ELDER TIP As a person ages, his bladder muscles weaken, which may result in incomplete bladder emptying and chronic urine retention — factors that predispose the older person to bladder infections.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Primary tumors of the spinal cord may be extramedullary (occurring outside the spinal cord) or intramedullary (occurring within the cord itself). Extramedullary tumors may be intradural (meningiomas and schwannomas), which account for 60% of all primary malignant spinal cord neoplasms, or extradural (metastatic tumors from breasts, lungs, prostate, leukemia, or lymphomas), which account for 25% of these malignant neoplasms.
Intramedullary tumors, or gliomas (astrocytomas or ependymomas), are comparatively rare, accounting for only about 10%. In children, they're low-grade astrocytomas.
Spinal cord tumors are rare compared with intracranial tumors (ratio of 1:4). They occur equally in men and women, with the exception of meningiomas, which occur mostly in women. Spinal cord tumors can occur anywhere along the length of the cord or its roots.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant brain tumors:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The cause of most brain tumors is unknown, but exposure to ionizing radiation is a known environmental risk. Additionally, most malignant tumors of the brain are of metastatic origin; 20% to 40% of patients with cancer develop brain metastasis.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Primary malignant bone tumors:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Causes of primary malignant bone tumors are unknown. Some researchers suggest that primary malignant bone tumors arise in areas of rapid growth because children and young adults with such tumors seem to be much taller than average. Additional theories point to heredity, trauma, and excessive radiotherapy.
For incidence information, see Comparing primary malignant bone tumors.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Bladder distention:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia (BPH)
In BPH, bladder distention develops gradually as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi
Bladder calculi may produce bladder distention, but pain is usually the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It’s usually most severe when micturition ceases. The pain may be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Cultural Cue: Bladder cancer is twice as common in Whites as in Blacks. It’s relatively uncommon among Asians, Hispanics, and Native Americans.
Multiple sclerosis
In this neuromuscular disorder, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostate cancer
Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. In some patients, urine retention and bladder distention are the only signs.
Cultural Cue: Prostate cancer is more common in Blacks than in other ethnic groups.
Prostatitis
In acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and a sensation of suprapubic fullness. Other signs and symptoms include perineal pain; tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
Bladder distention is rare in chronic prostatitis, which may be accompanied by perineal discomfort, a sensation of suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that often mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
In urethral calculi, urethral obstruction leads to interrupted urine flow and bladder distention. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation due to catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysuria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Appendicitis
Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney’s point, anorexia, nausea, vomiting, constipation, slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer
In this predominantly male disorder, dysuria throughout voiding is a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
Cultural Cue: Bladder cancer is twice as common in White males as in Blacks. It’s relatively uncommon in Asians, Hispanics, and Native Americans.
Cystitis
Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, a low-grade fever. In chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. In viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and fever.
Gender Cue: Women are more prone to develop cystitis than men because they have a shorter urethra. For men, age is a factor: Older men have a 15% higher risk of developing cystitis.
Diverticulitis
Inflammation near the bladder may cause dysuria throughout voiding. Other effects include urinary frequency and urgency, nocturia, hematuria, fever, abdominal pain and tenderness, perineal pain, constipation or diarrhea and, possibly, an abdominal mass.
Paraurethral gland inflammation
Dysuria throughout voiding is accompanied by urinary frequency and urgency, diminished urine stream, mild perineal pain and, occasionally, hematuria in this disorder.
Prostatitis
Acute prostatitis commonly causes dysuria throughout or toward the end of voiding as well as a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, fever, chills, fatigue, myalgia, nausea, vomiting, and constipation. In chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects are urinary frequency and urgency; diminished urine stream; perineal, back, and buttocks pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute)
More common in females than in males, this disorder causes dysuria throughout voiding. Other features include persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter’s syndrome
In this predominantly male disorder, dysuria occurs 1 to 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urethral syndrome
Occurring in sexually active women, this syndrome mimics urethritis. Dysuria throughout voiding may occur with urinary frequency, diminished urine stream, suprapubic aching and cramping, tenesmus, and low back and unilateral flank pain. In the absence of pyuria, symptoms will usually resolve without intervention.
