Problems with Urination

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Problems with Urination
CAPT Mike Hughey, MC, USNR
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Cystitis

• Pain, burning, frequency, tender bladder
• Treat on the basis of symptoms
• Confirm cure with culture
• Bactrim, Gantrisin, Keflex, Macrodantin
• Pyridium 200 mg PO TID x 2 days

Video
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Gonorrheal Urethritis

• Burning, frequency, tender urethra
• Purulent discharge from urethra/Skene's
• GC culture
• Cephtriaxone 250 mg IM, plusDoxycycline 100 mg
  PO BID x 7 days
• Treat partner

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Non-Gonorrheal Urethritis

• Burning, frequency, tender urethra, bladder
• They don't improve on antibiotics
• Negative urine culture
• Treat on basis of suspicion
• Doxycycline 100 mg BID x 7 days, orClindamycin
  150 mg TID x 7-10 days
• Treat sexual partner

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Herpes Vulvitis

• Severe pain when urine passes over the vulva
• Multiple tiny blisters/ulcers
• Zovirax 200 mg PO Q4 hours while awake x 10 days
• May need Foley cather
• Try urinating into bathtub
• Will resolve within 5-10 days

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Causes of Urinary Frequency

• Bladder infection (with dysuria)
• Excessive fluid intake (particularly at night)
• Increased stress
• Pelvic mass
• Pregnancy

Naval Hospital Camp LeJeune
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Evaluation of Urinary Frequency

• Palpate for bladder tenderness (inf)
• Palpate for pelvic mass
• Urine culture (dipstick OK)
• Pregnancy test

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Blood in the urine

• Usually due to cystitis
• If it persists or returns, thenUrology
  consultation necessary to r/o -Renal stones
  -Bladder tumors -Endometriosis
• Microscopic hematuria most commonlydue to
  exercise in this age group

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Bad odor to the urine

• Either cystitis or vaginitis
• Look for -Lost and forgotten tampon
  -Yeast -Trichomonas -Bacterial vaginosis
  -Asparagus eating -Ampicillin intake

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Can't Urinate

• Put in Foley catheter
• Drain about 500 cc, then wait 5-10 minutes before
  draining another 500 cc...and then another 500 cc
• Leave Foley in place for 1-2 days to allow the
  bladder to regain its' tone
• Rule out -pregnancy -pelvic mass
  -pelvic trauma -herpes

Video
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Forms of Urinary Incontinence

• Stress incontinence
• Irritable bladder
• Loss of urine at unpredictable times

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Stress Urinary Incontinence

• Anatomic problem -Loss of urethrovessicle
  angle -UV junction exteriorized
• Loss of urine with cough, sneeze, exercise
• Mild, Mod Severe
• Surgery
• Kegel Exercises
• Double-voiding
• Caffeine, tobacco, alcohol, antibiotics

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Irritable Bladder

• Local problem
• Sudden urge to urinate
• Eliminate caffeine, tobacco and alcohol
• Double voiding
• Antibiotics
• Will need consultation

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Urethral Diverticulum

• Local problem
• Unexpected loss of urine on rising
• Will need consultation
• Surgery is curative
• Nothing else helps

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Unpredictable Urine Loss

• If not associated with urgency or activity,
  suggests neurologic cause such as -multiple
  sclerosis -spinal cord tumors -spinal disc
  compression
• If single episode, reassure patient
• If recurring problem or worsening, evaluate for
  neurologic disease or injury

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Pyelonephritis

• Severe flank pain and tender kidney(s)
• Fever (typically quite high)
• May or may not have urinary symptoms
• Treat with IV antibiotics
• This patient is very ill and may need MEDEVAC

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