The bladder and urethra are among the main parts of the urinary system that have to work together to effectively manage urination habits. When this doesn't happen for one reason or another, it's known as a voiding dysfunction, which can affect both men and women.
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A voiding dysfunction is typically caused by over-active pelvic floor muscles. Other possible causes include nerve problems affecting the way bladder muscles contract and blockages within the tube that takes urine out of the body (urethra). Bladder stones and both cancerous and non-cancerous tumors are other possible causes of voiding issues. Urinary incontinence and interstitial cystitis may also contribute to voiding difficulties.
Voiding dysfunction symptoms are generally classified as lower urinary tract symptoms (LUTS). Men may have urination control difficulties related to an irritated, inflamed, or enlarged prostate gland. Such symptoms are common in approximately 40 percent of older men. Women may experience similar lower urinary tract symptoms that include slow or incomplete urination. LUTS symptoms may also include:
Diagnosis of a voiding dysfunction involves a physical examination. In addition to collecting a urine sample, a urologist may perform a test with a device called a uroflowmeter that shows urination patterns as a graph. A bladder ultrasound is sometimes done to determine if there is urine remaining in the bladder after voiding. The leftover urine is collected with a catheter. A special catheter with a pressure-measuring sensor might be used to test bladder pressure.
If symptoms are mild or moderate, pelvic floor therapy to improve the strength of bladder-supporting may be recommended as the first attempt at treating a voiding dysfunction. When symptoms are related to incomplete voiding, intermittent self-catheterization (ISC) may help minimize issues with bladder control.
If an overactive bladder is what's causing a voiding problem, muscle relaxants and similar medications that relax bladder muscles may be prescribed. Should patients not respond well to exercises or medication, a form of electrical stimulation called neuromodulation is sometimes suggested. It involves the use of an implanted device and related components to help control nerve signals being transmitted to and from the bladder.
With voiding dysfunctions related to underlying issues such as an enlarged prostate or urethral strictures (scar tissue), the problem is usually corrected once those issues are treated. In some cases, minimally invasive surgery is needed to address underlying causes of voiding dysfunctions.
It's possible to have a voiding dysfunction that goes away with little or no intervention. This is often the case with bladder control issues related to pregnancy or bladder infections that are treatable with medication. In some instances, changes to medication being taken for other reasons and bladder training can also restore normal urination patterns. Patients may benefit from preventative efforts such as maintaining a healthy weight, avoiding smoking and excessive alcohol consumption, and managing chronic conditions like diabetes that sometimes contribute to bladder issues.
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