Abnormal symptoms associated with urination
Summary/Definition
The symptoms associated with the lower urinary tract can be classified as accumulation symptoms, urination symptoms, and post-urination symptoms. Their occurrence can be caused by various factors, for example, benign prostatic hyperplasia, overactive bladder, stress urinary incontinence, aging processes, changes in the level of sex hormones, disorders of the spinal nerves and drug use. These symptoms can occur in both men and women, but there are differences between the sexes. In men, the most common disease is obstruction of the exit part of the bladder due to benign prostatic hyperplasia, and in women – stress urinary incontinence and hyperactive bladder.
Symptoms
Symptoms from the lower urinary tract can be classified as accumulation symptoms, urination symptoms, and post-urination symptoms. The symptoms of accumulation refer to those cases when the bladder is not sufficiently filled with urine, and a person feels frequent and urgent urge to urinate. Symptoms of urination include pain during urination, difficulty or slow urination, and a feeling of residual urine after urination is completed. Symptoms after urination manifest as discomfort.
Diagnostics
Various methods and tests are used to diagnose urination disorders, including a medical examination, urine analysis, blood analysis, tests for the nature of urine flow and imaging studies. Violations of urination can be caused not only by diseases of the urinary system, but also by other pathologies, so it is important to conduct a comprehensive medical examination. A medical examination allows you to assess the duration and degree of urination disorders, determine whether symptoms have been present since childhood or have recently arisen, and also find out information about drug or alcohol use that may affect urination. Structured methods are used to more accurately assess the severity of symptoms, for example, the International Preclinical Assessment of Symptoms (IPSS). Various scales and tables are also used to assess symptoms, including an assessment of bladder hyperactivity.
<Table. International Clinical Evaluation of Symptoms>
| Questions | Practically not | 1 time out of 5 | 2 time out of 5 | 3 time out of 5 | 4 time out of 5 | Almost always |
| 1. When you usually urinate, do you ever feel that there is still urine left, even if you have finished urinating? | 0 | 1 | 2 | 3 | 4 | 5 |
| 2. Do you usually urinate again within 2 hours after urinating? | 0 | 1 | 2 | 3 | 4 | 5 |
| 3. Do you usually have difficulty holding your urine? | 0 | 1 | 2 | 3 | 4 | 5 |
| 4. Have you ever felt that the pressure of urine is weak? | 0 | 1 | 2 | 3 | 4 | 5 |
| 5. Have you ever had to strain your lower abdomen due to the fact that urine comes out slowly when urinating? | 0 | 1 | 2 | 3 | 4 | 5 |
| 6. How many times a night do you pee after waking up from sleep? | 0 | 1 | 2 | 3 | 4 | 5 |
| The sum of points from 1 to 7 points indicates mild symptoms, from 8 to 19 points — moderate symptoms, from 20 to 35 points — severe symptoms. | ||||||
Physical examination includes a thorough assessment of the urinary system, including a general examination, as well as blood pressure measurement. It is important to pay attention to the presence of motor or sensory disorders that may be caused by neurological diseases, and check for abnormalities in the area of the external genitalia. Urine analysis is an integral part of the diagnosis and is mandatory for all patients who have symptoms associated with the lower urinary tract. This analysis includes a general urine analysis, cultural studies and analysis for the presence of cancer cells. The procedure of collecting urine and then sending the sample to the laboratory can detect hematuria, leukocytes and cancer cells. When hematuria is detected, a urinary tract infection is suspected and urine is seeded. If the results of sowing indicate the presence of bacteria, a diagnosis of urinary tract infection is made. If tumors of the urinary tract are suspected, including bladder cancer, special tests are performed to detect cancer cells in the urine. Kidney function tests and specific antigens are checked using blood tests. Additional diagnostic methods include the following: keeping a urination diary, a pad test, measuring the volume of residual urine, urodynamic tests, imaging studies and cystoscopy.
Treatment and course of the disease
Treatment of urinary disorders is aimed at identifying and eliminating the underlying disease causing these disorders, with the main goal of preserving kidney function and controlling urinary tract infections. The main causes of urination disorders are accumulation dysfunction and bladder urination dysfunction, which require appropriate treatment. Treatment methods include drug treatment, non-drug treatment, and surgical treatment.
Pharmacological treatment of bladder accumulation dysfunction involves the use of drugs that enhance the ability of the bladder to accumulate urine or improve its emptying. Non-drug methods include physical exercises for the pelvic muscles, biofeedback, electrical stimulation and behavior correction. Surgical treatment may include operations aimed at improving the function of the bladder, for example, an operation to narrow the anterior wall of the vagina, ligation of the neck of the bladder, periurethral injection and the installation of an artificial urethral sphincter. Treatment of bladder-related urination dysfunction may include pharmacological methods using alpha-sympathetic blockers and muscle relaxants to reduce resistance to urination. Non-drug methods include physical exercises for the pelvic muscles, biofeedback, electrical stimulation and behavior correction. Surgical treatment may include dilatation of the urethra, the use of balloons, urethral stents, prostate hyperthermia, transurethral resection of the prostate and prostatectomy.
