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
Urine cloudiness:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
UTI
Cloudy urine is common in UTIs. Other urinary findings include urgency, frequency, hesitancy, hematuria, dysuria, nocturia and, in males, a urethral discharge. Other effects include fever, chills, malaise, nausea and vomiting, bladder spasms, costovertebral angle tenderness, and suprapubic, low back, or flank pain.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
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
Nocturia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia
Common in men older than age 50, this disorder produces nocturia when significant urethral obstruction develops. Typically, it causes frequency, hesitancy, incontinence, reduced force and caliber of the urine stream and, possibly, hematuria. Oliguria may also occur. Palpation reveals a distended bladder and an enlarged prostate. The patient may also complain of lower abdominal fullness, perineal pain, and constipation. Obstruction may lead to renal failure.
Bladder neoplasm
A late sign of this neoplasm, nocturia involves frequent voiding of small to moderate amounts of urine. Besides hematuria, the most common sign, associated characteristics include bladder distention; urinary frequency and urgency; dysuria; pyuria; bladder, rectal, flank, back, or leg pain; vomiting; diarrhea; and insomnia. Signs and symptoms of urinary tract infection, such as tenesmus, low-grade fever, and perineal pain, may also occur.
Cystitis
All three forms of cystitis may cause nocturia marked by frequent, small voidings and accompanied by dysuria and tenesmus.
Bacterial cystitis may also cause urinary urgency; hematuria; fatigue; suprapubic, perineal, flank, and lower back pain; and occasionally, low-grade fever. Most common in women between ages 25 and 60, chronic interstitial cystitis is characterized by Hunner’s ulcers—small, punctate, bleeding lesions in the bladder; it also causes gross hematuria. Because symptoms resemble bladder cancer, this must be ruled out.
Viral cystitis also causes urinary urgency, hematuria, and fever.
Diabetes insipidus
The result of antidiuretic hormone deficiency, this disorder usually produces nocturia early in its course. It’s characterized by periodic voiding of moderate to large amounts of urine. Diabetes insipidus can also produce polydipsia and dehydration.
Diabetes mellitus
An early sign of diabetes mellitus, nocturia involves frequent, large voidings. Associated features include daytime polyuria, polydipsia, polyphagia, frequent urinary tract infections, recurrent yeast infections, vaginitis, weakness, fatigue, weight loss and, possibly, signs of dehydration, such as dry mucous membranes and poor skin turgor.
Heart failure
Nocturia may develop early in this disorder—the result of increased glomerular filtration associated with movement of edematous fluid from dependent areas during recumbency. Other early effects include fatigue, jugular vein distention, dyspnea, orthopnea, tachycardia, and a dry cough with wheezing. Later, the patient may develop tachypnea, weight gain, hypotension, oliguria, cyanosis, and hepatomegaly.
Hypercalcemic nephropathy
With this disorder, nocturia involves the periodic voiding of moderate to large amounts of urine. Related findings include daytime polyuria, polydipsia, and occasionally, hematuria and pyuria.
Hypokalemic nephropathy
Again, nocturia involves the periodic voiding of moderate to large amounts of urine. Associated findings typically include polydipsia, daytime polyuria, muscle weakness or paralysis, hypoactive bowel sounds, and increased susceptibility to pyelonephritis.
Prostate cancer
The second leading cause of cancer deaths in men, this disorder is usually asymptomatic in early stages. Later, it produces nocturia characterized by infrequent voiding of moderate amounts of urine. Other characteristic effects include dysuria (most common symptom), difficulty initiating a urine stream, interrupted urine stream, bladder distention, urinary frequency, weight loss, pallor, weakness, perineal pain, and constipation. Palpation reveals a hard, irregularly shaped, nodular prostate.
Pyelonephritis (acute)
Nocturia is common with this disorder and is usually characterized by infrequent voiding of moderate amounts of urine. The urine may appear cloudy. Associated signs and symptoms include a high, sustained fever with chills, fatigue, unilateral or bilateral flank pain, costovertebral angle tenderness, weakness, dysuria, hematuria, urinary frequency and urgency, and tenesmus. Occasionally, anorexia, nausea, vomiting, diarrhea, and hypoactive bowel sounds may also occur.
