If you suffer from pain while urinating, blood in the urine (hematuria) or frequent urinary tract infections, it is time to consult a urologist. Marlon Perera is reputable urologist and expert in diagnosing and treating conditions of the urinary tract.
Using certain tests like a voiding chart and post-void residual test, a urologist can pinpoint the reason for your voiding problems.
Causes
The urinary tract consists of the bladder, kidneys, ureters and the tube that carries urine out of the body (the urethra). When the system functions normally, it allows people to store and empty urine as needed. Problems with storing or releasing urine are called voiding dysfunction Melbourne and can affect men and women of any age.
Voiding problems can stem from many conditions. For example, they may be related to bladder muscle weakness or a nerve disorder that causes dyssynergic striated sphincter activity. They can also be caused by blockages of the bladder, the urethra or both.
A urologist will typically start by asking about the patient’s medical history and performing a physical exam. They might order an imaging test, such as a CT scan or an MRI, to pinpoint the cause of the problem. They might also use a cystoscope, a long tube with a camera on the end, to examine the urethra and bladder for any signs of disease. They might also take a urine sample for testing and may prescribe medication to treat symptoms.
Men might be reluctant to talk about voiding problems with their doctors, but doing so can help them get the treatment they need. For example, a medication called duloxetine (Cymbalta) is used to treat depression but has been found to reduce the frequency of voiding episodes in some patients.
Symptoms
If the muscles of your bladder don’t coordinate with the tube that carries urine out of the body (the urethra), it may be difficult to empty your bladder completely. This lack of coordination is called voiding dysfunction. Voiding problems can occur in children and adults. In some cases, they are a result of underlying conditions like an enlarged prostate or a urethral stricture. In other cases, they are related to nerve-related malfunctions or abnormalities.
In children, voiding dysfunction can also be the result of behavior or bathroom habits. For example, some kids have a tendency to hold in their urine for long periods of time because they are too busy playing to stop and use the bathroom. In some cases, a child’s voiding problem is the result of a learning disability that interferes with their ability to recognize when they need to go.
In adults, voiding dysfunction can be caused by an enlarged prostate, a urethral stricture, or bladder stones. For these types of voiding issues, your doctor can help you manage your symptoms through medication or by performing minimally invasive surgery. In some cases, a urologist may recommend bladder training to retrain your bladder muscles to increase the strength of your urine stream. For patients who do not respond to medications or bladder training, a type of electrical stimulation called sacral neuromodulation may be recommended.
Diagnosis
Often, doctors can diagnose voiding problems by asking patients to keep a urination log and then analyzing it. They may also perform a physical exam or use uroflowmetry, which measures how much urine is produced and the strength of a person’s urinary stream.
A urologist can recommend bladder training for adults with non-neurogenic voiding dysfunction. This involves delaying the urge to urinate, so the bladder muscles learn to relax and hold more urine. Then, a patient can gradually increase the amount of time between urination until they reach a safe limit. Behavioral therapy can also help strengthen the pelvic floor muscles and prevent urine leakage.
In men, voiding dysfunction can be due to an enlarged prostate or urethral stricture disease. In some cases, a man can get a catheter to help prevent leaking. A urologist can also prescribe medication to treat the condition or perform surgery.
Non-neurogenic voiding dysfunction in women can be caused by pregnancy, urinary tract infections or pelvic inflammatory disease. It can also be the result of unaddressed childhood voiding dysfunction, which often leads to an overactive bladder as an adult.
Pediatric urologists at Riley at IU Health have extensive experience diagnosing and treating problems with children’s anatomy, physiology or bathroom habits that cause voiding problems. In addition, they’re experts at finding the root causes of recurring incontinence and urinary tract infections that can damage kidney function.
Treatment
Depending on the type of voiding dysfunction, treatment options range from medications and bladder “training” to surgery. Often, patients with neurogenic voiding disorders may require intermittent self-catheterization to manage the condition. These are devices that can be inserted into the urinary tract to temporarily empty the bladder during periods when there’s an urge to urinate but the urethral sphincter is unable to relax. These are also called timed voiding catheters. Other treatments include medication, such as muscle relaxants, to manage nerve signals that trigger bladder muscles to contract.
Non-neurogenic voiding problems are usually the result of weak bladder muscles and blockages in the flow of urine. Symptoms can include daytime or nighttime wetting, a feeling that the bladder is always full, and a sudden urge to urinate with leakage of urine (urge incontinence).
The key to treating these conditions is making sure the correct diagnosis is made. For example, a man with symptoms of voiding dysfunction might have both an overactive bladder and an enlarged prostate (benign prostatic hyperplasia — BPH). Having the right diagnosis ensures that appropriate medications are prescribed to address each problem. For example, the BPH is treated with alpha-blockers that help to relax the prostate so it can urinate more easily. This prevents the buildup of bacteria in the bladder that can cause a UTI.
