Stranguria is difficult urination, in which the patient has to make an effort to empty the bladder. It is observed with lesions of the lower urinary tract, some andrological and gynecological diseases. As a rule, it is combined with other dysuric disorders. The cause of the development of stranguria is determined on the basis of survey data, an objective examination, hardware and laboratory techniques. Treatment includes drug therapy, physiotherapy, exercise therapy. Operations are performed according to indications.
general characteristics
Stranguria is a pathological condition in which the patient feels the urge, but hardly empties the detrusor due to muscle spasm of the neck of the organ and the urethra. Often combined with increased urination, pain during micturition. Urgent urges, stress or urgency incontinence are possible. Violation occurs against the background of narrowing of the urethra or infravesical obstruction.
Gradual progression is typical. At the same time, the muscles in the wall of the bladder sometimes hypertrophy, which makes it possible to compensate for the presence of an obstacle to the flow of urine and smoothes dysuric manifestations. Subsequently, hypertrophy is replaced by dystrophy, the changes are growing rapidly. Due to the accumulation of residual urine, pressure in the urinary tract increases, favorable conditions are created for the occurrence of infectious complications.
Less commonly, stranguria develops suddenly due to emergency conditions. The causes and frequency of urination difficulties in urological pathologies differ somewhat depending on gender. In most cases, with the same diseases of the urethra and bladder, men are more likely to suffer from stranguria, which is explained by a longer urethra.
Why stranguria occurs
Urethral lesions
Emergency conditions that provoke the sudden development of stranguria are urethral injuries and urethral stones. In the first case, difficulty in micturition, urethrorrhagia, cramps and pain indicate an incomplete rupture, damage to the urethra is often combined with pelvic fractures. Patients with stones complain of intense pain, weakening of the jet. Blood impurities are found in the urine.
Bladder diseases
In most cases, the symptom is determined in the stronger sex. Stranguria accompanies the following diseases:
- Acute cystitis in men. There are frequent and painful micturitions, imperative urges, nocturia, terminal hematuria, turbidity of urine, pain in the genitals and lower abdomen.
- Tuberculosis of the bladder. Develops with the spread of infection from the affected kidney. Characterized by weight loss, weakness, fatigue, periodic hematuria, urination disorders.
- Sclerosis of the bladder neck. Occurs in men after surgery on the prostate. First, the weakness of the jet is detected, after a while the clinical picture is supplemented by pain, increased urges, and a feeling of incomplete emptying.
- Overactive bladder. Diagnosed in both sexes, it is a consequence of neurogenic dysfunction against the background of injuries and diseases of the brain and spinal cord. Stranguria is characteristic of a hyperactive type of disorder.
- Leukoplakia. It appears in both men and women. Caused by the degeneration of the epithelium of the bladder. It develops gradually, manifested by pain in the lower abdomen, difficulty in micturition, incontinence, imperative urges.
stranguria
The gradual progression of stranguria is typical of a paraurethral cyst. This pathology is observed only in women, in the initial stages it is asymptomatic. Subsequently, patients are concerned about frequent urination, cramps, burning, pain, mucous discharge from the urethra. In other diseases, stranguria occurs more often and is more pronounced in men. It can be determined during the following processes:
- Benign tumors of the urethra. Discomfort, burning and itching during urination, bifurcation or deviation of the jet, episodes of incontinence, urethrorrhagia are possible.
- Cancer of the urethra. In men, increasing stranguria is one of the main symptoms; in women, the violation is absent or insignificant. Pain in the urethra and perineum, lymphadenopathy, general signs of cancer intoxication are found.
- Benign detrusor neoplasia. It is characterized by an oligosymptomatic or asymptomatic course, a slow increase in symptoms. Stranguria becomes a consequence of infectious complications, complemented by an increase in urge, pain during urination.
- Bladder cancer. The first sign is often hematuria. The pathology progresses rapidly. Urges become more frequent, pains are observed during micturition. The pain syndrome spreads to the suprapubic region, sacrum and groin. At first, it is noted only with a full bladder, then it becomes permanent.
Andrological diseases
The most common andrological cause of stranguria is an increase in the volume of the prostate. Sometimes difficulty urinating due to damage to the head or corpora cavernosa. In emergency conditions, the symptom develops as a result of direct compression of the urethra and concomitant edema, or becomes the result of reflex reactions. The following are considered as etiofactors of stranguria:
- Prostate pathologies: acute and chronic prostatitis (including congestive and calculous), benign hyperplasia (adenoma), sclerosis and prostate cancer.
- Lesions of the penis: balanitis, balanoposthitis, cavernitis.
- Emergency conditions: paraphimosis, testicular torsion.
Gynecological diseases
Stranguria in diseases of the female reproductive system is caused by compression of the urinary tract by volumetric formations, a violation of the relationship between the anatomical structures of the small pelvis with weakening of the muscles of the pelvic floor and prolapse of internal organs. Sometimes the cause is a malignant lesion of the vulva. In some women, difficulty urinating develops during childbirth or accompanies postpartum complications. The symptom is found in the following cases:
- Ovarian neoplasms: teratoma, teratoblastoma, Brenner tumor, borderline neoplasia, primary and metastatic cancer.
- Genital prolapse: vaginal prolapse, uterine prolapse, cystocele.
- Diseases of the cervix: cysts, elongation.
- Tumors of the external genitalia: Paget's disease of the vulva.
- Conditions associated with childbirth: discoordination of labor, threatening uterine rupture, postpartum thrombophlebitis with lesions of the iliac-femoral segment.
Other reasons
Among neoplasms outside the genitourinary system, chondrosarcomas of the pelvis and tumors of the cauda equina can provoke a symptom. In newborns, the disorder is observed with sacrococcygeal teratomas. Patients with Wolfram syndrome suffer from stranguria. In addition, difficulties in urination are formed against the background of taking MDMA, develop with dorsal tabes.
