Surgery For Women With Cystocele Or Rectocele
Women may need surgery to lift a fallen bladder or rectum. The most common procedure for cystocele and rectocele repair is for the surgeon to make an incision in the wall of the vagina to find the defect or hole in the membrane-a wall of tissue called fascia-that normally separates the vagina from the other pelvic organs. The surgeon places sutures in the fascia to close up the defect, then closes the incision in the vaginal wall with more stitches, removing any excess tissue. These suturing steps tighten the layers of tissue that separate the organs, creating more support for the pelvic organs.
Other Causes Of Urinary Hesitancy
Both women and men are susceptible to urinary hesitancy resulting from:
- Dysfunction of bladder muscles
- Surgery and surgical anesthetics
- Psychological influences, including shy bladder syndrome
Women can also suffer nerve damage resulting from pregnancy that causes urinary problems, including a weak urine stream.
Clinical Events And Treatment Of Aki Due To Opioids
Clinically, opioids can result in AKI from changes in GFR, dehydration, rhabdomyolysis and urinary retention. The presentation of opioid overdose may be with hypopnea or apnea, miosis, and stupor. The combination of decreased respiratory drive, hypoxia, a drop in renal blood flow and GFR results in renal tubular damage. Dehydration with signs of volume depletion and hypotension may be noted. Confusion or a change of mental status could be seen.
The drop in renal blood flow would activate renal sympathetics, furthering the effect of renal ischemia and tubular damage. Overall cardiac output and mean arterial pressure decreases are noted. Physical examination should include a careful evaluation for muscle tenderness the only finding in a comatose patient may be muscle edema that could reflect the start of muscle necrosis. Abdominal examination may reveal a palpable distended bladder from urinary retention.
Once this stage is reached, with decreased kidney function, metabolism of opioids may further change depending on the specific drug. With morphine, for example, there is an increase in the mean peak concentration and the area under the concentration-time curve for both active and principle metabolites which could further worsen respiratory depression.
In the setting of methodone use, an electrocardiogram should be done early to determine if there is QT interval prolongation that could lead to arrhythmias.
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What The Patient Can Do
Here are some things that may help make urine retention less of a problem:
- Empty your bladder at least every 4 hours, even if you donât feel the urge to do so.
- Empty your bowels regularly.
- If tolerated, drink 6 to 8 glasses of fluid daily, preferably water.
- Talk to your doctor about all medicines, vitamins, herbs, and supplements youre taking.
- Avoid drinks with caffeine or alcohol and citrus juices, which can irritate the bladder.
- Avoid hygiene products and chlorinated pools and hot tubs that may irritate the bladder
- Avoid smoking.
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What Are The Risks Of Irregular Urination And Intermittent Urine Flow
Men with irregular urination and intermittent urine flow often experience a split urine stream which makes the urine stream go sideways and makes it difficult to aim the stream in the toilet. This can cause urine stream to miss the toilet, which can be embarrassing when visiting other people homes and causes discord at home.
Intermittent urination is usually a sign of significant underlying bladder problem, most often incomplete bladder emptying can predispose to urinary tract infections, bladder stone formation, and renal insufficiency . An enlarged prostate can also lead to blood in urine.
Intermittent urination can also cause pain and discomfort in the lower abdomen, urethra, and pain in the penis especially at the tip of the penis due to incomplete bladder emptying. Nocturia can cause multiple problems including falls in the elderly, poor energy levels and sleepiness during the day as well as unhappy mood due to poor sleep.
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How Is It Diagnosed
To diagnose urinary retention, a doctor will first ask about the history of your symptoms and perform a physical exam. The physical will include an examination of your genitals and rectum to look for any symptoms affecting those areas that may also affect the urinary tract.
Some other tests that may be used to confirm a diagnosis
likely be inserted to help quickly drain the urine. Local anesthesia will be used to make sure you dont feel pain or discomfort from the catheter.
If a catheter doesnt work or cant be used because of an injury or other condition, a doctor may insert a suprapubic catheter into the skin above your bladder to drain the urine.
Causes Of Urinary Retention
There are many different causes.
Blockage In men, the urethra may be constricted by an enlarged prostate a common condition for men over 50. In women, blockage can be caused by certain types of pelvic prolapse, including Cystocele and Rectocele .
Other blockage reasons for both men and women include urethral stricture and urinary stones.
Infection / Swelling In men, prostatitis , can cause swelling that blocks the free flow of urine. Urinary Tract Infections and Sexually Transmitted Diseases can also cause swelling that leads to urinary retention.
