Urinary problems are not just problems faced by the elderly. Dr Ng Lay Guat, Senior Consultant and Head, at the Urology Centre, Singapore General Hospital, shares how urinary problems can affect young patients.
Urinary problems are not restricted to the elderly. Young men and women can also suffer from poor urination or severe urgency, the sensation of incomplete urination or even urinary incontinence, just like older people. These problems are known in medical terms as lower urinary tract symptoms (LUTS).
Young LUTS patients can complain of various voiding (obstructive) symptoms:
- a poor stream when urinating,
- the need to wait very long before urine can be passed out (“hesitancy”),
- the need to strain or push to clear urine,
- the sensation of incomplete voiding or even
- urine retention.
Patients can also present with storage (irritative) problems such as:
- urinary frequency,
- severe urgency
- need to pass urine many times after going to bed (nocturia) or even
- urge incontinence.
While many older men with voiding symptoms are diagnosed with benign prostate hyperplasia (BPH), this diagnosis cannot be made in a younger man (below the age of 50).
Functional bladder outlet obstruction: When voiding problems occur in young patients
Many young patients, both men and women, are found to have “functional bladder outlet obstruction”. “Functional” implies that there is a problem with the functioning of the lower urinary tract while its structure is normal.
The offending part of the bladder outlet may be the bladder neck, external sphincter or the pelvic floor. This is frequently related to their inability to open and close as required when the bladder contracts during voiding. Doctors use various terms to describe this condition, including ‘functional bladder neck obstruction’, ‘primary bladder neck obstruction’, ‘detrusor sphincter dys-synergia’ or dysfunctional voiding.
Other functional urinary problems include overactive bladder syndrome, painful bladder syndrome, chronic pelvic pain, etc.
Could you have functional bladder outlet obstruction?
Doctors are more likely to suspect this condition in the following situations:
- in younger patients,
- in patients who have voiding symptoms,
- if there is no previous history of trauma, infection to the lower urinary tract or neurological system or surgical intervention that may have contributed to the faulty functioning of the bladder.
What are the causes of functional bladder outlet obstruction?
The exact causes of this condition are generally unknown. However, stress, psychosocial issues, and a learnt habit are some suggested causes of this condition.
How do doctors diagnose functional bladder outlet obstruction?
- By excluding any structural or mechanical problem of the bladder, frequently based on the patient’s history. The doctor may also look into your bladder using a thin, lighted tube (procedure called “cystoscopy”).
- By excluding other causes of weak bladder, such as a previous spinal injury or diabetes mellitus.
- By measuring the rate of urine flow with a diagnostic procedure called “uroflometry”or urodynamic study.
What are the treatment options for functional bladder outlet obstruction?
If the problem is found to be the bladder neck, doctors can prescribe alpha-blockers medications to relax the bladder neck (e.g. terazocin, alfuzocin or tamsulocin). If conservative therapy is not effective, then an incision of the bladder neck may be indicated. Botulinum toxin A injection to the bladder neck muscles can be used for this purpose but results have not been encouraging.
If the problem lies with the external sphincter, then the best treatment is a direct injection of Botulinum toxin A to the external sphincter. Other treatment options include biofeedback and physiotherapy.
If the obstructing element is a very tense pelvic floor, treatment is generally difficult. Treatment options include pelvic floor relaxation exercises, trigger point relaxation, biofeedback, analgesia, counseling, etc.
In conclusion, lower urinary tract symptoms are not always related to benign prostate hypertrophy. In patients who do not fit the usual profile, such as female patients or younger male patients, further investigations are warranted so that a definitive diagnosis can be made and a treatment regime planned accordingly.