Examination

Examination of a Patient with Retention

A distended bladder arises from the pelvis and one is unable to get below it unlike other abdominal masses. It is usually midline fixed and dull to percussion. Huge bladders may rise above the umbilicus although this is unusual. A careful inspection of the external genitalia for phimosis, trauma blood or vesicles.

Digital rectal examination (DRE) is of great importance not only to assess the prostate, but also anal sphincter tone. It should be considered after catheterisation with patient consent and with a chaperone present. The size, consistency and contour of the prostate gland should be documented.

Learning Bite:

Do not forget to examine and document perianal sensation and tone to exclude cauda equina syndrome.

Bladder scanning is increasingly available not only in the emergency department, but also on medical wards. These scanners allow staff to follow simple instructions, and an algorithm calculates bladder volume. Increasingly ultrasound (US) is a prerequisite in the placement of a catheter and decreases the dangers inherent in catheterisation where the diagnosis of retention is in doubt.