urology Voiding difficulties

Voiding Difficulty is a condition when the Patient find the passing of urine to be slow and intermittent. She gets a feeling that  urine has not been completely voided. This condition might begin suddenly without any warning or develop gradually. This problem may not be associated with pain. The condition might develop in such a way that one day the patient unable to pass urine completely that results in the bladder becoming distended and the urine overflowing.

It is very important to diagnose the disease early to prevent an acute retention of urine and the bladder and kidneys sustaining injuries from overstretching. This might lead to a chronic urine retention. The larger the amount of the urine that had been retained in the bladder and the longer that this retention of urine persists, the longer it would take for the bladder to recover.

What are the general symptoms of the voiding difficulty?

The common symptoms of the voiding difficulty include:

  • strain to pass out urine
  • delay in initiating the urine flow
  • a slow or intermittent urine flow
  • increased frequency of  voiding
  • a sensation of incomplete bladder emptying
  • a strong feeling of need to pass out urine
  • frequent passing out of small amounts of urine
  • uncontrollable leakage of urine
  • an inability to pass urine leading to pain in the lower tummy

What are the different causes of voiding difficulty?

The voiding difficulty is generally caused due to an obstruction of the urethra or the urinary tract. There could be several reasons for this:

  • a vaginal infection
  • an infection in the urinary tract
  • severe prolapse in the pelvic organ, especially of the bladder ( cystocele) and the uterus, resulting in kinking of the urine pipe
  • postmenopausal changes of the genital and urinary tract and the vagina
  • a complication of surgery for a pelvic organ prolapse or a stress incontinence of the urinary system
  • difficult vaginal or instrumental delivery after a prolonged labour, especially with the help if epidural for pain relief
  • constipation
  • side effects of medications
  • uterine fibroids situated in the back wall of the womb
  • mucocele or cyst of the para urethral glands.
  • Urethral curuncle.

Lazy Bladder Syndrome

Due to unavailability of proper toilets ladies tend to post pone voiding thus retaining lot of urine for prolonged time. This over a prolonged period of time leads to bladder muscle  weakening and resulting “ lazy bladder”. Bladder sensation of fullness of urine is delayed, it cannot generate sufficient pressure to pass urine in a good stream, cannot completely evacuate urine. Thus it is very important to all of us to void promptly when ever there is sensation of fullness of bladder.

What are the treatment options available for the voiding difficulty in women?

The voiding difficulty can only be treated by treating the underlying cause of the condition. This could either be a vaginal infection, a urinary tract infection, swelling, pain, menopause, an inflammation, piles or constipation. An acute retention of urine is generally relieved by inserting a fine catheter  into the bladder and draining the urine into a urine bag to rest the bladder for a few days.
You would be encouraged to pass urine regularly after the removal of the catheter. Bladder scans would be performed at regular intervals to ensure that you would be able to void properly.
Obstruction to the out flow  of urine is treated surgically. Urethral Stenosis is dilated, prolapse is surgically corrected. Large fibroids are treated by hysterectomy. Urethral mucocle or curunle is excised.

Voiding Difficulty should be treated without any delay to relive symptoms and  prevent any chronic damage to urinary system.

Authored By : Dr. Mahendra Jain

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Dr. Mahendra Jain

MBBS.MS.MCh.DNB Consultant Urologist

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