SYMPTOMS

What is dysuria?

Dysuria primarily refers to a series of symptoms caused by difficulty in emptying urine from the bladder. In severe cases, it may lead to urinary retention, where the bladder contains urine but cannot expel it.

Anyone can experience dysuria. In men, it is often associated with benign prostatic hyperplasia (BPH) or urethral stricture, while in women, it may be related to bladder neck sclerosis, psychological factors, or certain gynecological conditions. In children, it could be linked to neurogenic bladder or posterior urethral valves.

At what age is dysuria more common? Who is more prone to dysuria?

Generally, dysuria is more prevalent in older adults than in younger individuals, and men experience it more frequently than women. It is relatively rare in children.

This is because the likelihood of developing conditions that affect urination increases with age. Additionally, the male urethra is longer and more curved than the female urethra, and as men age, they are more susceptible to BPH, making them more prone to dysuria.

What are the common symptoms of dysuria?

Dysuria typically manifests as difficulty initiating urination, straining to urinate, split urine stream, incomplete emptying, intermittent or weak urine flow, shortened urine stream range, or post-void dribbling.

The severity of dysuria depends on the underlying condition. Mild cases may involve delayed urination or a shortened stream, while severe cases may present with a thin or dribbling stream, requiring abdominal straining or even manual pressure on the lower abdomen to urinate. In extreme cases, dysuria can progress to urinary retention.

What are hesitancy, straining, incomplete emptying, split stream, thinning, and dribbling?

• Hesitancy refers to a delay in initiating urination.
• Straining involves using abdominal effort to start or maintain urination.
• Incomplete emptying is the sensation that the bladder is not fully emptied after urination.
• Split stream occurs when urine flows in two or more directions, resembling a showerhead spray.
• Thinning refers to a narrower urine stream due to increased urinary resistance.
• Dribbling is the leakage of small amounts of urine after completing urination. In older men, post-void dribbling often indicates BPH, as it is an early symptom of the condition.

What is residual urine?

Residual urine refers to the volume of urine remaining in the bladder after complete voiding. In 87% of healthy individuals, residual urine is less than 5 mL, and no healthy person has residual urine exceeding 12 mL.

What is urinary retention?

Simply put, urinary retention is the inability to empty the bladder despite it being full, leading to overdistension. It can be classified as acute or chronic based on the duration of symptoms.

• Acute urinary retention is one of the most common urological emergencies, characterized by sudden bladder distension and an urgent but unsuccessful need to urinate. It is often accompanied by pain and anxiety due to the intense urge to void. Acute retention requires immediate diagnosis and treatment.
• Chronic urinary retention develops gradually due to long-standing dysuria. Most patients with chronic retention do not experience pain. Over time, the bladder becomes chronically overdistended, and intravesical pressure exceeds urethral resistance, leading to involuntary urine leakage, known as "overflow incontinence."

What is overflow incontinence?

Overflow incontinence, also called paradoxical incontinence, occurs when the bladder is excessively full, and urine leaks involuntarily due to high intravesical pressure overcoming urethral resistance (similar to water overflowing from an overfilled jug).

It often follows chronic urinary retention caused by conditions such as urethral stricture, tumors, or BPH.

TREATMENT

What can I do to relieve difficulty urinating on my own?

You can try turning on the faucet to listen to the sound of running water, which may help induce urination.

If that doesn’t work, try applying a warm compress to the lower abdomen. Heat therapy is often effective for patients with recent-onset difficulty urinating and mild bladder distension. Generally, apply warmth to the lower abdominal bladder area and perineum, or take a warm bath. If you feel the urge to urinate while in warm water, you can try urinating directly in the water.

You can also try massaging the lower abdomen. Gently massage from the navel to the bladder area, gradually increasing pressure. Use your palm to apply light downward pressure above the bladder to aid urination. Be careful not to press too hard to avoid bladder rupture.

Whether successful or not, seek medical attention promptly.

How is difficulty urinating treated?

