Urinary retention

Pediatric urinary retention is defined by a bladder volume exceeding expected capacity—calculated in ounces as age in years plus two—rather than the time elapsed since last voiding. While uncommon in children, its presence often stems from simple infections like cystitis or mechanical issues like severe constipation, where a distended rectum physically obstructs the bladder floor. More concerning etiologies include neurologic conditions such as transverse myelitis or acute disseminated encephalomyelitis (ADEM), which may present alongside ataxia or paresthesia. Effective management involves immediate bladder decompression via in-and-out catheterization for temporary causes, while a Foley catheter is preferred for chronic or neurologic concerns. Diagnostic protocols must include a urinalysis, a pregnancy test for adolescent females to rule out uterine displacement of the bladder, and a thorough neurologic exam to identify underlying spinal cord or pelvic nerve pathology.