Various underlying conditions can give rise to different kinds of urinary symptoms which may have similar, overlapping or different symptoms.
For example an infection can lead to frequent painful urination , an enlargement of prostate can lead to frequent urination, urgency, hesitancy and leakage.
Incontinence may be problem in elderly females.
Various Symptoms of Urinary Problems
Frequent symptoms of a urinary problem include
- Frequency of urination
- Nocturia – Increase in night time frequency of urine
- Hesitancy – Difficulty in starting urination
- Anuria or absence of urine
- Polyuria – Increase in quantity of urine
- Burning urination
- Frequency – Frequent urge to urinate without the ability to pass a desired amount of urine
- Urgency – Need to urinate becomes urgent
- Retention of Urine – Feeling of incompletely emptying of your bladder.
- Hematuria – Blood in the urine
- Incontinence – Leakage of urine
Various conditions which give rise to these Symptoms
Increased Frequency of Micturition and Nocturia
- Interstitial cystitis
- Radiation therapy
- Bladder dysfunction
- Bladder cancer
- Small contracted bladder
- Bladder or urethral tumors
- Vesicular calculus
- Prostate enlargement
- Stricture of urethra
- Incompetent internal urethral sphincter
- Ectopic ureter
- Pinhole meatus
- Surrounding mass lesion.
Urgency of Urine
- Cerebrovascular accidents
- cerebral tumors
- head injuries
- Enlarged prostate
- Bladder neck obstruction
- Alcohol, caffeine and artificial sweeteners
- Bladder conditions and stones
- Bladder irritation
- Interstitial cystitis
- Urge incontinence
- Urinary tract infection
- Blocked urine flow
- Urinary Retention
- Urinary Incontinence
Anuria or Absence of Urine
- Polycystic kidne
- Chronic renal failure
- Nephrotoxic drugs
- Autoimmune diseases like systemic lupus erythematosus.
- Diarrhea and vomiting
- Blood loss
- Intravascular hemolysis
- Calculi in kidney or urinary tract
- Blockage of ureters by malignancy or crystals
- Retroperitoneal fibrosis
- Accidental ligation of ureter during surgery
Retention of Urine
This problem may be acute or chronic
Blockages in the urinary system due to urinary tract stones or birth defects
- Narrowing of the urethra due to scarring from injury or infection
- Benign enlargement of the prostate gland
- Nerve or bladder muscle problems
- Prostate cancer or kidney stones
- Side effects from some medications, such as antihistamines
- Spinal cord diseases – Transverse and compression myelitis
- Cauda equina lesions
- Multiple sclerosis.
- Posterior urethral valves
- Foreign body in urethra
- Stricture of urethera
- Rupture of urethera
- Spasm of the bladder sphincter
- Prostatic enlargement
- Bladder atony, tumor, stone, or compression by fibroids or retroverted uterus.
- Drugs: Sympathomimetic agents, salbutamol, terbutaline, anti-cholinergic drugs, etc.
- Viral infections
- Cancers of renal system
- Renal stones
- Urinary tract obstruction
- Medications that thin the
- Benign prostate enlargement.
- Drying of vagina or female urethra, particularly after menopause
- Inflamed prostate gland or prostate surgery in men
- Automatic bladder
- Spine injuries
- Prolonged immobilization
- Urinary tract infection
- Elevated calcium levels
Diagnosis of Urinary Problems
Diagnosis making in urinary problems require a detailed history and physical examination.
- What is the presenting complaint
- Details of presenting complaint and timeline of its occurrence.
- Any exaggerating factors
- Daily void schedule including night time wake up frequency?
- Any of the following urinary symptoms
- Painful urination
- Hematuria, discharge
- Lower abdominal pain with urination
- Any muscle weakness, numbness, or tingling
- Alcohol, tobacco or drug usage
- Exposure to toxic substance for the last 25 or more years
- History of kidney stones
- Any injuries and infections
- Recent illness
- Urinary or voiding history
- Examination of external urinary organs – inspection, palpation
- Per rectal examination to assess the prostate gland in males
- Examination of abdomen and spine
- Urine examination to look for pus cells, glucose, blood and protein
- Culture and sensitivity test
- Special urological studies like pressure studies
- Blood investigations may be done for infection [CBC, ESR, CRP] , renal function test and other parameters
Immediate Treatment Measures
This is required in case of acute urinary retention. A thin, flexible tube, known as a catheter, is placed through your urethra to your bladder to release the urine.
In some cases, such as urethral strictures or big prostate, it may not be possible to pass the catheter successfully. In such cases, a procedure called suprapubic catheterization is done. In this, a special catheter is placed per abdomen into the bladder under local anesthesia.
Treatment of Urinary Problems
The treatment of urinary problem depends on the diagnosis. For example in case of urinary infection, antibiotics and hydration is the usual treatment. If there is benign enlargement of the prostate which is causing the symptom, the patient might benefit from drug therapy and in some cases prostate surgery.
The treatment would vary from disease to disease and person to person as patient profile needs to be taken into account for the treatment
Some treatments are carried on outpatient basis whereas others would require admission in the hospital.
Apart from medical and surgical treatment bladder and bowel training, special diet, Kegel exercises, medications, and treatment of muscle spasms may be required.
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