Written by epgonline.org - Last updated 29 May 2018
This topic consists of a group of symptoms frequently resulting in emergency or primary care presentation. The symptoms may relate to numerous disease processes, comprising: urinary incontinence and frequency; retention or difficulty passing urine; pain or discomfort when passing urine; abnormal findings in the urine; and other symptoms including urethral discharge and reflux uropathy.
To provide an overview of what is covered in this section, they will be discussed in these five broad areas.
Urinary incontinence and frequency are two linked symptoms, with the differentiating factor being the ability to retain urine. Incontinence may relate to:
- neurological dysfunction and lack of sensation of bladder filling;
- detrusor instability – leading to symptoms of overactive bladder and urge incontinence;
- stress incontinence – lack of continence due to mechanical dysfunction, such as pelvic floor weakness;
- or numerous other causes.
Nocturnal enuresis (bedwetting) is of particular note, as it is more prominent in children and adolescents, and the social and psychological consequences can be distressing to both affected children and their parents.
Retention, or difficulty passing urine, can be explored in several ways; mechanical obstruction can be used as a term for symptoms caused by a physical blockage – this may be as a result of an enlarged prostate, constipation or a mass within the pelvis and congenital urethral valves or strictures. Neurogenic retention is a result of disruption to the nervous pathways and may be due to pelvic splanchnic nerve damage, cauda equina syndrome, demyelination, Parkinson’s disease, or any other process that causes reduced signalling. Equally, retention may be caused by some medications – anticholinergic medications and opioids are two of the more common.
Pain or discomfort when passing urine may be due to urinary tract infection – the locus may be anywhere from the kidneys to the urethra; drugs and chemical irritants may also cause the symptoms; genital causes such as endometriosis or prostatic enlargement are also differentials.
Abnormal substances in the urine may come from any part of the urinary tract, and may reflect a systemic or a local problem. Proteinuria, myoglobinuria and haemoglobinuria may be indicative of renal pathology or of a systemic problem such as rhabdomyolysis. Haematuria and chyluria are more likely to be post-renal.
Other symptoms covered in this topic include urethral discharge, other abnormal findings in the urine, and symptoms of reflux uropathy.