Urethritis
Primarily found in sexually active males, this infection causes dysuria throughout voiding. It’s accompanied by a reddened meatus and a copious, yellow, purulent discharge (gonorrheal infection) or a white or clear mucoid discharge (nongonorrheal infection).
Urinary obstruction
Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (In a complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features are diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis
Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants
Dysuria may result from irritating substances, such as bubble bath salts and feminine deodorants; it’s usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes as well as urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs
Monoamine oxidase inhibitors and metyrosine can cause dysuria.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urethral discharge:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Prostatitis
Acute prostatitis is characterized by a purulent urethral discharge. Initial signs and symptoms include sudden fever, chills, low back pain, perineal fullness, myalgia, and arthralgia. Urination becomes increasingly frequent and urgent, and the urine may appear cloudy. Dysuria, nocturia, and some degree of urinary obstruction may also occur. The prostate may be tense, boggy, tender, and warm. Prostate massage to obtain prostatic fluid is contraindicated.
Chronic prostatitis commonly produces no symptoms, but it may produce a persistent urethral discharge that’s thin, milky or clear, and sometimes sticky. The discharge appears at the meatus after a long interval between voidings—for example, in the morning. Associated effects include a dull ache in the prostate or rectum, sexual dysfunction such as ejaculatory pain, and urinary disturbances, such as frequency, urgency, and dysuria.
Reiter’s syndrome
In this self-limiting syndrome that usually affects males, a urethral discharge and other signs of acute urethritis occur 1 to 2 weeks after sexual contact. Asymmetrical arthritis, conjunctivitis of one or both eyes, and ulcerations on the oral mucosa, glans penis, palms, and soles may also occur.
Urethral neoplasm
This rare cancer is sometimes heralded by a painless urethral discharge that’s initially opaque and gray and later yellowish and blood-tinged. Dysuria progresses to anuria as the urethra becomes blocked.
Urethritis
This inflammatory disorder, which is often sexually transmitted (as in gonorrhea), commonly produces a scant or profuse urethral discharge that’s either thin and clear, mucoid, or thick and purulent. Other effects include urinary hesitancy, urgency, and frequency; dysuria; and itching and burning around the meatus.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary hesitancy:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia
Signs and symptoms of this disorder depend on the extent of prostatic enlargement and the lobes affected. Characteristic early findings include urinary hesitancy, reduced caliber and force of the urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream, and occasionally urine retention. As the obstruction increases, the patient may develop urinary frequency, nocturia, urinary overflow, incontinence, bladder distention and, possibly, hematuria.
Prostate cancer
In advanced cancer, urinary hesitancy may occur along with frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion
A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from urine retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture
Partial obstruction of the lower urinary tract secondary to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
UTI
Urinary hesitancy may be associated with UTIs. Characteristic urinary changes include frequency, dysuria, nocturia, cloudy urine and, possibly, hematuria. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs
Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Hesitancy also may occur in patients recovering from general anesthesia.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary urgency:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Amyotrophic lateral sclerosis (ALS)
ALS occasionally produces urinary urgency. More common findings include muscle weakness, cramping, atrophy, and coarse fasciculations in the forearms and hands. Brain stem involvement causes difficulty speaking, chewing, swallowing, and breathing. Cognitive function is usually unaffected.
Bladder calculus
Bladder irritation can lead to urinary urgency and frequency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. Pain may be referred to the penis, vulva, lower back, or heel.
Multiple sclerosis (MS)
Urinary urgency, frequency, and incontinence are common urologic findings in MS. Like other symptoms of MS, these effects may wax and wane. Visual and sensory impairments are usually the earliest findings. Others include constipation, muscle weakness, paralysis, spasticity, intention tremor, hyperreflexia, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability.