Diagnostics
Determining the etiology of stranguria is the responsibility of urologists. If there is a suspicion of damage to the reproductive organs, men are shown a consultation with an andrologist, women - a gynecologist. Diagnosis of pathological conditions that have arisen during childbirth is the competence of an obstetrician. The main role is played by the results of the survey and obstetric examination, patients with discoordinated labor activity perform cardiotocography.
In the rest of the patients, during the survey, the anamnesis of life and disease is clarified, the moment and circumstances of the onset of symptoms, changes in the clinical picture of the disease over time are clarified. As part of a physical examination, signs of inflammation, volumetric formations, and other external manifestations indicating the nature of the pathology are revealed. To clarify the cause of stranguria, the following methods are used:
- Gynecological examination. It is recommended for all women with stranguria to exclude possible gynecological causes of the symptom, to assess the state of the reproductive system. Informative for prolapse, Paget's disease, lesions of the cervix, ovarian masses.
- Finger examination of the prostate. Needed by men with suspected prostate disease. Helps to confirm hyperplasia, detect volumetric formations. Allows you to indirectly judge the presence of an inflammatory process based on soreness and some increase in the size of the organ.
- Ultrasonography. Patients with urethral calculi are prescribed an ultrasound of the urethra. With gynecological prolapse, diseases of the cervix and ovarian tumors, ultrasound of the small pelvis is performed. With a cavity, an ultrasound of the penis is performed, with pathologies of the prostate gland - an ultrasound of the prostate. Ultrasound of the bladder is indicated both in detrusor diseases and in other conditions accompanied by the accumulation of residual urine.
- Beam techniques. With neoplasms of the bladder, excretory urography and cystography are performed. Patients with calculi and paraurethral cysts are recommended urethrography. With stranguria against the background of neurological disorders, a comprehensive examination using various x-ray techniques may be required. Computed and magnetic resonance imaging play a significant role in tumors of any localization.
- Urodynamic studies. Necessary for vaginal prolapse, neurogenic dysfunction, detrusor neck sclerosis. Uroflowmetry, profilometry, tension cystometry, filling cystometry can be performed. In some cases, a video urodynamic study is indicated. The scope of the examination depends on the nature of the disease.
- Endoscopic methods. With pathologies of the bladder, cystoscopy or urethrocystoscopy is performed. Patients with paraurethral cysts undergo ureteroscopy. Women with cervical cysts and elongation are shown colposcopy and cervicoscopy in combination with special tests. Ovarian neoplasms may require diagnostic laparoscopy.
- Laboratory tests. In the general analysis of urine, crystals, bacteria, leukocytes, erythrocytes are detected. To determine the pathogen, exclude specific infections, microscopy, seeding on nutrient media, ELISA, RIF PCR are performed. With tumors, a cytological or histological examination is performed to clarify the structure and degree of differentiation of neoplasia.
Urologist examination
Treatment
Conservative therapy
The treatment plan is drawn up taking into account the nature of the pathology that provoked stranguria:
- Cystitis. Antibiotics, uroseptics, NSAIDs, antispasmodics are used. In some cases, detrusor lavage and blockade are recommended. Physiotherapeutic procedures include inductothermy, ultrasound, electrophoresis, UHF.
- neurogenic dysfunction. Drug therapy is carried out using succinic acid preparations, anticholinergics, calcium antagonists, adrenoblockers. In some cases, the introduction of botulinum toxin is effective. As part of non-drug treatment, exercise therapy, electrical stimulation, and thermal procedures are prescribed.
- Diseases of the prostate. With prostatitis, antibiotic therapy, prostate massage, and physiotherapy are indicated. In adenomas, alpha-reductase inhibitors, alpha-blockers, vasodilators, immunocorrectors are used.
- Other andrological pathologies. Balanitis requires washing the penis with local antiseptics, applying corticosteroids and immunosuppressants, taking antibiotics or antifungal drugs. Patients with cavernitis are prescribed antimicrobial and anti-inflammatory drugs, immunostimulants, urethral instillations, and physiotherapy.
- Genital prolapse. The therapy is effective in the initial stages. Measures are being taken to normalize the stool, special exercises, gynecological pessaries, hormonal preparations are used.
- Postpartum thrombophlebitis. Treatment is carried out using NSAIDs, anticoagulants, angioprotectors, microcirculation correctors. With the septic nature of the inflammatory process, antibiotics are required. In other cases, antibiotic therapy is not indicated.
- oncological lesions. Radiation therapy and chemotherapy may be the primary treatment or given before and after surgery to improve surgical outcomes and reduce the risk of recurrence. Some patients require hormone antagonists.
Surgery
Depending on the etiology of stranguria, the following operations can be performed:
- Pathologies of the urinary tract: external urethrolithotomy or cystolithotripsy for calculi, radiofrequency ablation, cryodestruction and laser vaporization of genital warts, surgical excision of the tumor, transurethral or open resection of the urethra or bladder, cystectomy.
- Andrological diseases: TUR of the prostate, laser techniques, brachytherapy, adenomectomy, surgical removal of the prostate, opening of the abscess of the penis, dissection of the infringing ring, circumcision, correction of the curvature of the penis, surgery for torsion of the spermatic cord, removal of the testicle in case of necrosis.
- Gynecological diseases: adnexectomy, oophorectomy, resection of the ovary, panhysterectomy, amputation of the uterus with appendages, vulvectomy, colporrhaphy, vaginopexy, vaginoplasty, colpoclesis, installation of slings, operations to strengthen the pelvic floor, amputation of the cervix.