in the operating room. His bladder was emptied with a urinary catheter. Almost immediately, his heart rate climbed back to normal, his blood pressure corrected, and his agitation disappeared. After a short nap, he woke up feeling just fine with no recollection of having the catheter placed. He had no further issues and was discharged to go home.
As summarized in the above video, there are many points along the pathway that could interrupt normal bladder emptying.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Francine Carson on January 19, 2018:
My boyfriend had his gallbladder removed yesterday. He said that he is not urinating very much. Also he had a sleepless night. I'm glad I read this article and know this urinary retention is not unusual. Will call the doctors office when they open.
Donald L Clugston on August 20, 2017:
BOTCHED wrong hospital wrong doctors now I spend the future in a nursing home with a catherpier stuck in me
Janie Balams on August 15, 2017:
My sister had a colonscopy about two weeks ago. After the surgery, she got dressed and left the outpatient office and went home. She felt the urge to urinate, but nothing happened and immediately, she was in a lot of pain. Went back to the Doctor's office that performed the colonoscopy and he told her to go to the emergency room, but she did not go. The next day, the pain was so bad and she could not urinate still. The hospital put a catheter in immediately she voided 600ml of fluids, so they put her in the hospital, By this time, she had accumulated a UTI, a high fever and pressure was up, They kept her for three days sent her home and told her to follow up with her Doctor. The same night, again she could not urinate without the Catheter, so she went back to the ER, they put a catheter in and made an appointment with the Urologist for the next day. They took the Catheter out, told her to drink water and she should be OK. Not so, her bladder was and is still not working. So, now another procedure; a Cystoscope which did not show anything, so he says. She has to keep the catheter in another two weeks; so what is going on? I just don't know!!!!!?????
SAM DEPECAN on June 23, 2017:
I just had a Colonoscopy and that is all I did last night is go back-and-forth to the bathroom . . . A LOT!!!! Hence, my experience was just-the-opposite. Which is not so unusual for me. I'm still drinking a lot of water today; no-matter what. So be it. If I die; I die standing in front of the toilet bowl.
Mary Van Meter on June 19, 2017:
What if they can not get a cath in to drain my husband's bladder?
janice on April 09, 2017:
I had gall bladder surgery last Thursday - 3 days ago.. I couldn't pee afterwards .. had to go so bad but couldn't so then the nurse put a catheter on me and got some relief..but prior to that they had given me 2 bags of fluid as I was dehydrated a little but she thought the 2nd bag would make me pee... Wrong. They sent me home anyway saying if I can't go, and its bad to go to the ER to get drained. 2 hours later I was in the ER in terrible pain and had a catheter again. Sent me home with a catheter all night. The next morning the nurse from outpatient surgery called and I told her about it.. I was upset. I then went in and the surgeon kept me on the catheter and has a schedule of clamping to retrain my bladder.. I am so worried that I won't be able to pee! I am upset that they gave me so much fluid, distended my bladder which is not good. I just don't get why they sent me home.. they just said insurance companies would pay... and that it was not serious..Lawsuit if I don't get better. They never told me about this possible complication.
M Stein on April 04, 2017:
Shortly after reconstructive surgery, I requested Pelvic Floor Therapy. It helped remind my brain to respond and strengthened the voluntary and involuntary response of a healthy bladder. If you're core strength is slow to return post op, ask for a few weeks of this Awesome Therapy. Happy recovery
RDMAN on March 06, 2017:
Ok when is happens, go drink 2 cups (1 btl usually) of coconut water. This will give you ~1 gram of potassium (a natural diuretic or pee maker). Walk around or stay up right as much as possible while staying relaxed. Once you have to pee, go pee. Once you're done, you might still feel the need to pee more but can't go anymore. At that moment, hop in warm/hot shower and just relax. You'll soon pee out more. Be sure to drink more water and only 2 more btls of coconut water max that day to prevent dehydration and hypotension/bradycardia. If you have kidney problems or cardiovascular issues, I suggest you ask your Dr before doing this or just stick to 1 btl of coconut water for that 24 hr period which is generally longer than the time period that anesthesia will be in your system. I hope this helps, and if it soes, please comment and let me know!
catalina2 on March 05, 2017:
had a bladder lasertripsy done. voided immediately post surgery. experienced exquisite urinary retention pain that evening that resulted in an ER visit. a catheter was placed with immediate relief. the catheter became painful the second day so I removed it. was pain free thereafter. have had multiple surgeries including a protatectomy. NEVER had this experience before. Gave anesthesia to outpatients and never informed them of this complication. THIS CONDITION AND INFORMED CONSENT SHOULD BE EXPLAINED TO EVERY PATIENT!!!