Reiter’s syndrome
In this self-limiting syndrome that primarily affects males, urinary urgency and other symptoms of acute urethritis occur 1 to 2 weeks after sexual contact. Other symptoms include asymmetrical arthritis of the knees, ankles, or metatarsal phalangeal joints; conjunctivitis in one or both eyes; and ulcers on the penis, mouth, tongue, palms, or soles.
Spinal cord lesion
Urinary urgency can result from incomplete cord transection when voluntary control of sphincter function weakens. Urinary frequency, difficulty initiating and inhibiting a urine stream, and bladder distention and discomfort may also occur. Neuromuscular effects distal to the lesion include weakness, paralysis, hyperreflexia, sensory disturbances, and impotence.
Urethral stricture
Bladder decompensation produces urinary urgency, frequency, and nocturia. Early signs and symptoms include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence may occur.
UTI
Urinary urgency is commonly associated with UTIs. Other characteristic urinary changes include frequency, hematuria, dysuria, nocturia, cloudy urine, and sometimes urinary hesitancy. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Treatments
Radiation therapy may irritate and inflame the bladder, causing urinary urgency.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Dysuria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Lower urinary tract infection
❑ Acute pyelonephritis
❑ Urethritis
❑ Vaginitis
❑ Acute prostatitis
❑ Urethral calculus
❑ Reiter syndrome
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Source: Field Guide to Bedside Diagnosis, 2007
Urinary tract infection, lower:
Causes
(Handbook of Diseases)
Most lower UTIs result from ascending infection by a single gram-negative enteric bacterium, such as Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, or Serratia. However, in a patient with neurogenic bladder, an indwelling urinary catheter, or a fistula between the intestine and bladder, lower UTI may result from simultaneous infection with multiple pathogens.
Infection may result from a breakdown in local defense mechanisms in the bladder that allow bacteria to invade the bladder mucosa and multiply. These bacteria cannot be readily eliminated by normal micturition.
The risk of cystitis is higher when the bladder or urethra becomes blocked and urine flow stops. It can occur when instruments are inserted into the urinary tract during procedures such as catheterization or cystoscopy. Other risks include pregnancy, diabetes, and a history of analgesic or reflux nephropathy. The elderly are at increased risk for developing UTIs due to incomplete emptying of the bladder; this is associated with conditions such as benign prostatic hyperplasia (BPH), prostatitis, and urethral strictures. Also, lack of adequate fluids, bowel incontinence, immobility or decreased mobility, indwelling urinary catheters, and placement in a nursing home all place the person at risk for developing an infection.
Bacterial flare-up
During treatment, bacterial flare-up is generally caused by the pathogenic organism’s resistance to the prescribed antimicrobial therapy. The presence of even a small number (less than 10,000/ml) of bacteria in a midstream urine sample obtained during treatment casts doubt on the treatment’s effectiveness.
Recurrent UTI
In 99% of patients, recurrent lower UTI results from reinfection by the same organism or from some new pathogen; in the remaining 1%, recurrence reflects persistent infection, usually from renal calculi, chronic bacterial prostatitis, or a structural anomaly that may become a source of infection.
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Source: Handbook of Diseases, 2003
Bladder cancer:
Causes
(Handbook of Diseases)
Certain environmental carcinogens — such as 2-naphthylamine, benzidine, tobacco, and nitrates — predispose people to transitional cell tumors. Thus, workers in certain industries (rubber workers, weavers, leather finishers, aniline dye workers, hairdressers, petroleum workers, and spray painters) are at high risk for such tumors. The period between exposure to the carcinogen and development of symptoms is about 18 years.
Squamous cell carcinoma of the bladder is most common in geographic areas where schistosomiasis is endemic. It’s also associated with chronic bladder irritation and infection (for example, from kidney stones, indwelling urinary catheters, and cystitis caused by cyclophosphamide).
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Source: Handbook of Diseases, 2003
Bone tumors, primary malignant:
Causes
(Handbook of Diseases)
Although some cases of osteosarcoma are associated with genetic abnormalities (retinoblastoma, Rothmund Thomson syndrome) or exposure to carcinogens (such as ingested radium in watch dial painters), most cases have no immediately apparent cause. Ewing’s sarcoma cells demonstrate a characteristic translocation of genetic material from chromosome 22 to chromosome 11. Additional theories point to heredity, trauma, and excessive radiation therapy.