Nerve Problems Urinary retention could be caused by a problem with the nerves that control the bladder. If the nerves are damaged, it can cause a breakdown in the signals between the brain and bladder. Some causes of nerve damage include:
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Similarities And Differences Between Utis And Stds
UTIs share symptoms similar to STDs and are misdiagnosed more often than you may think. According to the American Society for Microbiology, 64 percent of the patients with a sexually transmitted infection were actually diagnosed as having a UTI instead. This is problematic. Not only are women being needlessly prescribed a UTI treatment , but it may also cause an undiagnosed STD to develop into a more serious issue. In the beginning stages, many STDs are treatable, but the further they are allowed to progress, the more complicated and expensive treatment becomes.
Helpful Tips For Managing Urinary Retention And Incontinence
Urinary incontinence is a prevalent issue, with anywhere from 25-50 percent of women reporting an episode in the past year.
Managing urinary conditions can be frustrating and time consuming, but there are helpful tips and lifestyle changes that can reduce the burden this condition causes.
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Urine retention can be uncomfortable and symptoms might include:
- Pain and bloating in the lower abdominal area.
- A frequent, urgent need to urinate but then having trouble doing it.
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Increasing Worsening Or Changing Symptoms
If any of your symptoms increase, worsen or change from the normal UTI symptoms, it might be an STD instead. If symptoms start to include ones like discharge or smell, its far more likely to be one of the most common STDs instead.
For any repeated urinary tract infections that appear to keep coming back, see your doctor: There are many things that can cause repeated UTIs. The same is true for any symptoms that can point to more than just an STD: Again, see your doctor.
Blockage Or Narrowing Of The Urethra Or Bladder Neck
In order for you to urinate normally, all parts of the urinary tract must work together in the correct order. Urine normally flows from the kidneys to the bladder through the ureters and out through the urethra. If a blockage or narrowing occurs somewhere along the urinary tract, the person may have difficulty urinating and, if the blockage is severe, may not be able to urinate at all.
Medical problems that could narrow the urethra and block the flow of urine include:
- serotonin and norepinephrine reuptake inhibitors
- nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen
- Parkinsons medications
Surgery. It is common to develop temporary urinary retention immediately after surgery. During surgery, the patient is often given fluid through a vein , which can cause a full bladder. You are also given anesthesia , which can keep you from feeling the need to urinate despite a full bladder. Additionally, pelvic surgery can cause inflammation, scar tissue, and trauma that can partially or completely block the flow of urine out of the bladder or urethra.
Weak bladder muscles. Weak bladder muscles may not contract with enough power or force to empty the bladder completely. Causes of weakness can include:
- pregnancy and childbirth
- age-related loss of bladder muscle power
- overdistention or a bladder that has been stretched in such a way that the muscles are injured
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What Are The Risks Of Urinary Retention
Urinary retention exposes men to a number of risks and requires prompt evaluation.
Is very important to find out the cause of urine retention. Prostate enlargement can be caused by prostate swelling from infection, enlargement of the prostate that slowly grows beginning at around age 40. Urinary obstruction and urine retention can also be caused by prostate cancer and other serious problems, including bladder cancer and urinary stricture.
Urinary retention man can lead to damage to the kidneys and occasionally leads to a need for dialysis and kidney transplantation if not addressed promptly.
Urinary retention can also cause UTIs, urinary incontinence, and if not treated promptly, can over time cause damage to the bladder to the point that it will not work.
Did you know?Dr. Shteynshlyuger has performed over 1,000 surgeries and procedures for enlarged prostate, including Rezum, Urolift, prostate enucleation, laser ablation of the prostate, and TURP. He performs over 100 prostate procedures a year.
Home Remedies For Chronic Urinary Hesitancy
If your issues with a weak urine stream arent acute, there are some things you can do at home to ease the problem. None of these are difficult, nor will they interfere with any prescribed treatments. Home care for urinary hesitancy includes:
- Using a hot water bottle or heating pad over your bladder and lower abdomen
- Taking a warm bath
- Massaging your lower abdomen and bladder area
- Drinking plenty of water and other fluids
If your urinary hesitancy comes and goes, maintaining a log of your symptoms may help you identify conditions that contribute to your weak bladder stream when it occurs, and it could be helpful to share with your urologist when you visit the Urology Center of Florida.
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When To Seek Urgent Medical Care
On its own, a weak urine stream may not be cause for concern, but if its accompanied by other symptoms, it could be an indication of a more serious medical issue. Urinary hesitancy could be an issue if you also experience:
- Chills and/or fever
- Lower back pain
If your urine stream stops entirely, a condition called urinary retention, youll need emergency medical attention, since this can become a serious problem without immediate treatment.
What Are The Complications Of A Neurogenic Bladder
The following are often linked to a neurogenic bladder:
- Urine leakage often happens when the muscles holding urine in do not get the right message.