33 female on January 28, 2017:
I had ear surgery. Urinated before they took me in, afterwards it took m 40 mins to pee, and it was just a trickle. We tried everything, just for a trickle. I insisted on a catheter and almost filled up the bag. When I went home, the problem persisted. I'd have to run my fingers under warm water, while I sat on the toilet, and sometimes that helped to "trick" my mind or muscles, and I'd be able to pee a little. I probably need a catheter because i'm not completely emptying my bladder. An e.r visit comes with a $250 copay so I will keep trying tonight and see how I'm doing tomorrow. I know it's not healthy to retain urine for so long so I hope things will flow better asap. Patients should be told about this when given the run done about anesthesia prior to surgery! Thank you for your article, it's a reliever. :)
T. Moshansky on January 25, 2017:
Never had surgery or any need for 45 years of my life thankfully.
Tore my groin last summer and ended up with double hernia and screwed by WCB hung out to dry (Real...'shocker' there!).
Like 'Older and Wiser's' experience, just had surgery last week and experienced this excruciating problem afterwards with absolutely '0' mention from any of the Dr's nor nurses etc before being released.
Upon frantically searching internet for my own solutions, I came across one fellow's suggestion here that is the only thing that worked for me thankfully! He suggested lessening pain killer dosage(Tylenol 3's), taking Senekot (laxative) drinking cranberry and hot tea continuously until urination and bowel movements move through. (Bowel movement was absolutely agonizing as well...nearly 4 hours trying to pass stool, read that the kidneys can literally explode and was so close to this it was scary!!!!)
Alarming and completely disconcerting the lack of concern or caring from medical professionals really, and find it deplorable that none of the 'Dr's' commenting here have any solutions whatsoever....SCARY. The medical community need to look in the mirror and ask themselves would they like to be informed and truly ask what the hell is going on here??!
Hope this helps those suffering from the neglect of the providers and hospital staff's moral obligation and duty. If they don't know, then they surely need to be retrained or replaced.
Joel Moskowitz on December 30, 2016:
Just went through two traumatic knee surgeries on the same knee, six weeks after the two surgeries still have issues urinating, I am very concerned that this will become permanent condition. I am very upset that the Anesthesia caused this situation.
william goode on December 12, 2016:
Hi. I read the article and comments and I'm interested in finding out what drugs are available for preventing urinary retention after surgery for people with bph. Also, are they effective?
Reggie Fairfax on October 31, 2016:
Revisitation to elbow prosthesis replacement on 11 October 2016. Operation took seven hours. Indwelling catheter inserted during operation & remained in place for five further days. For two days urination was normal. Upon release home after eight days retention began with a vengeance. Luckily I had unused catheters at home from a previous, but not similar, problem. It is now 31 October 2016 & the retention remains exactly as initially. Pain, apparently in penis, void 150 - 200 cc, more pain, relief for about an hour, then same again. Catheterisation yields between 400 & 700 cc. & a urination free period of about three to four hours. Then repetition of above. No warning was given in the hospital that this could occur. My GP assured me the retention would cure itself with time, though she gave no specific period. Your article has been most reassuring to realise I am not alone. I am male & 77 years of age.
Yvonne on October 10, 2016:
Please could anyone tell me which drugs are used to counteract the effects of anesthesia on the area of the brain that controls urination?
Three months post op' my husband still has a catheter.
Phil Beeson on October 07, 2016:
Had back surgery 9/12/16 and a good job was done by my surgeon. No after pain. However the catheter remains to this day 10/7/16. Today I have an appointment with a urologist and am hope full for a good outcome.
Irene on August 29, 2016:
I visited my father today who is 58 years old at the Rehabilation Center. He had a lower back surgery five days ago. I found out that he has a problem emptying his bladder. I did not ask anyone there and got so concern when I got home. I surf on the internet about this problem and I found your article. It's helps me a lot to understand by reading it and by reading some of the comments. I hope he will recover soon. This is his first surgery and it's hard for me to see him in pain.
Older and wiser on August 25, 2016:
I had bilateral hernia repair yesterday The hospital staff made sure I urinated before and after surgery before sending me home. I was drinking a lot of water and passing too. I had terrible pain when I coughed so I took Wallgreen's version of Robitussen along with 600 mgs of Advil 3 times with 4 hour intervals. Coughing stopped pain subsided woke up this morning OMG no urine at all! Switched pain med to Tylenol and stopped cough meds. Drank cranberry juice lots of water thank God I was able to urine. Thanks for information
Floridagal on August 21, 2016:
I had spinal surgery on 8/4/16. It's now 8/28 and I'm just starting to urinate without pushing and only getting a small amount. I'm 65 and this is my 4th back surgery. I've never had this problem before. It is very painful because of the pain in my spine and pushing is almost more than I can take. I seem to do better after moving around during the day but when I get up at night, I have a terrible time emptying my bladder. No one ever told me about this problem.
