Difficulty urinating in women is observed with urological pathologies, genital prolapse, ovarian tumors, and some other gynecological diseases. It is often supplemented with other variants of dysuria: pain, imperative urge, incontinence. The cause of the symptom is determined by the results of the survey, gynecological examination, imaging and laboratory techniques. Therapeutic measures include drug therapy, exercise therapy, physiotherapy, and surgery.
Why is it difficult to urinate in women?
Bladder diseases
An overactive neurogenic bladder is manifested by stranguria, the absence of an urge to urinate when autonomic disorders appear, signaling the filling of the detrusor. With leukoplakia in 50% of women, the symptom is determined already at the initial stage of the disease. 80% have pain in the lower abdomen, imperative urges, urinary incontinence are possible. Subsequently, the symptoms gradually worsened.
Benign neoplasia is characterized by an asymptomatic course and slow progression. Difficulties in urination are rare, occur with the growth of a neoplasm located in the cervical region. With bladder cancer in women, the disorder may be due to bleeding and the formation of clots in the organ cavity. Increased miction, pain during urination, imperative urges are possible. There is a rapid increase in symptoms.
Other urological pathologies
Paraurethral cyst is hidden for a long time. With an increase in education, frequent urges, burning, cramps, pain, mucous discharge from the urethra appear. Some women experience stranguria or incontinence, the sensation of a foreign object in the urethra. Stones provoke a symptom with partial obstruction of the urethra. Women complain of pain, blood impurities in the urine and weakness of the jet are objectively determined.
Benign neoplasms of the urethra prevent the flow of urine when it reaches a significant size, but this symptom is much less common in women than in men. In cancer of the urethra, pain, cramps, urethrorrhagia, urinary incontinence, and ulceration in the vulva are determined. With exophytic growth of neoplasia, difficulties in micturition are found.
Tumors of the ovaries
Stranguria occurs with large neoplasms that compress the urinary tract. It is observed in the following ovarian neoplasias:
- Teratoma. It is mature and immature. Mature tumors typically have an oligosymptomatic course, a slow increase in symptoms. Severity and non-intensive pain in the abdomen are determined, sometimes - difficulty or increased urination, problems with stools. Immature teratomas (teratoblastomas) progress rapidly, are accompanied by weight loss, anemia.
- Brenner tumor. May be benign, transient, or malignant. The clinical picture depends on the type, with estrogen-producing neoplasms, metrorrhagia and menorrhagia develop, with androgen-producing neoplasms - amenorrhea, virilization, and infertility. Large neoplasias compress the gastrointestinal tract and urinary tract, which is manifested by stranguria, pollakiuria, and digestive disorders.
- borderline tumors. Occupy an intermediate position between benign and malignant formations. The most typical symptom is pulling pain in the abdomen, radiating to the lower back and lower limbs. Weakness, weight loss, dyspepsia, frequent urges are revealed.
- metastatic cancer. It is formed during the spread of malignant cells from tumors of other localizations (breast cancer, lymphoma, gastrointestinal neoplasia). Against the background of general signs of the oncological process, a feeling of fullness in the abdomen appears. Compression of the detrusor is manifested by stranguria, rectum - by constipation.
Difficulty urinating in women
genital prolapse
The prolapse of the internal genital organs occurs as a result of birth injuries, operations in the pelvic area, increased intra-abdominal pressure, weakness of the connective tissue, lack of female sex hormones. Difficulty urinating may be accompanied by the following conditions:
- Vaginal prolapse. Manifested by the feeling of a foreign object in the perineal area, pulling pains, sometimes - dyspareunia. Mixed dysuric disorders are characteristic, stress incontinence develops first, and then urgent incontinence. Mictation difficulties are possible. In severe cases, acute urinary retention is determined.
