Dr Moses de Gaulle Dogbatsey
IT is commonly known that men suffer from urinary problems due to the prostate gland getting infected, enlarged or becoming cancerous, but little is known of women suffering from similar urinary symptoms not caused by the prostate, but as a result of other reasons. While voiding dysfunction (urination problems) has been adequately studied in men, female voiding dysfunction is considered complex in nature, poorly understood and difficult to treat. Consensus on its standard definition,diagnosis and management is poor. voiding disorders or lower urinary tract symptoms, (LUTS) in women are common and they may remain untreated until the patient presents with troublesome symptoms such as urine retention, renal insufficiency (Kidney problems), recurrent urinary tract infections, or overflow incontinence, especially in those who suffer bladder outletobstruction.
Women with voiding dysfunction experience a greater degree of depression and anxiety compared with asymptomatic controls and bother scores are significantly higher among women compared to men (7.55 versus 4.81; P <.001). Symptoms of voiding dysfunction and storage symptoms, such as, frequency, urgency and nocturia, may coexist, making diagnosis and management even more challenging. Voiding dysfunction symptoms are commonly associated with post- micturition symptoms and women may also complain of concomitant stress and urgency urinary incontinence.
Causes Voiding dysfunction is associated with age and pelvic organ prolapse. A history of hysterectomy (removal of the uterus) and continence surgery increase the risk of voiding dysfunction. The causes of female voiding dysfunction can be broadly divided into detrusor (urinary bladder muscle) underactivity and bladder outlet obstruction (BOO). These may be physiological, neurogenic (due to problems of the nerves) or Iatrogenic (caused by the doctor).
Detrusor underactivity is defined as the ‘contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span’.
Bladder outlet obstruction is ‘the generic term for (physical) obstruction during voiding and is characterised by increased detrusor pressure and reduced urine flow rate’.
Physiological causers of bladder outlet obstruction comprise urogenital prolapse, urethral stricture, or obstruction.
There may be Iatrogenic causes (caused by the doctor) and that they include urethral trauma, surgery for continence, or prolapse, or both.
Neurological conditions, such as, multiple sclerosis or spinal cord compression may present with symptoms of altered voiding.
Urinary disturbances and voiding symptoms are observed in sufferers of Parkinson’s disease and results in negative impact to the individual’s quality of life.
The LUTS are categorised as follows, bladder storage symptoms, which are experienced during the storage phase; frequency (increased urination during daytime); nocturia (waking at night one or more times to void); urgency (unable to hold or control urination) and overactive bladder (urinary bladder over reacting to expel urine when it is not due for emptying)
There is the incontinence syphons. These happen when the urethral sphincter or the valves that controls the opening and closing of the urinary bladder are not functioning properly resulting urinary incontinence (urine leaking without control) and there are various types. Investigation
Patients with voiding dysfunction should be investigated with a urine analysis, uroflowrnetry and post-void residual urine.
If the free flow rate is abnormally low, filling cytometry with pressure flow studies will help to determine whether the cause is ‘detrusor underactivity or bladder outlet obstruction.
If bladder outlet obstruction is suspected then urethral pressure profilometry may help in the diagnosis of a urethral stenosis or obstruction. Video cystourethrography can provide more information regarding lower urinary tract function and anatomy, voiding difficulties following continence surgery, any other pelvic surgery or where a neurogenic cause of voiding dysfunction is suspected.
There are various ways to treat and manage LUTS in women
The first is the non-pharmacological conservative treatments, which involve pelvic floor muscle training, bladder training, behavioural modification, bladder reflex triggering and bladder expression.
The other interventions are pessaries for pelvic organ prolapse, electrical or magnetic stimulation and catheterisation- using urethral catheter (a rubber either indwelling or put in and out of the urethral.
There are also the surgical interventions, which involves various surgical procedures aimed at correcting the problem.
Last but not least, is herbal treatment. There is a reasonable herbal alternative treatment.
The writer is a pharmacologists and CEO of Medi Moses Medical Centre