forest lover on July 28, 2016:
Prior to hip replacement I had managed an enlarged prostate without medication with the usual stinging, dribbling, frequency etc. In recovery I could not urinate so they catheterized me. I was given a flowmax which did not really help. I struggled to produce a few drops with many failing attempts so they catheterized me again. This procedure was painful and the nurse knew it and apologized beforehand. After the second I passed undiluted blood with the attempts. Just before release a doctor I did not know came in and told be I should be catheterized upon release while waiting for a urologist exam. (Good thing I did not as my appointment is a one month wait) I fought this verbally as I was passing some urine, though very little. So the catheter was removed and I had two "successful " attempts where the ratio of urine in the catch bowl was around 500 cc and retained (seen by ultra sound hand instrument) was 50cc, if memory serves. This article is excellent and should be available to all patients with any kind of urine problem. The discharge doc seemed to think the third or more catheterizations would be better by getting a smaller catheter. Later the nurse told me she had never seen a smaller catheter. ( I wonder how that doc would have faired with a catheter, though he meant well and his advice was based upon sound experience of er trips and infections). They let me go with flow max and I am at home and urinating every couple hours with no blood. This article did not speak of the reason that supine periods drastically increase frequency of urination. Best wishes to all fellow travellers.
Mike on June 28, 2016:
I just had hip replacement surgery yesterday. Once I finally was able to urinated, I've been going every 30-60 minutes, but only small amounts. And when it hits me it's painful. This has been horrible since it's so hard to move with a new hip day 1 &2.
dilip on June 19, 2016:
I am 65.prostate surgery was done due to enlargement.Bleeding didnot stop post surgery and found tobe clotting factor 9 deficient.I am ok after the factor was injected.Before that the cystoscopy was done 3 times to remove clots in bladder.Now i am urinating drop by drop.there is retention of urine always.I will take an appointment of urologist again.
Adrianne on June 16, 2016:
My husband had thoracic laminectomy and fusion in April and was catheterised and still is. We are being told it will eventually return to normal, but this is taking a long time. He had a problem with his prostate before surgery, some years ago, but this is controlled with medication. He saw a urologist within two weeks of discharge, who said this would take time.. we don't really know what the problem is. He is 72.
Patient Modesty on September 03, 2015:
This was a well-written article. I appreciate you bringing attention to what factors could cause to urinary bladder retention after surgery. As the founder of Medical Patient Modesty (http://www.patientmodesty.org), a non-profit organization that works to educate patients about how to stand up for their rights to modesty and maximum amount of modesty for procedures, I am very concerned about how often unnecessary urinary catheterizations are done. One of our goals is to reduce number of unnecessary urinary catheterizations due to modesty concerns and complications such as UTI. I appreciate you mentioned that a catheter could cause UTI. I feel we need to educate patients and medical professionals about how to take precautions to reduce the chances that a patient would have urinary retention so urinary catheter can be avoided.
You can find an article about how informed consent is missing from urinary catheterizations at http://patientprivacyreview.blogspot.com/2013/05/i...
I could not find your email address. I would love to correspond with you via email further. You can find email address for MPM by going to the contact page.
slack on August 25, 2015:
Went in for minor surgery at VA hospital, peed before going under and was sent home afterwards without the slightest knowledge that I might not be able to pee. Which is exactly what happened. Languished til 4:00 in the morning, with the urge to go but inability to do so before driving frantically to the e.r. where they shoved down a catheter. My first and hopefully my last. ..who knew???...5 days later still trying to recover.
bill tramontozzi on May 06, 2015:
I have bph. Biopsy on my prostate shows no cancer. I had this problem twice. Once with a colonoscopy and once with double hernia laposcopic surgery. Both times I ended up going the the emergency room and both times a catheter was inserted. Very uncomfortable and leary about future surgery if needed.
felix on October 19, 2014:
if you have complicated urinary tract issues on the west coast please see Dr Joel Gelman in Orange California. If you have the same problem on the East Coast please see doctor purohit at the uro center in New York City.
rather be hiking on September 28, 2014:
I recently had outpatient surgery under general anesthesia. I was sent home without voiding. I went 11 hrs without going & ended up in ER. I was vomiting & very dehydrated. I was admitted and became very sick. I'm a healthy active young 45yr old & can not believe that this happened. Its been a week aand I'm still trying to recover. All this because I should of never been sent home without peeing! I hope this never happens to anyone else.
wetweather on November 27, 2013:
Thank you. This explanation was very helpful.
Yesterday, I had minor surgery. I was not allowed to go to the bathroom before surgery (even though I asked) but kept getting more IV fluids for about two hours. When I awoke in recovery, I was panicky and shaking and desperate to go the bathroom. I've had surgery before, but never felt panicked. I was terrified and cried. I begged to go to the bathroom but the nurse assured me I would have been catheterized during surgery and said I did not need to go. I kept asking and they finally let me get up and go. It turned out I had wet myself and was soaked and still plenty for the bathroom. I think I was like that 75 year old man. If I have to have surgery again, I guess I'll make sure I go first and ask them to dial back on the IV fluids. I'm not that big.
