Voiding Dysfunction Treatments

Voiding dysfunction treatments refer to methods of managing, controlling, or curing problems that a person has with storing or releasing urine. These conditions usually are caused by:

• • Bladder control problems;

• • Nerve dysfunction;

• • Bladder draining problems; or

• • Urinary blockage.

Treatments for voiding dysfunction are chosen for each patient based on the underlying cause of the urinary abnormality.

WHAT TO EXPECT

Bladder Control
Timed voiding. Timed voiding is the act of emptying the bladder on a frequent and set schedule. This lowers urine volume and pressure on the bladder.

Medications. Anticholinergic medications depress bladder contractions, reducing urination frequency.

Other medications that treat bladder control problems include:

• • Musculotropic relaxants;

• • Potassium channel openers;

• • Prostaglandin inhibitors;

• • Beta-adrenergic agonists;

• • Alpha-adrenergic antagonists;

• • Tricyclic antidepressants;

• • Dimethyl sulfoxide, or DMSO;

• • Polysynaptic inhibitors;

• • Ephedrine or pseudoephedrine;

• • Phenylpropanolamine;

• • Imipramine; and

• • Estrogens.

Another treatment is to inject a paste-like material into the tissues just under the lining of the urethra.

Capsaicin. Capsaicin, derived from red peppers, temporarily reduces the bladder’s sensitivity.

Electrical stimulation. Electrical stimulation with removable anal or vaginal devices decreases the urge to urinate. In another form of electrical stimulation, a device is surgically placed under the skin in the lower abdomen or back. It sends mild electrical impulses to the nerve that regulates bladder control.

Pelvic floor exercises and biofeedback. Pelvic floor exercises, or Kegel exercises, are the voluntary contraction of pelvic muscles to improve tone and strengthen this area.

In biofeedback, a device electrically monitors or stimulates the pelvic muscles while prompting a patient with audio or visual signals, so that the patient can better identify his or her pelvic muscles.

Surgery. Physicians may address stress incontinence surgically through one of the following methods:

• • Implanting a suburethral sling;

• • Implanting an artificial sphincter device;

• • Cryoplasty;

• • Reconstructing and lifting the bladder when it has fallen; and

• • Closing the bladder neck.

Nerve Dysfunction
Intermittent catheterization. Intermittent catheterization requires that the patient or a family member insert a catheter into the urethra to fully empty the bladder.

Last resort options for patients with neuromuscular dysfunction are catheters that remain in the urethra for a short period of time, external urine collection devices, or absorbent pads.

Medications. Certain medications that may help nerve dysfunction-related urination problems include:

• • Benzodiazepines;

• • Baclofen;

• • Dantrolene; and

• • Alpha blockers.

Surgery. In surgical sphincterotomy, a surgeon relaxes the urinary sphincter by making an incision into it. Urethral stents may be used in place of sphincterotomy.

Bladder Draining
Manual approach. Patients press their hands into their abdomens to compress a section of the bladder to start urination, called a Crede maneuver.

Medications. Medications that encourage urination include:

• • Parasympathomimetic agents;

• • Prostaglandins; and

• • Opioid antagonists.

Electrical stimulation. Electrodes are applied to certain parts of the spinal cord to elicit bladder contractions.

Surgery. Physicians may recommend temporary indwelling catheters or try various forms of surgery to stop the bladder from overstretching.

Bladder Obstruction
Medications. Medications that may help to unblock a constricted urinary tract include:

• • Phenoxybenzamine;

• • Prazosin;

• • Terazosin;

• • Doxazosin;

• • Tamsulosin; and

• • Alfluzosin.

Surgery. If imaging and urine tests reveal that the bladder neck or a portion of the urethra is significantly obstructed, physicians may recommend patients undergo transurethral resection or other therapies for enlarged prostates.