Urinary Retention – Pelvic Floor Dysfunction
Another source of urinary retention, which can affect both men and women, includes pelvic floor dysfunction (PFD). The pelvic floor is comprised of musculature that is innervated at the S2/S3 nerve roots. When describing PFD, the muscles in the pelvis must relax and the bladder contract simultaneously for urination to occur.
The inability to relax the pelvic floor in a coordinated fashion may result in conditions such as:
- Urinary retention
- Slow urinary stream
- Recurrent urinary tract infections due to incomplete bladder emptying
- Urinary incontinence
- Dyspareunia
- Constipation
Diagnostic Options for Pelvic Floor Dysfunction
The diagnosis of PFD is not always easy. Obtaining a good health history from the patient is important.
Voiding diaries or fluid tracking forms that enable a patient to document the quality of their urinary stream, number of voids, and incontinence episodes can provide useful information.
Completing a physical exam and palpating the internal musculature will give additional information to support the diagnosis of PFD. For female patients, you can feel the tense pelvic floor musculature intravaginally. An internal assessment for men is a rectal exam.
A Urodynamic Study (UDS) or Electromyography (EMG) during the voiding phase will help provide additional information supporting the diagnosis of PFD. If there is increased activity of the pelvic floor on EMG and incomplete bladder emptying, there is a likelihood that the patient is struggling with PFD.
Treatment Options Pelvic Floor Dysfunction
Treatment for PFD may begin with pelvic floor therapy. Therapy focuses not only on strengthening of the pelvic floor, but also on relaxation of the pelvic floor – which may help alleviate other symptoms of PFD such as constipation, dyspareunia, and others.
Deep breathing exercises and voiding techniques are strategies used to improve bladder emptying.
It might be necessary to teach intermittent catheterisation to improve bladder emptying while working on these strategies.
There may be additional symptoms of PFD such as vaginal prolapse that would require surgical intervention to improve bladder emptying.
The good news is that appropriately diagnosing and treating PFD can significantly improve quality of life for your patients.
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