John on July 23, 2013:
A great read
Jmillis2006 from North Carolina on February 11, 2013:
Great hub, this actually happened to me in 2006 after a hernia repair surgery, the surgery was outpatient but I ended up back in the ER later that day because of this and had to have a catheter for 5 days. Worst experience ever. Voted up.
Funom Theophilus Makama from Europe on December 30, 2012:
Keep up with the good work. This is your second medical hub I am digesting today. I think I really would want to learn a lot from you.
buckwheats on July 19, 2012:
for sure! thank you!
TahoeDoc (author) from Lake Tahoe, California on July 19, 2012:
Wow, buckwheats- you are certainly dealing with a lot, yourself. All I hope is that people who have their health never take it for granted (which is really easy to do, until you don't have it).
Take care of yourself and thanks for stopping by.
buckwheats on July 14, 2012:
i have been trying to find the right place to tell you that i have an ostomy not because of UC but IC. I had my bladder removed 13 years ago and it never cured the frequency. i can hardly leave my home because it is so extreme. i am sorry you have had a battle with UC. A close friend of mind is presently fighting for his life again as a result.
TahoeDoc (author) from Lake Tahoe, California on June 22, 2012:
Shane- sorry, it sounds like you are pretty miserable and I'm sure you are getting frustrated by not having any answers.
Unfortunately, I don't have any either. I can't find any good literature about the effects of marijuana on the bladder, except to increase the risk of bladder cancer. I'm not suggesting you have bladder cancer as they would have (most likely) seen this on the cystoscopy if you did.
It is used to treat urinary incontinence - the loss of urine when you don't want to. It seems possible that if it can prevent incontinence, maybe it goes farther in some people and causes retention. I have no good scientific basis to say that, though. It's purely speculation.
The anesthesia can cause temporary retention as you read in this hub. It should not cause long-term problems, though.
You are in the right place with the urologist. If you don't get answers, don't be afraid to ask more questions. Also, make sure they know about the mj use as they may have more knowledge about potential effects on the urinary system.
I wish I could help you but this is really out of the scope of my practice. Follow up with the urologist. Sorry Shane :(
Good luck! I hope you get some answers soon.
shane on June 22, 2012:
my name is shane im 25 years old and i have been experiencing bladder problems for quite some time. It seems to be worse after a surgery or when i have smoked marajuana sometimes not emptying at all. I have been to see a urologist and had cystocpy and uradynamics test back yet to no avail. If anyone could give me some insight that would be fantastic as its starting affect my life and make a single trip to the toilet a nightmare. My email is email@example.com if anyone can get back to me that would be fantastic
TahoeDoc (author) from Lake Tahoe, California on May 21, 2012:
Thanks everyone! I was reminded of this issue again the other day when my patient could't pee after surgery. Took a while, but we got her home with no problems :) This is really very common I'm glad you all find it 'readable'. That means a lot.
Amy Gillie from Indiana on April 21, 2012:
This is such an interesting hub! I love the diagrams and sidebars. And, I feel like I completely understand the condition and its causes. Voted up!
alliemacb from Scotland on April 21, 2012:
This is a great hub and very interesting to read. The way you set out the main points, along with the video and diagrams made the topic easy to understand. Voted up.
Horatio Plot from Bedfordshire, England. on April 21, 2012:
You made what could have been a boring piece of text really interesting. Held my attention all the way through. What a great bit of writing. Loved the "From the Operating Room..." section. House, eat you heart out.
I love stuff where I know more at the end than I did at the beginning. Up and shared.
Holle Abee from Georgia on April 17, 2012:
Wow - I love the way you explained this. Luckily, I've never had a problem "going" after surgeries. I was already to go home! lol. Voted up!
Marcy Goodfleisch from Planet Earth on April 16, 2012:
Excellent and very informative hub! I had not heard this was an actual diagnosis, but I've known of it happening, and it is extremely uncomfortable for the patient. It is so helpful for those of us who are non-scientific to have understandable information about things we might encounter.
Voted up, useful and interesting!
TahoeDoc (author) from Lake Tahoe, California on April 16, 2012:
Thanks for the reminder Dr. Kate- I wanted to include a reference to a great article for health care providers. I will go add it now. This was a tough one to write because more words would be WAY boring and too few words would not provide enough explanation. I hope this helps some curious souls understand this common issue.
FutureDrKate on April 16, 2012:
Great hub! Voted up. I had forgotten a lot of the physiology. I always wondered about this because on some services the residents would keep patients till they voided and then on other ones I would assume that and they would ask if we were anywhere near the bladder (ex after thyroid surgery).