- Urine retention happens if the muscles holding urine in do not get the message that it is time to pass urine.
- Damage to the tiny blood vessels in the kidney may happen if the bladder becomes too full and urine backs up into the kidneys. This causes extra pressure and may lead to blood in the urine.
- Infection of the bladder, ureters, or kidneys often results from urine that is held too long before its passed out of the body.
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Not Sure What To Do Next
If you are still concerned about your urinary retention, why not use healthdirects online Symptom Checker to get advice on when to seek medical attention.
The Symptom Checker guides you to the next appropriate healthcare steps, whether its self care, talking to a health professional, going to a hospital or calling triple zero .
How Is Urinary Retention Diagnosed
Your healthcare provider will ask about your health history and the medicines you take. He will press or tap on your lower abdomen. You may need any of the following tests:
- A digital rectal exam is when healthcare providers carefully feel the size of your prostate.
- A post void residual test will show how much urine is left in your bladder after you urinate. You will be asked to urinate and then healthcare providers will use a small ultrasound machine to check how much urine is left in your bladder.
- Blood or urine tests may show infection or prostate specific antigen levels. PSA may be elevated in prostate cancer.
- An ultrasound uses sound waves to show pictures on a monitor. An ultrasound may be done to show bladder stones, infection, or other problems.
- A CT scan , or CAT scan, is a type of x-ray that is taken of your prostate, kidneys, and bladder. The pictures may show what is causing your urinary retention. You may be given a dye before the pictures are taken to help healthcare providers see the pictures better. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.
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Common Causes Of Urinary Retention
Examples of some of the most common causes of non-obstructive urinary retention are:
A pelvic fracture is a break that affects the structure of the pelvis, which can include the hip bones, sacrum, or coccyx, and be extremely painful. If complications occur, it may lead to internal bleeding or an injury to the bladder.
Certain medications, such as antihistamines, and antispasmodic drugs which aid digestion, can cause urinary retention. They decrease bladder muscle contraction, preventing the bladder from being completely emptied.
Antidepressant meds have anticholinergic properties at therapeutic doses that contribute to urinary problems.
The side effects of anesthetics after surgery can impair muscle or nerve function of the bladder. The pain-relieving drugs often have a disruptive impact on the neural messaging to the part of the brain, which controls the nerves and the muscles in the urinary process.
Accidents that injure the brain or the spinal cord can also impact negatively on the neurological process of the urinary system.
Fortunately, no matter what type of urinary retention you may have, there is treatment available.
How Common Is Urinary Retention
Urinary retention in men becomes more common with age.
- In men 40 to 83 years old, the overall incidence of urinary retention is 4.5 to 6.8 per 1,000 men.
- For men in their 70s, the overall incidence increases to 100 per 1,000 men.
- For men in their 80s, the incidence of acute urinary retention is 300 per 1,000 men.
Urinary retention in women is less common, though not rare. The incidence of urinary retention in women has not been well studied because researchers have primarily thought of urinary retention as a manâs problem related to the prostate.
- weakened bladder muscles
Obstruction of the Urethra
Obstruction of the urethra causes urinary retention by blocking the normal urine flow out of the body. Conditions such as benign prostatic hyperplasiaâ also called BPHâurethral stricture, urinary tract stones, cystocele, rectocele, constipation, and certain tumors and cancers can cause an obstruction.
As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder.
Surgery to correct pelvic organ prolapse, such as cystocele and rectocele, and urinary incontinence can also cause urethral stricture. The urethral stricture often gets better a few weeks after surgery.
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Treatment Options For Men With Intermittent And Irregular Urine Stream
Treatment of men with urinary problems that result in intermittent pee flow aims to treat the underlying problem that caused inconsistent urine stream.
When the urinary problem in men is caused by swollen prostate as a result of urinary tract infection or sexually transmitted disease , antibiotics were used to treat the underlying infection.
When the problem is caused by scar formation in the urethra leading to urethral stricture, urethral dilatation, urethral stricture incision or urethroplasty may be necessary to solve the problem of poor urine flow.
When urinary problems are caused by prostate growth due to BPH, treatment of enlarged prostate with medication such as alfuzosin, Rapaflo, and finasteride is often effective. Office procedures such as Urolift procedure, REZUM procedure for BPH can be performed to widen the prostatic urethra so that urine can flow more easily. Other procedures such as prostatic artery embolization , Butterfly, iTind for BPH, and Aquablation of the prostate are currently being investigated in the treatment of blockage caused by an enlarged prostate.
When urinary problems are caused by prostate cancer, treatment of prostate cancer is usually necessary. In addition, medications and treatment options used for BPH are usually helpful.