What are Voiding Disorders ?
…..Voiding disorders are common in women. As many as 14% of women with bladder symptoms were found to have voiding disorders. It may be defined by an abnormally slow flow of urine during voiding , when the maximum urine flow rate is less than 15 ml per second, or a sensation of incomplete emptying of the bladder, when the residual urine volume is over 30 ml, within one minute post voiding
What are the complications that may arise ?
….It is important to diagnose voiding disorders because if left unrecognized, they may cause frequent urinary tract infections. In more severe cases, the kidneys may be damaged by the continuous back pressure that is created by a full bladder.
What are the symptoms ?
Symptoms of voiding disorders include:
- Delay in initiating urination
- Slow urinary flow 3
- Sensation of incomplete emptying of the bladder
- The need to immediately urinate again
- The need to strain when urinating
Patients with voiding disorders may also have symptoms such as frequency, urgency, passing urine more than once at night, urinary incontinence, and urinary tract infection. Some patients may have associated prolapsed of the womb, bladder or rectum.
What are the causes ?
There are many causes of voiding disorders in women. Some may be temporary while others may be permanent. The causes include:
- Acute inflammation such as genital or urinary tract infection.
- Drugs such as epidural anaesthesia, oxybutynin, detrusitol and antidepressants.
- Nerve damage such as spinal cord injury and diabetic neuropathy.
- Psychological influences such as anxiety, hysteria and depression.
- Pelvic surgery and vaginal delivery.
- Obstruction due to pelvic organ prolapsed, faecal impaction and urethral narrowing.
- Overdistension of the bladder.
- Inability to relax the urethral sphincter during urinating.
What are the investigations ?
When you consult your doctor, a detailed history is first obtained, followed by a comprehensive urogynaecological and neurological examination to ascertain the possible causes of voiding disorders. Various investigations may be ordered and these include:
- Uroflowmetry – this measures the rate of urine flow during urinating.
- Residual Urine Volume – this is the amount of urine remaining in the bladder after urinating. It candbe measured either by a scan or by inserting a tube into the bladder to drain out the urine.
- Cystometry – bladder pressure is measured during urinating and it is then possible to diagnose if the bladder muscle is not contracting normally during urinating.
- Electromyography – this detects the contractions of the sphincter muscles during urinating.
- Radiology – X-rays and ultrasound scans to look for tumours, diverticulum and foreign bodies in the bladder, or enlarged kidneys caused by urinating disorders.
- Cystoscopy – used to look into the bladder and the urethra for foreign bodies, diverticulum or tumours.
What are the treatment options?
- Prevention and early recognition
Prevention of voiding disorders is important. After pelvic or continence surgery, the use of temporary catheterization can prevent the immediate post – operative bladder overdistension. Early recognition is crucial to achieve an early return to normal urinary function.
Drugs may be used to treat the underlying cause of the voiding disorders. A course of antibiotic or antiseptic may be used if there is an infection. In patients with anxiety disorders, a small dose of anti-anxiety medication or sleeping tablets may help. Vaginal oestrogen pessaries may be used if atrophic changes are implicated in the voiding difficulties. Some drugs may be used to improve bladder muscle contraction.
- Clean Intermittent Self Catheterisation (CISC)
In CISC, the patient is taught to insert a urinary catheter under clean conditions at regular intervals. This procedure is easy to learn. The use of CISC enables many women to live normal lives with efficient bladder emptying, free from discomfort and distress. For patients not willing or unsuitable to use CISC, indwelling catheters may be used.
- Surgical treatment
In cases where the urethral opening has narrowed, it can be dilated using metal rods called Hegar dilators. However the main disadvantage is that voiding difficulty may recur following healing and scarring of the dilated area. Often, repeated dilatations are needed. If the woman has a bladder or uterine prolapsed, surgery is recommended.
….Urinary disorders are common in women. If left unrecognized, and untreated, they may cause permanent damage to the bladder and the kidneys. Hence treatment should be started early and the causes dealt with promptly.
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