CHAPTER 13: Urine Difficulty

Painful Urination in Women

When a woman notices uncomfortable, frequent urination,she probably has a urinary tract infection (UTI) or vaginitis; with vaginitis she will usually notice a discharge. (See Women's Issues)

Evaluation of a probable urinary tract infection depends on three factors.

1. How sick you are. In general, many UTIs in women are easily managed by increasing fluid when only discomfort is noted. However, high fever, shaking chills, nausea, or pain in the sides of the lower back are worrisome. A doctor should be contacted when these worrisome problems are present.
2. How often you have had this problem. If the problem comes back many times, long term or preventive treatment may be needed.
3. Whether you are pregnant or have (sugar) diabetes. Persons with these conditions are at risk for problems and must be carefully evaluated by a doctor whenever they have persistent painful urination.

Treament:

• Increasing fluid when discomfort is noted.
• Pyridium is an over the counter medication used to alleviate the pain, irritation, discomfort, or urgency of the UTI, but does not treat the infection.
• Urinating immediately after intercourse may reduce the risk of infection in some women.
• If after 24 hours without improvement of symptoms (regardless of which, if any, of the above have been tried) a doctor's visit or an antibiotic may be needed.
• (Despite its popularity, cranberry juice has no antibiotic properties and does not prevent recurrences if taken daily).

Painful Urination in Men

Urinary infections are rare in men. If urination is painful or there is blood in the urine, it may be caused by prostatitis or an STD (the sexually transmitted diseases chlamydia and gonorrhea are the most common causes for urethritis; a discharge from penis may be observed) or prostatitis. Long term antibiotic treatment may be required.

Difficulty Urinating

Trouble Emptying the Bladder is a problem that often affects men who have an enlarged prostate gland. They may have dribbling, a weak urinary stream, and feel that they have to urinate a lot, day and night. Taking time to void and avoiding some medicines, coffee, and alcohol can help a lot. But if it continues to get worse and really bothers, surgery or medicines can be considered.

"Alpha blocker" medicines (that relax bladder muscles) are a good choice because they take effect within a few weeks. If an alpha blocker is affordable and is giving good relief, it can be used for many years. The most common side effect is dizziness when standing.

Surgery is useful for men who have difficulty urinating despite trying an alpha blocker. The prostate is usually removed, cut or "heated" by passing a tube through the penis. Men who have this surgery usually recover completely within a few weeks.

Prostate cancer is seldom a cause for difficult urination in men.

Trouble Controlling Urine

About 1 in 20 (5%) of older adults have a lot of trouble controlling urination or urinary incontinence. Persons with incontinence often withdraw from social life and try to hide the problem from their family, friends, and even their doctor. These reactions are common. However it is important to know that many causes for incontinence can be treated and controlled, if not cured.

The most common forms of urinary incontinence.

• Stress incontinence is the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. It occurs most often in women.
• Urge incontinence is the inability to hold urine long enough to reach a toilet. It is often found in people who have conditions such as stroke, dementia, Parkinson's disease, and multiple sclerosis, but it can occur in otherwise healthy older persons.
• Overflow incontinence is the leakage of small amounts of urine from a bladder that is always full. In older men this type of incontinence occurs when an enlarged prostate blocks the flow of urine from the bladder. Another cause is loss of normal bladder contractions in some persons with diabetes.
• Functional incontinence may occur in persons who have normal urine control, but who have difficulty reaching a toilet in time. Since the urinary system is not really the problem, the approach must be to improve access to the toilet or schedule voiding to prevent an ineffective rush to the toilet.

Common treatments for incontinence.

• Behavioral techniques. This includes scheduled voiding, pelvic muscle exercises, and biofeedback. They are often very effective in reducing episodes of stress and urge incontinence. These behavioral techniques benefit most persons who try them. (See Women's Issues)
• Medications. Although they can be effective, drugs may cause side effects such as a dry mouth, eye problems, dizziness, and buildup of urine. Therefore, they must be used carefully under a doctor's supervision.
• Surgery. Incontinence that is related to a structural problem such as an abnormally positioned bladder or blockage due to an enlarged prostate can be improved or even cured.
• Catheters. Incontinence may be managed by inserting a flexible tube known as a catheter into the urethra and collecting the urine in a container. Although self-catheterization is very effective it is not a first choice treatment option.

Urinating at Night

Getting up to urinate at night is common for older men and women. The need for night time urination is usually caused by the way the older kidney controls salt (and salt affects the way we control water). Other common causes include "fluid pills," diabetes, prostate enlargement, and some heart conditions.

To reduce nighttime urination liquids (and alcohol) should be avoided within an hour of bedtime. The bladder should be emptied just before bed time and optimally after lying in bed for about 30 minutes. Hazards should be removed from the path between bedroom and bathroom.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.

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Last reviewed: January 2024 © 1997-2024 FNX Corporation and Trustees of Dartmouth College. All Rights Reserved.