Difficulty urinating in women is observed in urological pathologies, genital prolapse, ovarian tumors, and some other gynecological diseases. It is often supplemented with other variants of dysuria: pain, imperative urges, incontinence. The cause of the symptom is determined by the results of a survey, gynecological examination, imaging and laboratory techniques. Therapeutic measures include drug therapy, physical therapy, physiotherapy, surgical operations.
Causes of difficulty urinating in women
Diseases of the bladder
Hyperactive neurogenic bladder is manifested by stranguria, the absence of urge to urinate when vegetative 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 painful sensations in the lower abdomen, imperious urges, urinary incontinence are possible. Subsequently, the symptoms gradually worsen.
Benign neoplasia is characterized by a low-symptomatic course and slow progression. Difficulties in urination are rarely observed, they occur with the growth of a neoplasm located in the neck area. With bladder cancer in women, the violation may be due to bleeding and the formation of clots in the organ cavity. There may be an increase in infections, pain during urination, imperative urges. There is a rapid increase in symptoms.
Other urological pathologies
The paraurethral cyst has been hidden for a long time. With an increase in the formation, frequent urges, burning, pains, pains, mucous discharge from the urethra appear. Some women have stranguria or incontinence, a feeling of a foreign object in the urethra. Concretions provoke a symptom with partial obstruction of the urethra. Women complain of pain, blood impurities in the urine and the weakness of the jet are objectively determined.
Benign neoplasms of the urethra prevent the flow of urine when a significant size is reached, but this symptom is detected much less often in women than in men. With cancer of the urethra, pain, pain, urethrorrhagia, urinary incontinence, the formation of ulceration in the area of the external genitalia are determined. With the exophytic growth of neoplasia, difficulties of mycosis are found.
Stranguria occurs with large neoplasms that compress the urinary tract. It is observed with the following ovarian neoplasia:
- Teratoma. It can be mature and immature. For mature tumors, a low-symptomatic course, a slow increase in symptoms is typical. Severity and non-intense abdominal pain are determined, sometimes difficulty or increased urination, problems with stool. Immature teratomas (teratoblastomas) progress rapidly, accompanied by weight loss, anemia.
- Brenner’s tumor. It can be benign, transient or malignant. The clinical picture depends on the type, with estrogen-producing neoplasms, metrorrhagia and menorrhagia develop, with androgen-producing ones – amenorrhea, virilization, infertility. Large neoplasias squeeze the gastrointestinal tract and urinary tract, which is manifested by stranguria, pollakiuria, digestive disorders.
- Borderline tumors. They occupy an intermediate position between benign and malignant formations. The most typical symptom is pulling painful sensations in the abdomen, giving to the lower back and lower extremities. 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 bursting in the stomach appears. Compression of the detrusor is manifested by stranguria, rectum – constipation.
Omission of the internal genitalia occurs as a result of birth injuries, operations in the pelvic area, increased intra-abdominal pressure, weakness of connective tissue, lack of female sex hormones. Difficulty urinating may be accompanied by the following conditions:
- Vaginal prolapse. It is manifested by a feeling of a foreign object in the perineal area, pulling pains, sometimes dyspareunia. Mixed dysuric disorders are characteristic, first stress develops, and then urgent incontinence. There may be difficulties in mixing. In severe cases, acute urinary retention is determined.
- Prolapse of the uterus. At first, a woman is worried about dyspareunia, pressure and pulling pain in the lower abdomen, lower back and sacrum, spotting or white. Algodismenorrhea and hyperpolymenorrhea are often formed. With the progression of pathology, in half of the cases, there is an increase in infections and stranguria. Violation of the patency of the urinary tract creates favorable conditions for the development of complications: cystitis, pyelonephritis. UTS, hydronephrosis.
- Cystocele. Small hernias are asymptomatic. With an increase in protrusion, the feeling of a foreign body worries, which increases with urination and abdominal tension. Subsequently, there are difficulties in mixing, weakness of the jet, stress incontinence, violations of sexual function, pain in the abdomen and lower back. There may be a delay in urination.
Pathology of the cervix
Cysts often occur without obvious clinical signs, are detected accidentally during gynecological examination. Large formations can manifest dyspareunia, menometrorrhagia, menorrhagia, incontinence or difficulty urinating. With the prolongation of the cervix, the symptom occurs at the final stage, is found in a quarter of women, supplemented by incontinence, a feeling of a foreign object, discomfort during sexual intercourse.
Paget’s Vulva disease
This malignant neoplasm is characterized by relatively slow growth. Limited reddish dense areas appear on the external genitals, which retain their size and shape for a long time 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.
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 – rupture of the uterus. It occurs at the stage of a threatening rupture, manifests itself with severe painful contractions, swelling of the cervix and underlying genitals, deformity of the uterus.
In the second or third week after childbirth, less often – on 5-6 days, women may develop postpartum thrombophlebitis. In the period of prodrome, an increase in body temperature to subfebrile figures, a strong heartbeat are detected. At the stage of manifestation, a short-term chill appears. Difficulties of miction, pain in the sacrum and lower abdomen are found when the lesion is at the level of the ilio-femoral (ileofemoral) segment.