• For acute difficulty urinating with severe bladder distension, emergency treatment is needed. The priority is relieving symptoms (e.g., inserting a catheter or performing a cystostomy—after all, one shouldn’t be "held back" by urine). The underlying cause can then be addressed.
• For chronic difficulty urinating, treatment depends on the cause. If kidney function is already impaired, a catheter or cystostomy may be needed first. Further treatment can be considered after kidney function recovers.

What does inserting a catheter for difficulty urinating mean? Is it uncomfortable?

Inserting a catheter means placing a tube through the urethra into the bladder, allowing urine to drain and preventing excessive bladder distension, which helps protect kidney function.

Of course, the process may be slightly uncomfortable, especially for men due to their longer urethra. However, most patients can tolerate it, and the catheter generally doesn’t significantly impact daily life.

What does a cystostomy for difficulty urinating mean?

A cystostomy involves creating a passage to the bladder through a surgical incision or puncture in the lower abdomen, then inserting a tube to drain retained urine. Most cystostomies are performed via puncture, making the procedure simple and convenient.

This method can temporarily or permanently resolve difficulty urinating. A cystostomy isn’t only used when catheter insertion isn’t possible.

DIAGNOSIS

Which department should I visit for difficulty urinating?

Difficulty urinating caused by different reasons may require seeing different departments. For example, urinary difficulties due to nervous system damage may require a visit to neurosurgery, psychological factors may require psychiatry, and conditions like vaginal prolapse may require gynecology.

Of course, if you're unsure about the cause of your urinary difficulty, you can visit the urology department, as urological issues are the most common cause of such symptoms—after all, it's literally in the name.

What should I pay attention to when seeking medical help for difficulty urinating?

During your visit, be sure to describe your symptoms in detail to the doctor, such as whether you have lower abdominal or perineal pain, a history of kidney stones, the severity and duration of your urinary difficulty, etc.

If you're a female patient, also inform your doctor about your menstrual and pregnancy history to determine if gynecological or obstetric factors are contributing to the issue.

Additionally, disclose any history of diabetes, spinal injuries, or neuropsychiatric conditions to your doctor.

What tests are needed for difficulty urinating?

There are many tests related to urinary difficulty, and the choice depends on the specific condition.

• A digital rectal exam can preliminarily assess the size, texture, surface smoothness, tenderness, and potential tumors of the prostate.
• A routine prostate fluid test helps diagnose prostatitis.
• Cystoscopy aids in diagnosing urinary difficulties caused by bladder neck strictures, stones, or tumors.
• X-rays can detect hidden spinal fractures or injuries, while ultrasounds examine the bladder, kidneys, ureters, the prostate in men, and gynecological conditions in women.

How is a digital rectal exam performed? Is it uncomfortable?

A digital rectal exam involves the doctor inserting a finger into the rectum to palpate the prostate through the intestinal wall, checking for enlargement, hardness, or abnormalities.

Although this exam may sound embarrassing and feel slightly uncomfortable, it is highly valuable for patients suspected of having prostate enlargement or prostate cancer.

What is a cystoscopy?

Cystoscopy is a type of endoscopy where a lighted instrument is inserted through the urethra into the bladder to examine it, similar to looking through a peephole.

Its primary use is for detecting bladder tumors, allowing observation of their size, number, shape, and location, as well as collecting tissue samples for biopsy. It can also identify other conditions like bladder stones or prostate enlargement.

Is anesthesia required for a cystoscopy due to difficulty urinating?

Cystoscopy is usually performed under urethral mucosal surface anesthesia (applying anesthetic to the urethral lining). Alternatively, intravenous anesthesia can be used for a painless procedure, similar to gastroscopy or colonoscopy.

With mucosal anesthesia, some discomfort or pain may occur as the instrument passes through the urethra, but most patients can tolerate it. Some even undergo the examination without anesthesia.

POTENTIAL DISEASES

What are the types of dysuria? What are the main causes?

