Voiding Disorders

How do you know when you have voiding problems?

Women with voiding dysfunction commonly present with symptoms of:

  • Incomplete bladder emptying sensation

  • Abnormal urine flow – slow or intermittent (start-stop)

  • Voiding abnormalities – difficulty in initiating void (hesitancy), straining to void and needing to splint vagina during voiding

  • Bladder leakage due to bladder overflow

What are the causes of voiding dysfunction?

Patients with symptoms of voiding dysfunction are divided into 3 main groups i.e. bladder outlet obstruction, weak (underactive) bladder and functional voiding dysfunction. 

Common causes of bladder outlet obstruction

  • Pelvic organ prolapse

  • History of incontinence surgery 

  • Pelvic mass compressing bladder outlet

  • Urethral lesions e.g. diverticulum, narrowing

 Common causes of underactive bladder

  • Ageing

  • Diabetes melitus

  • Neurological disorders affecting nerve supply to the bladder

  • Medications related

  • Overdistension bladder injury

Common causes of functional voiding dysfunction

  • Hinnman syndrome - Inability to void in public places or needing to relax and concentrate during voiding

Identification & investigations for voiding dysfunction

Detailed clinical assessment will be undertaken to rule out the causes as listed above

  • Urine test will be performed to exclude evidence of UTI

  • You will be asked to complete a 3-day bladder diary to objectively assess your daily fluid intake and output 

  • In some cases, a pelvic and renal ultrasound scan may be required to rule out pelvic mass or pathology and also evidence of upper urinary tract injury due to long standing voiding dysfunction

  • A Urodynamics study may be undertaken to allow objective assessment of your bladder function and the ability to empty properly. A cystoscopy will be performed at the same time to rule out bladder and urethral lesion.

How do we manage the problem?

The treatment of voiding dysfunction will be individualised depending on the cause of symptoms. 

Patients are encouraged to double or triple void to help with emptying of residual urine in the bladder.

Sometimes a catheter may be used in the short-term to allow the bladder to rest. Patients who have a weak bladder may need to perform self-catherisation for a longer duration

Sacroneuromodulation (pacemaker-like device implanted into lower back) can be considered after careful assessment by specialist

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