Voiding Dysfunction

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What is voiding dysfunction?

Voiding dysfunction is a general term for the problems associated with emptying the bladder. Voiding dysfunction, a diagnosis by symptoms and urodynamic investigations, is defined as abnormally slow and/or incomplete urination. This can occur in women with neurological issues, pelvic floor problems including vaginal prolapse and those with previous pelvic surgery.

What are the symptoms?

Women with voiding dysfunction can have some or all of the following symptoms:

  • Hesitancy (complaint of a delay in initiating micturition (urination)
  • Slow stream
  • Straining to void
  • Incomplete bladder emptying
  • Sudden, strong urges to urinate during the day or night
  • The need to urinate often
  • Incontinence
  • Difficulty during urination
  • Recurrent urinary tract infections
What are the causes?

Voiding dysfunction can be caused by inappropriate muscular activity in the muscles of the bladder wall, the muscles that control the starting or stoppage of the flow of urine out of the body or the muscles of the pelvic floor. It can also be caused by neurological impairment and certain medications. 

How is it diagnosed?

Voiding dysfunction can be diagnosed using a number of tests that include:

MSU - Mid-stream urine testing (MSU) checks for bladder infection (cystitis). Urine is collected midstream in a sterile container and tested for possible infection. If an infection is present, then appropriate antibiotics are administered to manage the infection. Often, antibiotics are started before the test results are available especially if they symptoms present are highly suggestive of a bladder infection.

Urodynamics - Urodynamics is a way of testing the functions and behaviours of the bladder and urethra. It requires the placement of a very small tube in the bladder and another tube in either the vagina or rectum. Sterile fluid is then used to fill the bladder so that the behaviour of the bladder as it is getting filled can be determined. One part of the urodynamics testing involves women voiding into a special toilet followed by measurement of remaining volume of urine left behind in the bladder using a bladder scan.

This type of testing should not be painful. The catheters are very small and an anaesthetic gel may be used if it is required.

Treatment

Voiding posture
A good voiding posture is where you have your feet flat on the floor and bending over with elbows on the knees. This helps in better flow of urine. Double voiding is another technique where once urination is completed, patient is asked to lean back and count up to 10, then lean forward back again to the good voiding position. This helps in better emptying of the bladder.

Urethral dilation
This is a procedure where urethra is widened using some small metal dilators. This is helpful if there is any obstruction to the urethra that needs dilation. This helps to get a better stream of urination.

Clean Intermittent Self Catheterisation
This is where the woman is taught to self catheterise herself. This is done in situations where the voiding problem is severe and causing recurrent urinary tract infections. Though sounds difficult, once taught it is done relatively easy. In most situations, it needs to be done only twice a day.  If done appropriately, the risk of urinary tract infections is very low.

In dwelling catheter
A small soft, flexible plastic tube is inserted into the urethra to drain the bladder permanently. The tube is changed every 3 months and this can be done by a nurse or your GP. This is done only in situations where the woman is unable to catheterise herself due to various reasons like impaired mobility. There is a risk of urinary tract infection but this can be treated easily.

Suprapubic catheter
The initial insertion of the suprapubic catheter is done under general anaesthesia. The small, soft, flexible, plastic tube is inserted into the bladder directly through a small stab incision in the middle of the bikini line. This catheter needs to be changed every 3 months as well. The risk of urinary tract infection is relatively low with this catheter. This is done for women who are not suitable for in dwelling catheter