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Source: Handbook of Diseases, 2003
Brain tumors, malignant:
Causes
(Handbook of Diseases)
Some tumors are congenital, whereas others are hereditary. The cause of most brain tumors is unknown.
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Source: Handbook of Diseases, 2003
Bladder distention:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
See Bladder distention: Causes and associated findings, pages 46 and 47.
Benign prostatic hyperplasia (BPH)
With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi
Bladder calculi may produce bladder distention, but more commonly it produces pain as its only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Multiple sclerosis (MS)
With MS, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostate cancer
Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
Prostatitis
With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; tense, a boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare. However, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that usually mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Bladder distention:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
With benign prostatic hyperplasia (BPH), bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder cancer
By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
CULTURAL CUE:Bladder cancer is twice as common in Whites as in Blacks. It’s relatively uncommon among Asians, Hispanics, and Native Americans.
Multiple sclerosis
With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte’s sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski’s sign, and ataxia.
Prostatitis
With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
Spinal neoplasms
Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi
With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture
Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization
Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs
Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Appendicitis
Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney’s point, anorexia, nausea, vomiting, constipation, slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer
In bladder cancer, a predominantly male disorder, dysuria throughout voiding is a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
CULTURAL CUE:Bladder cancer is twice as common in White males as in Black males. It’s relatively uncommon in Asians, Hispanics, and Native Americans.
Cystitis
Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, low-grade fever. With chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. With viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and fever.
Diverticulitis
Inflammation near the bladder may cause dysuria throughout voiding. Other effects include urinary frequency and urgency, nocturia, hematuria, fever, abdominal pain and tenderness, perineal pain, constipation or diarrhea and, possibly, an abdominal mass.
Paraurethral gland inflammation
Dysuria throughout voiding occurs with urinary frequency and urgency, diminished urine stream, mild perineal pain and, occasionally, hematuria.
Prostatitis
Acute prostatitis commonly causes dysuria throughout or toward the end of voiding. Dysuria may be accompanied by a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, fever, chills, fatigue, myalgia, nausea, vomiting, and constipation.
With chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects include urinary frequency and urgency; diminished urine stream; perineal, back, and buttocks pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute)
More common in females, acute pyelonephritis causes dysuria throughout voiding. Other features include persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter’s syndrome
With Reiter’s syndrome, a predominantly male disorder, dysuria occurs 1 to 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urethral syndrome
Occurring in sexually active women, urethral syndrome mimics urethritis. Dysuria throughout voiding may occur with urinary frequency, diminished urine stream, suprapubic aching and cramping, tenesmus, and lower back and unilateral flank pain. In the absence of pyuria, symptoms usually resolve without intervention.
Urethritis
Primarily found in sexually active males, urethritis causes dysuria throughout voiding. It’s accompanied by a reddened meatus and copious, yellow, purulent discharge (gonorrheal infection) or white or clear mucoid discharge (nongonorrheal infection).
Urinary obstruction
Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (With complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features include diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis
Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants
Dysuria may be caused by contact with irritating substances, such as bubble bath salts and feminine deodorants; it’s usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes. Other findings include urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs
Dysuria can result from monoamine oxidase inhibitor use. Metyrosine can also cause transient dysuria.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urethral discharge:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Prostatitis
Acute prostatitis is characterized by purulent urethral discharge. Initial signs and symptoms include sudden fever, chills, low back pain, myalgia, perineal fullness, and arthralgia. Urination becomes increasingly frequent and urgent, and the urine may appear cloudy. Dysuria, nocturia, and some degree of urinary obstruction may also occur. The prostate may be tense, boggy, tender, and warm.
Although chronic prostatitis commonly produces no symptoms, it may produce a persistent urethral discharge that’s thin, milky, or clear and sometimes sticky. The discharge appears at the meatus after a long interval between voidings, as in the morning. Associated effects include a dull aching in the prostate or rectum, sexual dysfunction such as ejaculatory pain, and urinary disturbances such as frequency, urgency, and dysuria.
