Voiding Difficulty

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What is Voiding Difficulty

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Voiding difficulty is present :

When a woman finds that her passing of urine has become abnormally slow and intermittent (stopping and starting) or she feels that she has not completely relieved her urine after each void
It may begin suddenly or develop gradually
It is usually accompanied by lower abdominal pain or it may be painless
It may progress to the patient being unable to pass urine completely (acute retention of urine) resulting in the bladder becoming over distended (over stretched) and the retained urine overflows out (giving rise to overflow incontinence of urine)

Why is Voiding Difficulty important

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It is important to diagnose it early to prevent acute retention of urine and the bladder from sustaining over-stretch injury that may have the long term consequence of chronic retention of urine. The larger the amount of urine retained in the bladder and the longer the retention persists, the longer it will take for the bladder to recover.

What are the causes?

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Most of the difficulty in voiding arises from obstruction of the urethra (urine pipe), such as:

Urinary tract infection
Vaginal infection
Post menopausal changes of the vagina, genital and urinary tract
Severe pelvic organ prolapse, especially of the bladder (cystocoele) and -uterus (womb) causing kinking of the urine pipe
Complication of surgery for stress incontinence of urine or pelvic organ prolapse
After a prolonged labour, especially with epidural for pain relief, difficult vaginal or instrumental delivery with episiotomy (cut) or tears, piles and pain
End of first trimester of pregnancy (12-13 weeks) with a retroverted uterus (womb that is tilted backwards) causing the cervix (mouth of the womb) to push forwards onto the urethra (urine pipe) or bladder neck obstructing it
Uterine fibroid/s situated in the back wall of the womb causing the same effect as just mentioned above
Side effects of medications
Constipation

Bladder disorders due to neurological disease or chronic over-distension may also cause voiding difficulty.

Women with psychological impairment due to anxiety and depression may likewise present with these urinary problems.

Symptoms

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Some of the common symptoms include:

Delay in initiating urination
Slow or intermittent urine flow
Need to strain to pass urine
Sensation of incomplete bladder emptying
Need to repeat-void

You may also complain of:

Frequent passing of small amounts of urine
Strong feeling of need to pass urine
Inabilty to pass urine leading to pain in the lower tummy
Uncontrollable urinary leakage (overflow incontinence)

Treatment options

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Treatment of the cause, e.g., urinary tract infection, vaginal infection, menopause, pain, swelling, inflammation, constipation, piles.

Acute retention of urine is treated by inserting a fine catheter (latex or silastic tube) into the bladder to drain the urine into a urine bag to rest the bladder for a few days.

After the removal of the catheter you will be encouraged to pass urine regularly and a bladder scan would be performed to check that you are able to void well.

Post operation complications for stress incontinence of urine can be corrected within 1-2 weeks after surgery, e.g., by loosening the tape in TVT or TVT O.

Different bladder regimes would be taught for chronic retention of urine.

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2023/04/25