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Urinary Problems
in Gynaecology
U
rinary problems are the most
frequently encountered
complaints of the
gynaecological patients visiting the
outpatient department. Several
causes contribute to the varied
presentations and types of the urinary
problems. The establishment of a
proper diagnosis involves a detailed
history, meticulous examination and
a complete urological investigation.
Common urinary problems that
patients present with include Urinary
Tract Infections (UTI), retention of
urine, difficulty in micturition,
painful micturition, increased
frequency of micturition, difficulty in
controlling urination, involuntary
passage of urine on cough or sneeze,
abdominal pain associated with
micturition and increased night
frequency of micturition. Let’s
concentrate on a few of these
complaints in this article. into the bladder, due to anatomical
reasons – urethra is shorter in
females than males, and is closer to
vagina and anus. Some factors like
poor personal hygiene, sexual
intercourse, catheterization,
pregnancy, and menopause make
women more susceptible to UTIs.
Symptoms and signs of UTI are
painful micturition, increased
frequency, urgency (strong urge to
urinate), burning sensation, cloudy or
blood stained urine, foul smelling
urination, mild fever and/or passage
of frequent small amounts of urine; if
the infection reaches the kidney- high
fever with or without chills, nausea,
vomiting and pain in back radiating
on one side. Diagnosis is made by
characteristic symptoms and by
urinary examination- urine may
contain pus and organisms. Culture
and microscopy of the discharge
helps in establishing the diagnosis.
Urinary Tract Infection (UTI) Treatment consists of administration
of large quantities of fluids, at least
2.5 litres/24 hours, especially in
cases of cystitis (inflammation of
bladder) and appropriate antibiotics.
Patients are advised to avoid all
irritants like deodorants, vaginal
It can be an infection in any part of
the urinary system from kidneys to
ureters to bladder and/or urethra.
Most common method of infection in
women is ascending from the urethra
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contraceptives and douches. Alkaline
drinks and citrates are helpful.
Menopausal women may benefit by
supplementing oestrogen (hormonal)
creams to improve the atrophic (thin
and shrunk tissue) state of vagina and
urethra. Some preventive measures
can be followed to avoid UTI: like
use a 100% cotton inner wear,
maintain proper personal hygiene,
urinate after intercourse, use proper
antibiotics as advised, cranberry juice
can help in decreasing number of
UTIs, have plenty of oral fluids, use
lubricated condoms without
spermicide creams and most
importantly proper toilet training
should be followed.
Coming to the next common urinary
problems which most women elicit in
their history either as chief complaint
or on enquiring include frequency of
micturition, urgency to urinate and/or
inability to control urination or
involuntary passage of urine
(incontinence). Incontinence affects
nearly 400 million people worldwide.
Studies have found the incidence as
high even in younger population,
affecting nearly 24% women
between ages 18-44 years. Urinary