Difficulty urinating in men is noted in diseases of the urethra and bladder, damage to the prostate gland, some other andrological pathologies and oncological processes. Occurs acutely or develops gradually, usually combined with other dysuric disorders. To determine the cause of micturition difficulties, a survey, external examination, digital rectal examination are carried out, hardware and laboratory examinations are prescribed. Treatment includes drug therapy, physical therapy, local techniques, and sometimes surgery.
Why do men have difficulty urinating?
Pathologies of the urethra
The cause of the development of a symptom in men with an injury can be a tear of the urethra. There are cramps, an admixture of blood in the first portion of urine, bleeding from the urethra outside the micturition. Another emergency condition, accompanied by difficulty urinating, are calculi. With a partial overlap of the lumen with a stone, pain, hematuria, weakening and dispersion of the jet are noted.
In patients with benign tumors of the urethra, stranguria appears against the background of growth of neoplasia. A man is concerned about itching, burning and discomfort during micturition, deviation, spraying or splitting of the jet, imperative urges, partial incontinence. Characterized by urethrorrhagia. With cancer of the urethra, there is an increasing difficulty in urination up to urinary retention, purulent discharge, pain in the perineum and the affected area, and an increase in inguinal lymph nodes.
Bladder diseases
The symptom accompanies infectious and inflammatory processes. Nonspecific acute cystitis in men is characterized by pollakiuria, nocturia, painful micturition, imperative urges, cloudy urine, terminal hematuria, pain in the vulva and above the pubis. Tuberculosis of the bladder is a complication of tuberculosis of the kidneys, manifested by dysuric disorders, periodic gross hematuria, general weakness, subfebrile condition, and weight loss.
Increasing stranguria, turning into complete urinary retention, is the main manifestation of detrusor neck sclerosis. At first, men are worried about the lethargy of the jet, later the feeling of incomplete emptying, pain, and frequent urges join. With an overactive type of neurogenic bladder, there are difficulties when trying to voluntarily urinate and during micturition. In the absence of urges, vegetative disorders (elevation of blood pressure, hyperhidrosis) indicate the need for emptying.
The symptom is detected in half of the men with the initial stage of bladder leukoplakia, combined with aching pain in the lower abdomen, imperative urges, episodes of incontinence. Progression leads to severe pollakiuria and nocturia, which worsens the quality of life. In severe cases, terminal hematuria is possible.
Benign tumors develop slowly, gradually. Stranguria occurs against the background of joined cystitis. There are hematuria, frequent urges, pain in the perineum and in the suprapubic area, aggravated at the final stage of micturition. Bladder cancer is characterized by rapid progression with early hematuria, which is accompanied by frequent painful urination, imperative urges. Pain in the groin, pubis and sacrum at first disturb only when the detrusor is filled, then become constant.
Diseases of the prostate
An increase in the volume of the prostate gland and compression of the urethra are the cause of difficulty urinating in men with prostate pathologies:
- Acute prostatitis. The symptom occurs in the follicular form, is complemented by intense pain, fever. With the transition to the parenchymal form, dysuria increases, the pain becomes throbbing, marked hyperthermia is noted, there is a high probability of developing acute urinary retention.
- Chronic prostatitis. Stranguria, frequent urges and a feeling of incomplete emptying are found at the initial stage of the pathological process. Then, due to compensatory hypertrophy of the detrusor, the severity of symptoms decreases, and increases again during decompensation.
- Prostate adenoma. There is a delay in the onset of micturition, difficulties in the process of emptying the bladder, a sluggish intermittent stream, an increase in the time of urination. Patients are concerned about nocturia, pollakiuria, incontinence, persistent urge.
- Sclerosis of the prostate. Initially, stranguria, cramps, a weak stream are noted, subsequently urine will be released drop by drop. When the vesicles are involved, hemospermia is detected. The localization and intensity of painful sensations vary significantly, sharp or aching pains in the lower abdomen, testicles, perineum, and rectum are possible.