Dysuria can be classified into three types based on the cause:

• Mechanical obstruction: Similar to a clogged pipe at home, water cannot reach the faucet. Mechanical obstruction includes urethral stricture, bladder or urethral tumors, congenital urethral valves, bladder or urethral stones or foreign bodies, and obstruction caused by compression from tumors in adjacent organs.
• Dynamic obstruction: Sometimes, the basic structure of the pipe is fine, but the water pressure is insufficient (poor bladder contraction), or the muscles in the pipe wall or surrounding area fail to relax (like a hose tightly bound by a rubber band), preventing smooth water flow. Dynamic obstruction can occur in late-stage complications of diabetes, brain or spinal cord disorders, post-anesthesia, neurogenic bladder, dysfunctional voiding muscles, or pelvic surgery damaging the pelvic or pudendal nerves.
• Mixed obstruction: A combination of mechanical and dynamic factors, commonly seen in conditions like benign prostatic hyperplasia (BPH) or acute prostatitis.

What diseases might dysuria indicate?

Dysuria may be associated with but not limited to the following conditions:

• Bladder stones: Sudden dysuria during urination, severe lower abdominal pain radiating to the penis, thighs, or perineum, and possible hematuria during or after pain. Treatment options include extracorporeal shock wave lithotripsy, transurethral lithotripsy, or cystolithotomy.
• Bladder blood clots: Any condition causing urinary tract bleeding may lead to clot formation, such as tumors, trauma, or coagulation disorders like hemophilia, leukemia, aplastic anemia, or anticoagulant use.
• Bladder tumors: Progressive worsening of dysuria over a long course, with possible distant metastasis in advanced stages.
• BPH, prostate cancer, or prostatitis: Differential diagnosis can be made via ultrasound, prostate fluid tests, or prostate-specific antigen (PSA) testing.
• Urethral injury: Usually caused by trauma, leading to dysuria, anuria, or urethral bleeding.
• Urethral stricture: Often secondary to scarring, stones, or foreign bodies.
• Spinal cord damage: Seen in paraplegic patients, accompanied by motor and sensory impairments.
• Spina bifida occulta: Early onset, nocturnal enuresis, and prolonged bedwetting in childhood.
• Diabetic neurogenic bladder: Patients have a long history of diabetes.
• Drug effects: Such as atropine poisoning or anesthesia.

Is dysuria serious?

Not necessarily.

It depends on whether it severely affects the patient's health or quality of life and the underlying cause.

Does dysuria treatment require hospitalization?

It varies.

Mild cases without complications can be treated in clinics or outpatient settings. However, conditions requiring surgery (e.g., stones or BPH) or severe urinary tract infections may necessitate hospitalization.

What are the consequences of untreated dysuria?

Untreated dysuria may lead to residual urine, urinary retention, or overflow incontinence, increasing the risk of urinary tract infections and stone formation.

Increased abdominal pressure during urination may also raise the likelihood of inguinal hernias or hemorrhoids. Severe cases can cause hydronephrosis or kidney damage. Chronic infection may increase the risk of bladder tumors.

How to care for long-term catheter use in dysuria patients?

Some patients, such as those with BPH who are poor candidates for surgery or medication, may require long-term catheterization. Care includes:

• Avoid twisting or pulling the catheter.
• Drink plenty of water to reduce infection risks.
• Limit excessive activity to prevent friction-induced bleeding.
• Replace catheters and urine bags as per guidelines.
• Regularly disinfect the urethral opening and catheter; change dressings for stoma sites.
• If urine appears cloudy or contains sediment, perform bladder irrigation (at home or in a hospital).
• Replace the catheter immediately if it falls out.
• Keep the urine bag below catheter level.
• Communicate with doctors and remove the catheter as soon as possible.

How to prevent dysuria recurrence after treatment?

• Drink more water to flush the urinary tract and reduce infection risks.
• Avoid triggers like cold, infections, alcohol, or spicy foods.
• Wash the perineum with warm water to relax the urethral muscles or use running water sounds to induce urination.
• Apply a warm compress to the lower abdomen to improve bladder circulation and reduce swelling.
• Use medications like neostigmine to promote bladder contraction or tamsulosin/finasteride to relieve obstruction.
• Manage underlying conditions (e.g., diabetes control for neuropathy or medication adherence for BPH). Consult a doctor for specifics.