Urology/urology

Advertisement


Question
What would cause a healthy 59 year old female to have difficulty emptying her bladder?  There are no signs of UTI only voids in small amount, then stops & then starts again.  This may take up to 5 minutes to empty her bladder.

Answer
Elizabeth, there are many conditions that may cause difficulty emptying the bladder.  Ones ability to urinate depends on 2 opposing factors: the force with which the bladder muscle contracts which has to work against the resistance in the urinary canal (urethra).  Anything which decreases the former or increases the latter make it more difficult to urinate and empty the bladder efficiently.  Normally, after urination the bladder should retain less than 30 cc (one ounce) of urine.  This is called the "residual urine".   Excessive “residual urine” can predispose to urinary infections and  kidney damage from back pressure.   In addition, chronic distention of the bladder muscle prevents it from contracting with maximum force which exacerbates the residual urine accumulation.  In women, poor vaginal support of the bladder &/or uterus can cause a cystocele (sagging bladder) or uterine prolapse (procidentia) which can both interfere with normal bladder evacuation.  Bladder contractile force can also be adversely affected by a number of medications including those used for anxiety, depression, pain (especially narcotics), antihistamines, GI disorders, & many other conditions.  Furthermore, putting  off the desire to void by holding ones urine too long over-stretches the bladder muscle which then may not be able to contract forcefully enough to empty.  Urinary retention can also be precipitated by excessive alcohol as this is a central nervous system depressant.  Alcohol may also prevent one from being aware that your bladder is full before it is too late. Certain neurologic diseases, such as herniated discs, MS, parkinsonism, etc. often adversely affect bladder emptying.  Lyme disease sometimes affects the central nervous system and occasionally causes urinary retention.

Disorders that may increase the resistance in the urethra include urethral stricture (narrowing), cystocele, uterine prolapse, urethral stenosis, etc.  Estrogen deficiency may be a factor in some cases.  As there are so many disorders that can cause voiding difficulty, one needs to see a urologist in consultation .  A complete history, physical examination and some laboratory tests are needed.  At the very least, measurement of the residual urine will be done.  Depending on the above, further testing such as a cystoscopy, urodynamic studies,  and imaging of the upper urinary tract may be indicated.  Do not wait any longer to get this checked out!   Although this might sound complicated, usually the problem can be managed quite successfully by relatively simple means.  The key to treatment, however, is find the cause for the symptoms.  Good luck.

Urology

All Answers


Answers by Expert:


Ask Experts

Volunteer


Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

©2016 About.com. All rights reserved.