Voiding dysfunction is a broad term to encompass any abnormality with storing or expelling urine. Voiding dysfunction can be divided into irritative and obstructive voiding symptoms.
Symptoms of Irritative Voiding Dysfunction include:
- Frequency to void
- Waking at night to void
- Pain with urination
- Urge incontinence
Patients with these symptoms are first evaluated with history and physical exam, urine analysis, and possibly a bladder ultrasound to measure the residual volume after voiding.
Causes of these symptoms may include:
- Urinary tract infection (UTI)
- Tumors of bladder or kidney
- Neurological disease (spinal cord injury, Parkinson’s disease, prior stroke, dementia, multiple sclerosis, brain tumor)
- Bladder outlet obstruction
- Pelvic floor dysfunction
- Idiopathic (no cause is identified – most common)
After reversible causes are ruled out, such as a treatment of UTI or removing stones the remaining causes are treated along the CUI CarePath for these symptoms. If the cause is not identified, further evaluation with urodynamics may be necessary. Treatments include behavioral modification and dietary changes, pelvic floor rehabilitation and biofeedback, Botox, InterStim, and posterior tibial nerve stimulation. Patients found to have bladder outlet obstruction are treated with measures identified in the Obstructive symptoms section.
Symptoms of Obstructive Voiding Dysfunction include:
- Poor force of urine stream
- Slow to get started or finish stream
- Dribbling at the end of stream
- Incomplete emptying
- Inability to void
- Spraying stream
These symptoms most commonly occur in men with enlarged prostate symptoms. They may however occur in men and women with strictures (narrowing scar of the urine channel) or with a dysfunctional bladder that has little ability to contract and ‘push the urine out.’ Patients with these symptoms are first evaluated with history and physical exam, urine analysis, and a bladder ultrasound to measure the residual volume after voiding. The majority of these patients can be effectively treated with a class of medications called alpha-blockers. These medications have little side effects and are very effective. Medications will not improve patients with strictures, and their treatment will likely be surgical. Finally, patients with a poorly or non-contracting bladder may be treated with multiple modalities including medication and InterStim.