Reiter’s syndrome
Reiter’s syndrome is a self-limiting syndrome that usually affects males. Urethral discharge and other signs of acute urethritis occur 1 to 2 weeks after sexual contact. Asymmetrical arthritis, conjunctivitis of one or both eyes, and ulcerations on the oral mucosa, glans penis, palms, and soles may also occur.
Urethritis
Urethritis, which is commonly sexually transmitted (as in gonorrhea), typically produces scant or profuse urethral discharge that’s either thin and clear, mucoid, or thick and purulent. Other effects include urinary hesitancy, urgency, and frequency; dysuria; and itching and burning around the meatus.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary hesitancy:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
Characteristic early findings of benign prostatic hyperplasia (BPH) include urinary hesitancy, reduced caliber and force of urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream and, occasionally, urine retention. As obstruction increases, urination becomes more frequent, with nocturia, urinary overflow, incontinence, bladder distention, and possibly hematuria.
Prostate cancer
In patients with advanced prostate cancer, urinary hesitancy may occur, accompanied by frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion
A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture
Partial obstruction of the lower urinary tract produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
Urinary tract infection
Urinary hesitancy may be associated UTI. Characteristic urinary changes include frequency, possible hematuria, dysuria, nocturia, and cloudy urine. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs
Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Urinary hesitancy also may occur in those recovering from general anesthesia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary urgency:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Bladder calculus
Bladder irritation from a calculus can lead to urinary urgency and frequency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. Pain may be referred to the penis, vulva, lower back, or heel.
Multiple sclerosis
Urinary urgency can occur with or without the frequent UTIs that can accompany multiple sclerosis. Commonly, visual and other sensory impairments are the earliest findings. Other findings include urinary frequency, incontinence, constipation, muscle weakness, paralysis, spasticity, intention tremor, hyperreflexia, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability.
Reiter’s syndrome
Reiter’s syndrome is a self-limiting syndrome that primarily affects males. Urgency occurs with other symptoms of acute urethritis 1 to 2 weeks after sexual contact. Arthritic and ocular symptoms and skin lesions usually develop within several weeks after sexual contact. These symptoms include asymmetrical arthritis of knees, ankles, or metatarsal phalangeal joints; conjunctivitis; and ulcers on the penis, or skin, or in the mouth.
Spinal cord lesion
Urinary urgency can result from incomplete spinal cord transection when voluntary control of sphincter function weakens. Urinary frequency, difficulty initiating and inhibiting a urine stream, and bladder distention and discomfort may also occur. Neuromuscular effects distal to the lesion include weakness, paralysis, hyperreflexia, sensory disturbances, and impotence.
Urethral stricture
Bladder decompensation produces urinary urgency, frequency, and nocturia. Early signs and symptoms include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence may occur.
Urinary tract infection
Urinary urgency is commonly associated with a UTI. Other characteristic urinary changes include frequency, hematuria, dysuria, nocturia, and cloudy urine. Urinary hesitancy may also occur. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Treatments
Radiation therapy may irritate and inflame the bladder, causing urinary urgency.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysuria:
Principal Causes of Dysuria
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Urinarytract infection
- Urethritis
- Cystitis
- Pyelonephritis
- Chemical irritation
- Diaper dermatitis
- Trauma
- Psychogenic
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Bladder distention:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).With BPH, bladder distention gradually develops as the prostate enlarges. Occasionally, its onset is acute. Initially, the patient experiences urinary hesitancy, straining, and frequency; reduced force of and the inability to stop the urine stream; nocturia; and postvoiding dribbling. As the disorder progresses, it produces prostate enlargement, sensations of suprapubic fullness and incomplete bladder emptying, perineal pain, constipation, and hematuria.
Bladder calculi.Bladder calculi may produce bladder distention, but more commonly pain is the only symptom. The pain is usually referred to the tip of the penis, the vulvar area, the lower back, or the heel. It worsens during walking or exercise and abates when the patient lies down. It can be accompanied by urinary frequency and urgency, terminal hematuria, and dysuria. Pain is usually most severe when micturition ceases.
