Handling the Patient Unable to Provide Sufficient Urine for Testing (Shy Bladder Syndrome)

 

The minimum volume for urine drug testing is 45 mL.

 

Causes of inability to produce a specimen of sufficient volume (generically referred to as "shy bladder"):

(1) transient dehydration

(2) anuria or oliguria associated with renal failure

(3) urinary tract obstruction

(4) paruresis (psychological inability to urinate in public bathrooms or in front of others)

(5) subterfuge to avoid drug testing

(6) subterfuge to delay return to work

 

General rules:

(1) If a person claims upon arrival that he or she is unable to produce a urine specimen, the person is instructed to make the attempt anyway.

(2) Several urine specimens of lesser volumes should not be combined.

(3) Excess urine can be discarded.

(4) If absolutely no urine was produced, a urine container may be used for the next attempt and the same form can be used.

(5) If a specimen with inadequate volume has a temperature within range, then the specimen is discarded and a second attempt is made using a new container.

(6) If a specimen with inadequate volume has signs of tampering, adulteration or a temperature out of range (a certain volume of urine is required to activate the temperature strip), then this specimen is submitted for analysis and another specimen is collected under direct observation.

(7) If the person is unable to produce an adequate volume, then the person is encouraged to drink 40 ounces of a fluid over a 3 hour period or until the patient is able to produce a urine specimen. Refusal to drink the fluid is not a refusal to test. The time that the 3 hour period starts and ends should be recorded on the form.

 

If after 3 hours the patient has been unable to produce a urine specimen, then the patient must be evaluated by a physician acceptable to the MRO who is able to determine if there is a medical condition that may explain the inability to produce a specimen.

(1) If an examination by the physician demonstrates a physiologic explanation for the low urine volume, then the patient is evaluated for evidence of illicit drug use.

(2) In the situation where a negative drug test is a requirement for employment, and if the patient is unable to produce a urine specimen for documented reasons, then an alternative testing method (such as hair testing, sweat patch, blood test) or a combination of alternative methods can be considered.

 

Refusal to test includes:

(1) refusal to attempt specimen collection

(2) leaving the collection site before the collection process is complete

(3) absence of an adequate explanation (medical or psychological condition) for the inability to produce a specimen.

(4) refusal to be examined by a physician if indicated

 

The test is listed as cancelled if:

(1) the physiologic condition explaining the low urine output is not permanent or long-term

(2) if there are signs or symptoms of illicit drug use

(3) if patient has a permanent or long-term reason for oliguria and if the test is not for pre-employment, return-to-duty, or follow-up.