Voiding dysfuntion is a broad term to encompass any abnormality with storing or expelling urine. Voiding dysfunction can be divided into irritative and obstructive voiding symptoms.
Irritative symptoms include frequency to void, waking at night to void, urgency, pain with urination and urge incontinence. Patients with these symptoms are first evaluated with history and physical exam, urine analysis and possibly a measure of the residual volume after voiding (bladder ultrasound). Causes of these symptoms include some of the following; urinary tract infection, stones, 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, aging and commonly idiopathic (no cause is identified). After reversible causes are ruled out (ie.; treatment of UTI or removal of stone) the remaining causes are treated using a care path 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, medications, Botox, InterStim and posterior tibial nerve stimulation. Patients found to have bladder outlet obstruction are treated with measures identified in the Obstructive symptoms section.
Obstructive voiding symptoms include poor force of urine stream, straining, slow to get started or finish stream, dribbling at the end of stream, incomplete emptying, inability to void, and 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 measure of the residual volume after voiding (bladder ultrasound). 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 those with strictures and their treatment is likely surgical. Finally, patients with a poorly or non contracting bladder may be treated with multiple modalities including medication and InterStim.
Dr. Michael Scolieri is a board certified urologist specializing in female urology, female pelvic medicine and reconstructive surgery at Northeastern Ohio Urological Surgeons in Canfield, Salem and Alliance Ohio.