- Descent of the uterus. At first, the woman is concerned about dyspareunia, pressure and pulling pain in the lower abdomen, lower back and sacrum, spotting or leucorrhoea. Algomenorrhea and hyperpolymenorrhea are often formed. With the progression of pathology, in half of the cases there is an increase in micturition and stranguria. Violation of the patency of the urinary tract creates favorable conditions for the development of complications: cystitis, pyelonephritis. ICD, hydronephrosis.
- Cystocele. Small hernias are asymptomatic. With an increase in protrusion, the feeling of a foreign body is disturbing, aggravated by urination and abdominal tension. Subsequently, micturition difficulties, jet weakness, stress incontinence, sexual dysfunction, pain in the abdomen and lower back are noted. Possible urinary retention.
Pathology of the cervix
Cysts often occur without obvious clinical signs, are detected by chance during a gynecological examination. Large lesions may present with dyspareunia, menometrorrhagia, menorrhagia, incontinence, or difficulty urinating. With elongation of the cervix, the symptom occurs at the final stage, is found in a quarter of women, is supplemented by incontinence, sensation of a foreign object, and discomfort during sexual intercourse.
Paget's disease of the vulva
This malignant neoplasm is characterized by relatively slow growth. On the external genitalia, limited reddish dense areas appear, which for a long time retain their size and shape or slowly increase. With the spread of Paget's disease towards the urethra, stranguria is possible, which results in the accumulation of urine in the bladder, the development of infectious complications.
Conditions associated with childbirth
Discoordination of labor activity is accompanied by painful, frequent, intense, but ineffective contractions, premature discharge of water, nausea, vomiting, agitation, ischuria, and difficulty urinating. Stranguria is also observed in severe birth trauma - uterine rupture. It occurs at the stage of a threatening rupture, manifested by strong painful contractions, swelling of the cervix and underlying genital organs, and deformity of the uterus.
In the second or third week after childbirth, less often - on days 5-6, women may develop postpartum thrombophlebitis. In the period of the prodrome, an increase in body temperature to subfebrile numbers, a strong heartbeat are detected. At the stage of manifestation, a short chill appears. Difficulties in micturition, pain in the sacrum and lower abdomen are detected with lesions at the level of the iliofemoral (ileofemoral) segment.
Oncological diseases
In newborn girls, sacrococcygeal teratoma becomes the cause of difficulty urinating. In adult women, disorders of the nervous regulation that cause the appearance of a symptom are observed in primary and metastatic tumors of the cauda equina. Sometimes stranguria is detected in large pelvic chondrosarcomas that compress the urinary tract.
Diagnostics
Depending on the nature of the disease, women are examined by a urologist or gynecologist. Patients with mass lesions are referred for a consultation with an oncologist. Conditions that have arisen during childbirth are under the jurisdiction of the obstetrician, to confirm discoordinated labor activity and the threat of uterine rupture, use the data of the survey, physical examination, obstetric examination. With discoordination, cardiotocography is informative.
Patients with other pathologies are asked to determine the time of occurrence of stranguria and other symptoms, to assess the state in dynamics. The program of additional examination includes such methods as:
- Gynecological examination. Changes characteristic of Paget's disease are visible when examining the vulva. When examining the internal genitalia in women with prolapse, a displacement of the walls of the vagina, detrusor, and rectum is found. With a cystocele, a hernial protrusion along the anterior wall of the vagina is revealed. The technique allows you to confirm the presence of cysts, elongation of the neck.
- Ultrasonography. Ultrasound of the small pelvis is informative for prolapse of the reproductive organs, ovarian neoplasms. In combination with dopplerometry, it is performed to study cysts, with cervicometry - to confirm elongation. Ultrasound of the bladder is indicated for detrusor tumors, neurogenic dysfunction and cystocele, ultrasound of the urethra for calculi and paraurethral cysts.
- Urodynamic studies. Recommended for patients with cystocele, prolapse of the vagina and uterus, neurogenic dysfunction. Include uroflowmetry, filling cystometry, tension cystometry, profilometry. Additionally, a video urodynamic study is performed. The list of techniques varies depending on the nature of the pathology.
