Management of Urinary Retention in Older Women

Urinary retention in older women is a clinically significant and often underdiagnosed condition with complex and multifactorial etiology. Age-related changes in bladder contractile function and bladder sensation, combined with common comorbidities such as neurologic disease, diabetic bladder dysfunction, and pelvic organ prolapse, substantially increase the risk of retention in this population. Medications commonly prescribed to older adults, including anticholinergics and antidepressants, are an often overlooked cause of urinary retention. Evaluation includes a thorough history, physical exam, medication reconciliation, and post-void residual volume, especially because symptoms of retention that are common in men are often non-specific in women. Management should be risk stratified, with acute retention requiring prompt bladder drainage and chronic urinary retention requiring assessment of symptom burden and risk of upper tract deterioration. Pharmacologic treatment options, such as alpha-blockers, have limited evidence in women and broader therapeutic options remain poorly studied in older female populations. Sacral neuromodulation can be effective for non-obstructive urinary retention in older women. This review highlights the critical need for sex-specific and age-specific trials to guide evidence-based patient-centered management of urinary retention in older women.