Tricks to Deal with AUR (acute urinary retention)

Under the SilGro home page for Alan Silverstein and Cathie Grow
Email me at ajs@frii.com
Last update: August 6, 2026

This webpage shares my personal collection of ideas for what to try when all of a sudden (or perhaps over the course of a few hours), as an aging male with BPH (benign prostatic hyperplasia), you find yourself completely unable to urinate. This is a serious medical emergency.

First here is some background information about this webpage, and some "free advice" on living with BPH.

Since my body didn't come with an instruction manual, I seem to be writing my own!

Standard disclaimer: I am not a doctor. This is not medical advice. I offer this just in case it helps you with useful ideas. Personal discretion is advised.

First of all: Don't panic. Paradoxically you need to relax as much as you can, even though the clock is ticking to get to an ER if you can't fix the problem yourself, say by using any of the methods below.

AUR reminders (specific to the author! whose AUR almost always happens early in the night):

• late in the day, avoid salty or gassy food, or drinking too much fluid
• some say to avoid decongestants (like pseudoephedrine), or cold meds in general
• BM before bed if needed (reduce rectal pressure)
• any time awake at night, go pee even if the urge isn't strong ("strategic voiding"), to be empty as possible and buy more time if you wake up later with AUR

• immediately upon AUR, take one Azo plus one acetaminophen (in case they help later)
• walk around some, relax! (difficult to do with increasing distended bladder pain)
• if it's cold indoors, add a housecoat or something to stay warm

• take several deep breaths through nose, like smelling a rose, dropping and relaxing both diaphragm and pelvic floor
• legs spread, lean forward 1-2' against a wall, breathe deeply and slowly
• slow leg squats and rises (often work for me); or twist squat: wider stance, a bit deeper, gently shift weight left to right
• perineal press: two fingers, firm pressure up and back between scrotum and anus
• imagine a waterfall, hear dripping water, trickle warm water over your hands, or stick them in some warm water
• pee into a flat bucket instead of a toilet or jug (minimize reflex erection)
• try lifting buttocks with both hands!
• lie down again a while, rest bladder, repeat

• stand/squat in bathtub with 1" hot water (Cathie's brilliant idea!), also dripping water in for relaxing sound, and again pee into flat tub
• (similarly) rest testicles in a container of the hottest water you can stand
• (similarly) hot bath or shower

• self-catheterization or ER (groan) before excessive bladder distension

For the record, these suggestions don't seem to work for me:

• sit down on toilet
• press between belly button and groin (painful)
• hot compress in same location (also painful)
• sacral tap: gentle rhythmic tapping with hand on flat bone just above tailbone
• double Azo ASAP (one time some years ago it produced incontinence hours later)
• extra tamsulosin dose (that ship has sailed, I'm on 2x/night now)

Every single one of these moves is designed to do the same thing: Disrupt the micro-pressure behind your large prostate and swing that median lobe door open.