- Prostate cancer. The disease is latent for a long time, the existing disorders are caused by adenoma or prostatitis. Increased miction with difficulty at the beginning of urination, weakness of the jet, episodes of incontinence are determined. Possible hematuria, pain in the pelvis, above the pubis and in the perineum, erectile dysfunction.
Difficulty urinating in men
Other andrological pathologies
Stranguria is observed with balanitis. Signs are more pronounced in acute inflammation, include swelling and hyperemia of the head, the appearance of plaque and ulceration, itching, erectile dysfunction, in some cases - inguinal lymphadenitis, urinary retention. Cavernitis is characterized by a bright, rapidly developing clinical picture. Against the background of a febrile temperature, a man develops acute pain in the penis and a prolonged erection, which makes it difficult to urinate. Sometimes a symptom is found with a large varicocele.
Acute conditions
Paraphimosis develops as a result of infringement of the head by the foreskin, forcibly retracted behind its base. Due to edema and stagnation of blood, the head and foreskin increase significantly in volume, squeezing the urethra, which causes difficulty urinating. There is a sharp pain, increasing cyanosis of the tissues. In the absence of timely assistance against the background of ischemia, gangrene may form.
With testicular torsion, stranguria, pain during urination, and sometimes urinary retention are caused by an extremely intense pain syndrome, reflex influences. The pain in the scrotum is so sharp that it causes collapse, nausea and vomiting. The affected half of the scrotum is pale, cyanotic or hyperemic. The diseased testicle is higher than the healthy one.
Andrological diseases in children
Sometimes stranguria is noted in boys with synechia of the foreskin. Considered as an indication for dissection of adhesions. Difficulties in the process of urination are possible with a large volume of fluid in patients with dropsy of the testis, accompanied by bursting, heaviness in the groin, and discomfort when walking. The disorder is also found in children with prostatitis. Urination becomes frequent, painful, intermittent. There are pains in the lower abdomen.
Oncological diseases
Along with tumors of the genitourinary organs, the symptom may occur with some other neoplasms. So, neoplasia of the cauda equina at the initial stage is manifested by pain in the sacrum and lower back. In the future, first one-sided, and then bilateral numbness of the lower extremities develops. The man complains of difficulty in defecation and urination, sexual dysfunction. Large chondrosarcomas of the pelvis compress the surrounding organs and tissues, including the detrusor neck, which is manifested by stranguria.
Other reasons
Difficulties in the process of micturition are possible with the following diseases and pathological conditions:
- Neurological pathologies: dorsal tabes.
- Drug Problems: MDMA Abuse.
- Hereditary diseases: Wolfram's syndrome.
Diagnostics
Diagnostic measures are carried out by a urologist-andrologist. A man is interviewed to clarify the anamnesis of life, specify the moment of onset of difficulties, the dynamics of the development of symptoms over time. During an external examination, signs of inflammation, hematoma, accumulation of fluid in the scrotum, infringement of the head and other changes are revealed. As part of an additional examination, the following procedures are prescribed:
- Finger examination of the prostate. During the manipulation, the specialist determines the size and shape, evaluates the homogeneity of the prostate gland. Based on the results, one can assume the presence of inflammation or a volumetric process, which makes it possible to clarify further diagnostic tactics.
- Ultrasonography. With stones and injuries of the urethra, ultrasound of the urethra is performed. In detrusor pathologies, an ultrasound of the bladder is recommended, in some cases with an assessment of residual urine. Men with suspected prostatitis, adenoma, cancer and sclerosis of the prostate produce an ultrasound of the prostate. When cavernous, an ultrasound of the penis is necessary.
- Beam techniques. Patients with cervical sclerosis are prescribed retrograde urethrography. With tumor lesions of the detrusor, excretory urography and descending cystography are performed. With neurogenic dysfunction, a comprehensive examination is carried out, including conventional and voiding urethrocystography, ascending pyelography and other methods.
- Urodynamic studies. With cervical sclerosis and preserved urination, uroflowmetry is performed. In case of neurological disorders, along with uroflowmetry, profilometry, sphincterometry, and cystometry are performed.
