What is Voiding Difficulty?
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?
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?
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
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.
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 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.