Female Voiding Dysfunction

Female Voiding Dysfunction

The lower urinary tract, which includes the bladder and urethra, allows for storage and timely expulsion of urine. Voiding dysfunction is a broad term, used to describe conditions where there is poor coordination between the bladder muscle and the urethra. This results in incomplete relaxation or overactivity of the pelvic floor muscles during voiding. A variety of specific definitions exist; the International Continence Society and International Urogynaecological Association define female voiding dysfunction as “abnormally slow and/or incomplete micturition (voiding) based on symptoms and urodynamic investigations.”

Voiding dysfunction can manifest as a wide range of symptoms which can include difficulty in emptying bladder, urinary hesitancy, slow or weak urine stream, urinary urgency, urinary frequency or dribbling of urine.

Voiding dysfunction can be due to nerve dysfunction, non-relaxing pelvic floor muscles or both. Voiding dysfunction is also classified as being caused by either underactivity of the bladder (detrusor) or outflow (urethra). Evaluation by a clinician may include tests, such as uroflowmetry, post-void residual and pressure flow studies. Treatment is individualized, depending on specific etiology. Possible treatments include pelvic floor therapy, intermittent self-catheterization, muscle relaxants or placement of a neuromodulation device. Specific conditions that fall within spectrum of female voiding dysfunction include Urinary Incontinence and Interstitial Cystitis.

Recent UCSF Urology publications on female voiding dysfunction:

Breyer BN, Wang G, Lin G, et al. The effect of long-term hormonal treatment on voiding patterns during filling cystometry and on urethral histology in a postpartum, ovariectomized female rat. BJU international. Dec 2010;106(11):1775-1781.

Deng DY, Gulati M, Rutman M, Raz S, Rodriguez LV. Failure of sacral nerve stimulation due to migration of tined lead. The Journal of urology. Jun 2006;175(6):2182-2185.

Resources:

Robinson D, Staskin D, Laterza RM, Koebl H. Defining female voiding dysfunction: ICI-RS 2011. Neurourology and urodynamics. Mar 2012;31(3):313-316.

Groutz A, Blaivas JG. Non-neurogenic female voiding dysfunction. Current opinion in urology. Jul 2002;12(4):311-316.

  

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Assistant Professor of Urology