Bladder cancer.By blocking the urethral orifice, neoplasms can cause bladder distention. Associated signs and symptoms include hematuria (most common sign); urinary frequency and urgency; nocturia; dysuria; pyuria; pain in the bladder, rectum, pelvis, flank, back, or legs; vomiting; diarrhea; and sleeplessness. A mass may be palpable on bimanual examination.
Multiple sclerosis.With multiple sclerosis, a neuromuscular disorder, urine retention and bladder distention result from the interruption of upper motor neuron control of the bladder. Associated signs and symptoms include optic neuritis, paresthesia, impaired position and vibratory senses, diplopia, nystagmus, dizziness, abnormal reflexes, dysarthria, muscle weakness, emotional lability, Lhermitte's sign (transient, electric-like shocks that spread down the body when the head is flexed), Babinski's sign, and ataxia.
Prostate cancer.Prostate cancer eventually causes bladder distention in about 25% of patients. Usual signs and symptoms include dysuria, urinary frequency and urgency, nocturia, weight loss, fatigue, perineal pain, constipation, and induration of the prostate or a rigid, irregular prostate on digital rectal examination. For some patients, urine retention and bladder distention are the only signs.
Prostatitis.With acute prostatitis, bladder distention occurs rapidly along with perineal discomfort and suprapubic fullness. Other signs and symptoms include perineal pain; a tense, boggy, tender, and warm enlarged prostate; decreased libido; impotence; decreased force of the urine stream; dysuria; hematuria; and urinary frequency and urgency. Additional signs and symptoms include fatigue, malaise, myalgia, fever, chills, nausea, and vomiting.
With chronic prostatitis, bladder distention is rare; however, it may be accompanied by sensations of perineal discomfort and suprapubic fullness, prostatic tenderness, decreased libido, urinary frequency and urgency, dysuria, pyuria, hematuria, persistent urethral discharge, ejaculatory pain, and a dull pain radiating to the lower back, buttocks, penis, or perineum.
Spinal neoplasms.Disrupting upper neuron control of the bladder, spinal neoplasms cause neurogenic bladder and resultant distention. Associated signs and symptoms include a sense of pelvic fullness, continuous overflow dribbling, back pain that typically mimics sciatica pain, constipation, tender vertebral processes, sensory deficits, and muscle weakness, flaccidity, and atrophy. Signs and symptoms of urinary tract infection (dysuria, urinary frequency and urgency, nocturia, tenesmus, hematuria, and weakness) may also occur.
Urethral calculi.With urethral calculi, urethral obstruction leads to bladder distention. The patient experiences interrupted urine flow. The obstruction causes pain radiating to the penis or vulva and referred to the perineum or rectum. It may also produce a palpable stone and urethral discharge.
Urethral stricture.Urethral stricture results in urine retention and bladder distention with chronic urethral discharge (most common sign), urinary frequency (also common), dysuria, urgency, decreased force and diameter of the urine stream, and pyuria. Urinoma and urosepsis may also develop.
Other causes
Catheterization.Using an indwelling urinary catheter can result in urine retention and bladder distention. While the catheter is in place, inadequate drainage due to kinked tubing or an occluded lumen may lead to urine retention. In addition, a misplaced urinary catheter or irritation with catheter removal may cause edema, thereby blocking urine outflow.
Drugs.Parasympatholytics, anticholinergics, ganglionic blockers, sedatives, anesthetics, and opiates can produce urine retention and bladder distention.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Dysuria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Appendicitis.Occasionally, appendicitis causes dysuria that persists throughout voiding and is accompanied by bladder tenderness. Appendicitis is characterized by periumbilical abdominal pain that shifts to McBurney's point, anorexia, nausea, vomiting, constipation, a slight fever, abdominal rigidity and rebound tenderness, and tachycardia.