- Beam methods. Women with suspected bladder neoplasia undergo excretory urography and cystography to assess the condition of the upper urinary system, to determine detrusor filling defects. In the course of urethrography, the presence of stones, messages between the paraurethral cyst and the urethra are confirmed. In tumors, CT and MRI play a significant role in the diagnosis.
- Endoscopic studies. With elongation and cysts of the cervix, colposcopy with a Schiller test, cervicoscopy to confirm the presence and visual assessment of the formation are performed. With paraurethral cysts, ureteroscopy is performed. For neoplasms of the detrusor, cystoscopy is prescribed, for ovarian tumors, diagnostic laparoscopy. During the study, a biopsy is taken.
- Laboratory tests. Volumetric formations are verified on the basis of morphological examination data. With inflammatory changes, ELISA, PCR, microbiological analysis or microscopy are prescribed to determine the pathogen. With stones in the urine, crystalluria, hematuria, leukocyturia are found.
Examination by a urogynecologist
Treatment
Conservative therapy
Therapeutic tactics are chosen taking into account the characteristics of the disease that provoked difficulty urinating:
- Neurogenic bladder dysfunction. General drugs include anticholinergics, antidepressants, calcium antagonists, alpha-blockers, antioxidants, antihypoxants. Local injections of botulinum toxin are performed to reduce the tone of the bladder. Non-drug methods include correction of fluid intake, exercise therapy, electrical stimulation, ultrasound, and other physiotherapy.
- Genital prolapse. Conservative treatment is indicated for minor prolapse of the organs, the presence of contraindications to surgery. A special diet is recommended to prevent constipation. Gymnastics according to Atarbekov, Kegel exercises, estrogen-containing drugs, gynecological pessaries are used.
- Paget's disease. In common processes, radiotherapy is used as the main method. With local formations, it is prescribed in the pre- or postoperative period for invasive and secondary cancer. Cytostatics are required before or after the intervention in case of secondary, extensive and invasive lesions. Hormone antagonists are indicated for the prevention of relapse.
- Postpartum thrombophlebitis. To prevent the progression of thrombosis, anticoagulants are needed, to reduce inflammation and pain - NSAIDs. With purulent inflammation, antibacterial agents are used. Microcirculation correctors and angioprotectors are used to reduce the permeability of the vascular wall.
Surgery
The operational technique is determined by the cause of stranguria:
- Conditions caused by childbirth: extraction of the fetus with obstetric forceps in case of discoordinatory disorders during childbirth; caesarean section against the background of drug relaxation with a threatening rupture; thrombectomy, selective thrombolysis, cava filter implantation for thrombophlebitis.
- Genital prolapse: colporrhaphy, sacrospinal fixation, vaginopexy, sling surgery, or colpoclesis with vaginal prolapse; vaginoplasty, colpoperineolevathoroplasty, combined interventions, including vaginal plastic surgery, fixation of the uterus and strengthening of the ligamentous apparatus during uterine prolapse.
- Diseases of the cervix: exfoliation of the formation or cone-shaped amputation of the cervix with cysts; wedge-shaped or high amputation of the neck, Manchester operation for elongation.
- Ovarian neoplasia: wedge resection, laparoscopic or laparotomic oophorectomy or adnexectomy, extirpation or supravaginal amputation of the uterus with appendages, cytoreductive surgery before chemotherapy for common malignant processes.
- Detrusor tumors: with papillomas and polyps - electrocoagulation or electroresection during cystoscopy; in some cases, with benign formations - laser en-bloc resection, transvesical electroexcision, open or transurethral resection; with malignant neoplasia - TUR, radical cystectomy with ureterocutaneostomy or intestinal plastic bladder.
Women with Paget's disease have a vulvectomy or wide excision of the neoplasia. With paraurethral cysts, sclerosis or removal of the formation is performed. Urethral stones are pushed into the bladder and then crushed or an external urethrotomy is performed.