Dysuria frequency and urgency

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These are cardinal symptoms of urinary tract infection, the commonest condition to affect the urinary tract. Dysuria is pain experienced prior to. during or following micturition, usually in the urethra or suprapubic region. When due to urinary infection, it is often described as a burning sensation, even akin to passing broken glass. Urinary frequency describes an increased frequency of micturition without implying any increase in the total urine volume. Urgency is a strong desire to pass urine which may be followed by incontinence if the opportunity to urinate is not available.

In general, dysuria, frequency and urgency arc associated with disorders of the lower urinary tract - bladder, prostate and urethra. Although commonly due to urinary tract infec-

TABLE 5.19 List of genitourinary symptoms

General Pain passing urine (dysuria)

Severs suprapubic pain associated with inability to pass urine (strangury)

Passing urine more often than usual (frequency)

A sudden need to pass urine (urgency)

Passing a larger volume of urine than normal (polyuria)

Passing a smaller volume of urine than normal (oliguria)

Passing ume during the night (nocturia)

Total absence of urine output (anuria)

Blood in the urine (haematuria)

Air bubbles in the urine (pneumaturia)

Females Stress or urge urinary imcontinence Menstrual Irregularities Obstetric difficulties

Vaginal bleeding following intrauterine erosions, polyps, malignancy

Vaginal discharge (e.g. candidiasis or sexually acquired infection)

Altered sexual function, e.g. dyspareunia (painful intercourse)

Males Delay in initiating urine flow (hesitancy) Impaired urinary flow Post-micturition dribbling Dribbling Incontinence

Urethral discharge (suggesting sexually acquired infection) Altered sexual function (e.g. impotence)

tion, tumours, urinary calculi or urinary tract obstruction should also be considered. Dysuria alone may be due to infection of the urethra, as in gonorrhoea, when there may also be urethral discharge.

Frequency alone, particularly in young adults, may be due to anxiety. In the elderly, it is more often the result of abnormally high bladder muscle tone (detrusor instability). Urgency alone may occur in pregnancy, owing to extrinsic pressure on the bladder, or weakness of the pelvic floor muscles or uterine prolapse. It may also he a feature of neurological disease affecting the motor control of the bladder, such as multiple sclerosis. Patients with multiple sclerosis often present with bladder symptoms, including a false sensation of needing to pass urine.

The term strangury is used when the patient experiences suprapubic pain associated with a repeated and urgent desire to urinate every few minutes, often associated with severe dysuria or inability to pass urine. It is usually due to acute bladder neck obstruction by a stone or blood clot.

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