Chronic idiopathic urinary retention and Fowler’s syndrome are a debilitating problem primarily affecting women, characterised by an inability to urinate in the absence of any identifiable structural or other cause. An increasingly wide range of multifactorial predisposing, precipitating, and perpetuating biopsychosocial factors are being recognised. This has led to interest in nonsurgical treatments that may complement existing surgical approaches. We reviewed existing literature on nonsurgical management and combined this information with collective multidisciplinary professional and lived experience, to produce a new definition of chronic idiopathic urinary retention (the Fife Definition) and a framework for the assessment and nonsurgical treatment for women with chronic idiopathic urinary retention. The article provides a stepped care approach to nonsurgical treatment including explanation and formulation, basic bladder healthcare, optimising catheterisation, management of relevant comorbidities, multidisciplinary treatment and additional treatment options and emerging therapies.