Bladder cancer.Bladder cancer, a predominantly male disorder, causes dysuria throughout voiding—a late symptom associated with urinary frequency and urgency, nocturia, hematuria, and perineal, back, or flank pain.
Cystitis.Dysuria throughout voiding is common in all types of cystitis, as are urinary frequency, nocturia, straining to void, and hematuria. Bacterial cystitis, the most common cause of dysuria in women, may also produce urinary urgency, perineal and lower back pain, suprapubic discomfort, fatigue and, possibly, a low-grade fever. With chronic interstitial cystitis, dysuria is accentuated at the end of voiding. In tubercular cystitis, symptoms may also include urinary urgency, flank pain, fatigue, and anorexia. With viral cystitis, severe dysuria occurs with gross hematuria, urinary urgency, and a fever.
Paraurethral gland inflammation.Dysuria throughout voiding occurs with urinary frequency and urgency, a diminished urine stream, mild perineal pain and, occasionally, hematuria.
Prostatitis.Acute prostatitis commonly causes dysuria throughout or toward the end of voiding as well as a diminished urine stream, urinary frequency and urgency, hematuria, suprapubic fullness, a fever, chills, fatigue, myalgia, nausea, vomiting, and constipation. With chronic prostatitis, urethral narrowing causes dysuria throughout voiding. Related effects are urinary frequency and urgency; a diminished urine stream; perineal, back, and buttock pain; urethral discharge; nocturia; and, at times, hematospermia and ejaculatory pain.
Pyelonephritis (acute).Pyelonephritis causes dysuria throughout voiding. Other features include a persistent high fever with chills, costovertebral angle tenderness, unilateral or bilateral flank pain, weakness, urinary urgency and frequency, nocturia, straining on urination, and hematuria. Nausea, vomiting, and anorexia may also occur.
Reiter's syndrome.Reiter's syndrome is a disorder in which dysuria occurs 1 or 2 weeks after sexual contact. Initially, the patient has a mucopurulent discharge, urinary urgency and frequency, meatal swelling and redness, suprapubic pain, anorexia, weight loss, and a low-grade fever. Hematuria, conjunctivitis, arthritic symptoms, a papular rash, and oral and penile lesions may follow.
Urinary obstruction.Outflow obstruction by urethral strictures or calculi produces dysuria throughout voiding. (With complete obstruction, bladder distention develops and dysuria precedes voiding.) Other features are a diminished urine stream, urinary frequency and urgency, and a sensation of fullness or bloating in the lower abdomen or groin.
Vaginitis.Characteristically, dysuria occurs throughout voiding as urine touches inflamed or ulcerated labia with vaginitis. Other findings include urinary frequency and urgency, nocturia, hematuria, perineal pain, and vaginal discharge and odor.
Other causes
Chemical irritants.Dysuria may result from irritating substances, such as bubble bath salts and feminine deodorants; it's usually most intense at the end of voiding. Spermicides may cause dysuria in both sexes. Other findings include urinary frequency and urgency, a diminished urine stream and, possibly, hematuria.
Drugs.Dysuria can result from monoamine oxidase inhibitors. Metyrosine can also cause transient dysuria.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urethral discharge:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Prostatitis.Acute prostatitis is characterized by purulent urethral discharge. Initial signs and symptoms include sudden fever, chills, lower back pain, myalgia, perineal fullness, and arthralgia. Urination becomes increasingly frequent and urgent, and the urine may appear cloudy. Dysuria, nocturia, and some degree of urinary obstruction may also occur. The prostate may be tense, boggy, tender, and warm. Prostate massage to obtain prostatic fluid is contraindicated.
Chronic prostatitis, although commonly producing no symptoms, may produce a persistent urethral discharge that's thin, milky, or clear and sometimes sticky. The discharge appears at the meatus after a long interval between voidings, as in the morning. Associated effects include a dull aching in the prostate or rectum, sexual dysfunction such as ejaculatory pain, and urinary disturbances such as frequency, urgency, and dysuria.
