Voiding Difficulty

Voiding difficulty is characterised by :

• Abnormally slow or intermittent urine flow.
• Sensation of incomplete bladder emptying after urination.
• Possible sudden onset or gradual development.
  May be accompanied by lower abdominal pain or be pain-free.
• Can progress to acute urinary retention, resulting in bladder overdistension and overflow incontinence.

Early diagnosis is crucial to prevent acute urinary retention and overstretching of the bladder, which may lead to chronic retention. The larger the volume of retained urine and the longer it persists, the more prolonged the bladder‘s recovery.

Common causes include:

• Obstruction of the urethra, such as:
• Urinary tract infections
• Vaginal infections
• Postmenopausal changes in the vagina, genital and urinary tract
• Severe pelvic organ prolapse, especially of the bladder and uterus
• Complications from surgery for stress incontinence or pelvic organ prolapse
• Prolonged labour, particularly with epidural analgesia, instrumental delivery, episiotomies or tears
• Early pregnancy with a retroverted uterus
• Uterine fibroids affecting the urethra
• Side effects of medications
• Constipation
• Neurological diseases or chronic bladder overdistension
• Psychological conditions like anxiety or depression

Common symptoms include:

• Delay in initiating urination
• Slow or intermittent urine flow
• Straining to urinate
• Feeling of incomplete bladder emptying
• Need for repeat voiding

Additional symptoms may include:

• Frequent urination of small volumes
• Urgent need to urinate
• Inability to pass urine, leading to lower abdominal pain
• Uncontrollable urinary leakage (overflow incontinence)

Treatment targets the underlying cause, such as infections, menopausal changes, pain, inflammation, constipation or piles.

In acute urinary retention, a catheter is inserted to drain urine and rest the bladder. Post-catheter removal, regular urination is encouraged, and bladder scans ensure effective voiding.

Complications from stress incontinence surgery can often be corrected within 1–2 weeks after the operation, for example, by adjusting the tension of the surgical tape. Patients with chronic retention are educated on different bladder management strategies.