Acute urinary retention is a common complaint seen by emergency room physicians, and oftentimes the cause is benign. However, as emergency providers, it is imperative to always consider red flag symptoms pertaining to acute urinary retention. Red flag symptoms for acute urinary retention include saddle anesthesia, lower extremity weakness, history of cancer, history of IV drug use, or urinary incontinence, which is a sequela of retention leading to overflow incontinence. These are the typical red flag symptoms that emergency physicians inquire about to help elucidate a high clinical concern for cord compression. Early recognition of cord compression is paramount as it can lead to high morbidity and mortality. Once this clinical diagnosis is recognized, rapid neurosurgical consultation and glucocorticoid treatment are warranted.