Reiter's syndrome.In Reiter's syndrome (also known as reactive arthritis), urethral discharge and other signs of acute urethritis occur 1 to 2 weeks after sexual contact. Asymmetrical arthritis, conjunctivitis of one or both eyes, and ulcerations on the oral mucosa, glans penis, palms, and soles may also occur with Reiter's syndrome.
Urethritis.Urethritis commonly produces scant or profuse urethral discharge that's either thin and clear, mucoid, or thick and purulent. Other effects include urinary hesitancy, urgency, and frequency; dysuria; and itching and burning around the meatus.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary hesitancy:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).Signs and symptoms of BPH depend on the extent of prostatic enlargement and the lobes affected. Characteristic early findings include urinary hesitancy, reduced caliber and force of urine stream, perineal pain, a feeling of incomplete voiding, inability to stop the urine stream and, occasionally, urine retention. As obstruction increases, urination becomes more frequent, with nocturia, urinary overflow, incontinence, bladder distention, and possibly hematuria.
Prostatic cancer.In patients with advanced prostate cancer, urinary hesitancy may occur, accompanied by frequency, dribbling, nocturia, dysuria, bladder distention, perineal pain, and constipation. Digital rectal examination commonly reveals a hard, nodular prostate.
Spinal cord lesion.A lesion below the micturition center that has destroyed the sacral nerve roots causes urinary hesitancy, tenesmus, and constant dribbling from retention and overflow incontinence. Associated findings are urinary frequency and urgency, dysuria, and nocturia.
Urethral stricture.Partial obstruction of the lower urinary tract secondary to trauma or infection produces urinary hesitancy, tenesmus, and decreased force and caliber of the urine stream. Urinary frequency and urgency, nocturia, and eventually overflow incontinence may develop. Pyuria usually indicates accompanying infection. Increased obstruction may lead to urine extravasation and formation of urinomas.
UTI.Urinary hesitancy may be associated with a UTI. Characteristic urinary changes include frequency, possible hematuria, dysuria, nocturia, and cloudy urine. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, pelvic, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Drugs.Anticholinergics and drugs with anticholinergic properties (such as tricyclic antidepressants and some nasal decongestants and cold remedies) may cause urinary hesitancy. Hesitancy may also occur in those recovering from general anesthesia.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary urgency:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Bladder calculus.Bladder irritation can lead to urinary urgency and frequency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. Pain may be referred to the penis, vulva, lower back, or heel.
Multiple sclerosis (MS).Urinary urgency can occur with or without the frequent UTIs that can accompany MS. Like MS's other variable effects, urinary urgency may wax and wane. Commonly, vision and sensory impairments are the earliest findings. Others include urinary frequency, incontinence, constipation, muscle weakness, paralysis, spasticity, intention tremor, hyperreflexia, ataxic gait, dysphagia, dysarthria, impotence, and emotional lability.
Reiter's syndrome.In Reiter's syndrome, urinary urgency occurs with other symptoms of acute urethritis 1 to 2 weeks after sexual contact. Arthritic and ocular symptoms and skin lesions usually develop within several weeks after sexual contact. These include asymmetrical arthritis of knees, ankles, or metatarsal phalangeal joints; conjunctivitis; and ulcers on the penis, or skin, or in the mouth.
Spinal cord lesion.Urinary urgency can result from incomplete cord transection when voluntary control of sphincter function weakens. Urinary frequency, difficulty initiating and inhibiting a urine stream, and bladder distention and discomfort may also occur. Neuromuscular effects distal to the lesion include weakness, paralysis, hyperreflexia, sensory disturbances, and impotence.
Urethral stricture.Bladder decompensation produces urinary urgency, frequency, and nocturia. Early signs and symptoms include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence may occur.
UTI.Urinary urgency is commonly associated with a UTI. Other characteristic urinary changes include frequency, hematuria, dysuria, nocturia, and cloudy urine. Urinary hesitancy may also occur. Associated findings include bladder spasms; costovertebral angle tenderness; suprapubic, low back, or flank pain; urethral discharge in males; fever; chills; malaise; nausea; and vomiting.
Other causes
Treatments.Radiation therapy may irritate and inflame the bladder, causing urinary urgency.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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