- Endoscopic methods. Visualization of the affected area during urethrocystoscopy makes it possible to assess the localization, prevalence and severity of sclerotic changes in the cervix. Cystoscopy is the leading diagnostic method for leukoplakia, benign and malignant tumors of the detrusor. Along with determining the nature of the pathological process, it makes it possible to take a biopsy.
- Laboratory tests. In neoplasms and leukoplakia, a morphological study of the biopsy material is carried out to verify the diagnosis. In infectious processes, STIs are excluded by PCR, RIF, ELISA or microscopy of the discharge, the indicators of a general urinalysis are assessed: the presence of leukocyturia, bacteriuria, and other changes.
Urologist's consultation
Treatment
Conservative therapy
The list of therapeutic measures is determined depending on the nature of the disease:
- Cystitis. In order to fight infection, antimicrobials from the groups of nitrofurans, cephalosporins and fluoroquinolones, herbal uroseptics are prescribed. To reduce pain, antispasmodics and NSAIDs are used. Presacral, intravesical and prevesical blockades with local anesthetics, bladder lavage can be performed. As part of physiotherapy, UHF, drug electrophoresis, ultrasound, and inductothermy are used.
- Neurogenic MP. To reduce the tone of the detrusor, stimulate blood circulation, improve local metabolic processes, alpha-blockers, calcium antagonists, antidepressants, anticholinergics, and succinic acid preparations are recommended. Botulinum toxin is injected into the wall of the organ. The listed activities are supplemented with special exercise therapy complexes, detrusor training, ultrasound, thermal procedures, laser therapy, and electrical stimulation.
- Prostatitis. The basis of treatment are antibacterial agents, which are selected taking into account the sensitivity of the microflora. The duration of the course depends on the form of the disease (acute or chronic). Prostate massage is performed to eliminate congestion and activate blood flow. Assign ultrasound, laser therapy, sometimes medicinal microclysters.
- BPH. Drug therapy includes alpha-blockers, antibiotics, alpha-reductase inhibitors, herbal remedies, immunocorrectors. In the presence of atherosclerosis, which prevents the flow of drugs into the prostate, vasodilators are indicated. After completion of antibiotic therapy, probiotics are recommended to prevent intestinal dysbacteriosis.
- Balanitis. Men are advised to conduct thorough hygiene of the genitals using herbs with anti-inflammatory action and local antiseptics. Topical corticosteroids, dermatotropic immunosuppressants are prescribed. Depending on the etiology of the inflammatory process, antibacterial or antifungal agents are needed.
- Cavernite. In acute inflammation, hospitalization is required. At the stage of infiltrate formation, antibiotics, NSAIDs, immunostimulants are used. Carry out instillations of the urethra, electrophoresis, UHF, magnetotherapy, laser therapy. In chronic cavities, treatment is outpatient. Includes immunostimulants, anti-inflammatory drugs and physiotherapy.
Surgery
For men with difficulty urinating, the following surgical interventions can be performed:
- Urethral calculi: advancement of the stone from the urethra into the detrusor followed by lithotripsy, external ureterolithotomy, removal of the calculus from the posterior urethra through the bladder with epicystostomy.
- Tumors of the urinary tract: chemical, radio wave and laser removal of genital warts, surgical excision of benign neoplasia, transurethral or circular resection of the urethra, amputation of the penis for cancer, TUR, resection of the bladder, laser en-bloc resection, cystectomy.
- Diseases of the prostate: transurethral resection, thulium or holmium laser enucleation, laser vaporization, adenomectomy, brachytherapy, radical prostatectomy.
- Cavernitis, balanitis: opening of an abscess of the penis, emergency amputation in the development of gangrene, correction of penile curvature in the long term after cavernitis, circumcision in recurrent balanitis with phimosis.
- Emergency conditions: dissection of the infringing ring upon admission and circumcision after the subsidence of inflammation in paraphimosis, surgery for torsion of the spermatic cord, orchiectomy for testicular necrosis against the background of torsion.