What Is Voiding Dysfunction?
Voiding dysfunction is an umbrella term used in Singapore to describe a range of conditions characterised by poor coordination between the bladder muscles and the urethra. This lack of coordination often causes abnormalities in a person’s ability to fill, store, or empty the bladder. Voiding dysfunction is known to affect both men and women. Unlike neurologic lower urinary tract disorders, voiding dysfunction is not caused by any disorders of the nervous system.
What are the common causes of Voiding Dysfunction in Singapore?
Voiding dysfunction can have a number of causes, including:
- Weak bladder muscles
- Pelvic floor tension myalgia
- Urinary incontinence
- Interstitial cystitis
- Bladder obstruction
- Benign prostate hyperplasia
- Prostatitis
In such cases, there can be over-activity of the pelvic floor muscles, or they may have an inability to completely relax.
Voiding dysfunction may also have certain triggers, such as constipation or urinary tract infections (UTIs).
What are the symptoms of Voiding Dysfunction?
Some common symptoms of voiding dysfunction are:
- Frequent urination
- Incomplete voiding
- Urgency
- Nocturia
- Weak stream
- Dribbling/Leaking
- Urinary hesitancy
When should I see a doctor?
You should visit a doctor if you are experiencing any of the above symptoms, especially if you are unable to urinate. You should also see a urologist if you are showing any signs of infection, such as a fever, or if you have noticed any changes in the smell or appearance of your urine. Your doctor will be able to begin treatment and provide advice on what changes you can make to your lifestyle to alleviate your symptoms.
What can I expect during my first consultation?
Your consultation will generally start off with a series of questions in order to understand your medical history and symptoms for your urologist to get a better understanding of your condition. A physical examination and various diagnostic tests may be carried out such as blood tests or a uroflowmetry.
How is Voiding Dysfunction diagnosed in Singapore?
The tests used to diagnose voiding dysfunction include:
- Urinalysis and urine culture — Your urine sample will be sent to a laboratory to check for any blood or infection in your urine.
- Prostate-specific antigen (PSA) test — This is a blood test used for male patients that measures their PSA levels. Elevated PSA levels may be an indication of prostate cancer.
- Bladder diary — You will be asked to record how much fluid you drink, how often you urinate, and the volume of urine produced throughout a three-day period.
- Uroflowmetry — This test measures your voiding function by analysing the speed and volume of your urination.
- Urodynamic study — This is a real-time functional study of the bladder involving the infusion of saline into the bladder via a small urethral catheter. It aims to replicate any voiding issues in order to tailor the most appropriate treatment plan.
- Flexible Cystoscopy — This is a relatively painless test that uses a fibre-optic telescope to inspect the bladder, urethra. In males, the prostate gland will also be examined.
- Ultrasound Bladder — An ultrasound bladder can show any potential issues with the structure of the bladder. This test is commonly used in conjunction with a uroflowmetry test to check for residual urine after urination.
Can Voiding Dysfunction be cured?
The chance of cure is dependent on the cause of your voiding dysfunction and if the underlying cause can be treated. In other cases, your treatment plan will be tailored towards improving bladder control and managing your symptoms in the long term.
How is Voiding Dysfunction treated in Singapore?
Treatment plants for voiding dysfunction will be determined by the underlying cause of the condition. Some treatment options include:
Drug Treatment
Any medication given for voiding dysfunction is typically prescribed in combination with other forms of treatment. Some common medications prescribed to patients with voiding dysfunction are:
- Muscarinic Receptor Antagonists (MRAs)
These work to reduce abnormal contractions in the bladder. - Alpha-blockers
These help to relax the muscles in the bladder neck and sphincters. - Parasympathetomimetics
These help the bladder to contract and squeeze more urine out. - Antispasmodics
These medications help to relax the pelvic floor muscles and makes it easier to void.
Non-invasive treatments
- Bladder Training — This refers to deliberately delaying urination in order to train the bladder to hold urine more effectively.
- Double Voiding — To double void, a patient should urinate, then wait for a few minutes and try to urinate again. This treatment method helps to completely empty the bladder to prevent any leaking.
- Pelvic Floor Exercises — More commonly known as Kegels, these help to strengthen the muscles that control urination. Pelvic floor muscle relaxation may also be taught to aid in emptying the bladder if they are in spasms or tight.
- Electrical Stimulation Therapy — This is a method of strengthening the pelvic floor muscles over time using an external device.
- Intermittent Self-Catheterisation — Your doctor will instruct you on how to insert a catheter into your urethra at regular intervals in order to empty your bladder completely.
- Neurotoxin A Injections — Neurotoxins may be injected into the bladder muscles or sphincters to relax them and prevent any spasms.
- Neuromodulation — Various devices may be used to stimulate the tibial and sacral nerves in order to help with bladder control.
Lifestyle Changes
- Dietary changes Your doctor may ask that you avoid consuming certain types of food or drink, such as caffeine or spicy food, which act as irritants. You may also be asked to consume more fibre to prevent constipation, which can trigger symptoms of voiding dysfunction.
- Maintain a healthy weight Losing weight can help to reduce pressure on the bladder and thus reduce the likelihood of leaking.
- Stop smoking If you are a smoker, your doctor is likely to ask that you stop smoking, as the nicotine found in cigarettes can also act as an irritant for the bladder.
Summary
If you are experiencing any signs of voiding dysfunction, please do not hesitate to make an appointment with us. Voiding dysfunction should be treated as early as possible because it may be a sign of bladder obstruction, and may lead to further complications such as recurrent UTI, or even kidney damage if left untreated.
Your urologist will be able to provide treatment and suitable management techniques that you can easily incorporate into your lifestyle in situations that require long-term management.