In newborn girls, the cause of difficulty urinating becomes sacrococcygeal teratoma. In adult women, disorders of nervous regulation that cause the appearance of the symptom are observed in primary and metastatic tumors of the ponytail. Sometimes stranguria is detected with large chondrosarcomas of the pelvis, squeezing the urinary tract.
Diagnostics of difficulty urinating in women
Depending on the nature of the disease, women are examined by a urologist or gynecologist. Patients with bulky formations are referred for consultation to an oncologist. Conditions that have arisen during childbirth are under the care of an obstetrician, to confirm discoordinated labor and the threat of rupture of the uterus, survey data, physical examination, obstetric examination are used. In case of discoordination, cardiotocography is informative.
Patients with other pathologies are interviewed 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. The changes characteristic of Paget’s disease are visible when examining the vulva. When examining the internal genitals of women with prolapse, displacement of the walls of the vagina, detrusor, rectum is detected. With a cystocele, a herniated protrusion along the anterior wall of the vagina is detected. The technique allows you to confirm the presence of cysts, cervical elongation.
- Ultrasonography. Ultrasound of the pelvis is informative for omission of reproductive organs, ovarian neoplasms. In combination with dopplerometry, it is carried out 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 concretions and paraurethral cysts.
- Urodynamic studies. Recommended for patients with cystocele, vaginal and uterine prolapse, neurogenic dysfunction. They include uroflowmetry, filling cystometry, tension cystometry, profilometry. Additionally, a video-dynamic study is carried out. The list of methods varies depending on the nature of the pathology.
- Radiation methods. Women with suspected neoplasia of the bladder undergo excretory urography and cystography to assess the condition of the upper urinary system, determine defects in detrusor filling. During urethrography, the presence of stones, messages between the paraurethral cyst and the urethra is confirmed. CT and MRI play an important role in the diagnosis of tumors.
- Endoscopic examinations. With elongation and cervical cysts, colposcopy with a Schiller sample, cervicoscopy is performed to confirm the presence and visual assessment of the formation. With paraurethral cysts, urethroscopy is performed. With detrusor neoplasms, cystoscopy is prescribed, with ovarian tumors – diagnostic laparoscopy. During the study, a biopsy sample is taken.
- Laboratory tests. Verification of volumetric formations is carried out on the basis of morphological research data. In case of inflammatory changes, ELISA, PCR, microbiological analysis or microscopy are prescribed to determine the pathogen. With concretions in the urine, crystalluria, hematuria, leukocyturia are detected.
Treatment of difficulty urinating in women
Therapeutic tactics are chosen taking into account the characteristics of the disease that provoked difficulty urinating:
- Neurogenic dysfunction of the bladder. The number of drugs of general action includes anticholinergics, antidepressants, calcium antagonists, alpha-blockers, antioxidants, antihypoxants. Botulinum toxin injections are performed locally to reduce the tone of the bladder. Non-drug methods include correction of the fluid intake regime, physical therapy, electrical stimulation, ultrasound, and other physiotherapy procedures.
- Genital prolapse. Conservative treatment is indicated with a slight omission of organs, the presence of contraindications to surgery. A special diet is recommended to prevent constipation. Atarbekov gymnastics, 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 intervention in the case of secondary, extensive and invasive lesions. Hormone antagonists are indicated for the prevention of relapses.
- Postpartum thrombophlebitis. Anticoagulants are needed to prevent the progression of thrombosis, NSAIDs are needed to reduce inflammation and pain. With purulent inflammation, antibacterial agents are used. Microcirculation correctors and angioprotectors are used to reduce the permeability of the vascular wall.
Surgical treatment of difficulty urinating in women
The operative technique is determined by the cause of stranguria:
- Conditions caused by childbirth: fetal extraction with obstetric forceps for discoordination disorders during childbirth; cesarean section against the background of drug relaxation with a threatening rupture; thrombectomy, selective thrombolysis, implantation of a cava filter for thrombophlebitis.
- Genital prolapse: colporaphy, sacrospinal fixation, vaginopexy, sling operations or colpocleesis during vaginal prolapse; vaginoplasty, colpoperineolevatoroplasty, combined interventions including vaginal plastic surgery, uterine fixation 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 cervix, Manchester operation for elongation.
- Ovarian neoplasia: wedge-shaped resection, laparoscopic or laparotomic oophorectomy or adnexectomy, extirpation or supravaginal amputation of the uterus with appendages, cytoreductive operations before chemotherapy for common malignant processes.
- Detrusor tumors: with papillomas and polyps – electrocoagulation or electrosection 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 plasty of the bladder.
Women with Paget’s disease have a vulvectomy or a wide excision of neoplasia. With paraurethral cysts, sclerosing or removal of the formation is performed. Urethral stones are pushed into the bladder, and then crushed or an external urethrotomy is performed.