Urination difficulty at a glance:
- Having trouble urinating – also referred to as voiding difficulty – is caused by an underlying mechanical problem with the coordination between the urethra and the bladder muscle that allows urine to freely pass.
- Urination problems include difficulty initiating urination and impaired bladder emptying, as well as urinary incontinence.
- Urine voiding problems in women can be caused by a variety of conditions, including urinary retention, prolapsed bladder, urinary tract infections, and the effects of menopause and pregnancy.
- Symptoms are painful urination, difficulty starting the urine stream, a sense of incomplete bladder voiding, and sometimes an inability to urinate—an emergency situation known as acute urinary retention that requires immediate treatment.
- Treatments for voiding problems depend upon the underlying cause, but may include bladder muscle conditioning, medications, implant devices and surgery.
Causes of urination problems
Incomplete bladder voiding often goes unnoticed until it reaches its end stage, known as overflow incontinence. Overflow incontinence can be caused by nerve damage (from diabetes or multiple sclerosis) or by a blockage in the urinary tract, such as a kidney stone, or a urinary tract tumor that constricts the urethra.
Some common causes of voiding difficulty include:
- Urinary retention, partial or complete, which has three main causes.
- A hypotonic bladder, also called a lazy or neurogenic bladder, which causes the bladder to not contract properly and completely empty the bladder.
- Vaginal prolapse, in which vaginal structures can press the urethra and block the passage of urine.
- Dysfunctional voiding occurs when the muscles around the urethra do not relax properly during urination to allow a free flow. Spinal cord injuries, a herniated disc, infectious neurological processes, and pelvic surgery or fractures can also cause incomplete voiding of the bladder.
- A prolapsed bladder, also called a fallen bladder: When the vaginal wall supporting the bladder weakens (often due to age), the bladder can prolapse, or descend into the vagina. Common causes are stress from childbirth, heavy lifting, straining during bowel movements, long-term constipation, and the menopausal lack of estrogen – a hormone that strengthens vaginal muscles. Obesity can also contribute to a prolapsed bladder.
- Urinary infections, which result from bacterial infection in the kidneys, ureters (tubes that carry urine to the bladder), bladder or urethra (the tube that releases urine from the bladder outside the body). Infections can be caused by sexual intercourse, partial blockage of the urinary passage, catheters, or stool contacting the vagina.
Symptoms of urination problems
When a woman has difficulty urinating, it is a sign of one of the underlying conditions described above. Each condition has its own set of specific symptoms.
Symptoms of urinary retention include having difficulty urinating, having the sense that the bladder has not completely emptied, trouble beginning the flow of urine, recurrent urinary infections, and a weak, slow or intermittent urine stream.
In addition to voiding difficulty, overflow incontinence symptoms can be a sudden release of urine, a feeling of bladder fullness after urination, a urine stream that stops and restarts, and urine leakage while sleeping.
Symptoms of urinary infections include difficulty voiding, a burning sensation or cramps in the lower back or abdomen, frequent urination or having an urgent need to urinate, urine that looks cloudy or has a strong odor, and a burning sensation during urination.
Women with prolapsed bladders often note a lump of tissue in the vagina, which may subside when they lie down. Other symptoms include difficulty emptying the bladder, a feeling of incomplete voiding, and pain or pressure in the pelvis. Symptoms of a prolapsed bladder may increase after being on your feet for a long time, or while lifting or straining.
Treatment of urination problems
Treatment for urination problems depends on the underlying cause. For example, urinary infections are most often treated with a course of antibiotics, such as penicillin or amoxicillin.
A prolapsed bladder, depending on its grade and other factors, may respond to estrogen replacement therapy (topical or oral) in conjunction with other treatments. A removable diaphragm-like device called a pessary may be worn in the vagina to hold the bladder in place. In other cases, surgery may be performed to secure the bladder in its correct position.
Symptoms of urinary retention can also be treated with a pessary. Medication may also be a treatment option for this condition.
Clean intermittent self-catheterization is another treatment option for urinary retention. A woman inserts a small tube through her urethra to drain the remaining urine from the bladder after urination.
InterStim ™ Therapy is a urinary retention treatment that involves the implantation of a small device the size of a deck of cards under the skin of the upper buttocks to gently stimulate the sacral nerve to help the bladder function properly.
Urination problems may also be treated by pelvic floor therapy, in which a physical therapist may use biofeedback, functional electrical stimulation, and bladder training techniques to help the nerves and muscles involved in emptying the bladder work better.
Contact us to request an appointment with one of our Urogynecologists to learn more about your treatment options.