Renal failure (chronic)
Nocturia occurs relatively early in this disorder and is usually characterized by infrequent voiding of moderate amounts of urine. As the disorder progresses, oliguria or even anuria develops. Other widespread effects of chronic renal failure include fatigue, ammonia breath odor, Kussmaul’s respirations, peripheral edema, elevated blood pressure, decreased level of consciousness, confusion, emotional lability, muscle twitching, anorexia, metallic taste in the mouth, constipation or diarrhea, petechiae, ecchymoses, pruritus, yellow- or bronze-tinged skin, nausea, and vomiting.
Other causes
Drugs
Any drug that mobilizes edematous fluid or produces diuresis (for example, a diuretic or a cardiac glycoside) may cause nocturia; obviously, this effect depends on when the drug is administered.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Polyuria:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute tubular necrosis
During the diuretic phase of this disorder, polyuria of less than 8 L/day gradually subsides after 8 to 10 days. Urine specific gravity (1.010 or less) increases as polyuria subsides. Related findings include weight loss, decreasing edema, and nocturia.
Diabetes insipidus
Polyuria of about 5 L/day with a specific gravity of 1.005 or less is common, although extreme polyuria—up to 30 L/day—occasionally occurs. Polyuria is commonly accompanied by polydipsia, nocturia, fatigue, and signs of dehydration, such as poor skin turgor and dry mucous membranes.
Diabetes mellitus
With this disorder, polyuria seldom exceeds 5 L/day, and urine specific gravity typically exceeds 1.020. The patient usually reports polydipsia, polyphagia, weight loss, weakness, frequent urinary tract infections and yeast vaginitis, fatigue, and nocturia. The patient may also display signs of dehydration and anorexia.
Glomerulonephritis (chronic)
Polyuria gradually progresses to oliguria with this disorder. Urine output is usually less than 4 L/day; specific gravity is about 1.010. Related GI findings include anorexia, nausea, and vomiting. The patient may experience drowsiness, fatigue, edema, headache, elevated blood pressure, and dyspnea. Nocturia, hematuria, frothy or malodorous urine, and mild to severe proteinuria may occur.
Hypercalcemia
Elevated plasma calcium levels may lead to nephropathy, usually producing polyuria of less than 5 L/day with a specific gravity of about 1.010. Accompanying signs and symptoms include polydipsia, nocturia, constipation, paresthesia and, occasionally, hematuria, and pyuria. With severe hypercalcemia, the patient’s condition worsens rapidly and he experiences anorexia, vomiting, stupor progressing to coma, and renal failure.
Hypokalemia
Prolonged potassium depletion may lead to nephropathy, which results in polyuria—usually less than 5 L/day with a specific gravity of about 1.010. Associated findings include polydipsia, circumoral and foot paresthesia, hypoactive deep tendon reflexes, fatigue, hypoactive bowel sounds, nocturia, arrhythmias, and muscle cramping, weakness, or paralysis.
Postobstructive uropathy
After resolution of a urinary tract obstruction, polyuria—usually more than 5 L/day with a specific gravity of less than 1.010—occurs for up to several days before gradually subsiding. Bladder distention and edema may occur with nocturia and weight loss. Occasionally, signs of dehydration appear.
Psychogenic polydipsia
Most common in those older than age 30, this disorder usually produces dilute polyuria of 3 to 15 L/day, depending on fluid intake. The patient may appear depressed and have a headache and blurred vision. Weight gain, edema, elevated blood pressure and, occasionally, stupor or coma may develop. With severe overhydration, signs of heart failure may present.
Pyelonephritis
Acute pyelonephritis usually results in polyuria of less than 5 L/day with a low but variable specific gravity. Other findings include persistent high fever, flank pain (usually unilateral), hematuria, costovertebral angle tenderness, chills, weakness, dysuria, urinary frequency and urgency, tenesmus, and nocturia. Occasionally, nausea, anorexia, vomiting, and hypoactive bowel sounds occur.
Chronic pyelonephritis produces polyuria of less than 5 L/day that declines as renal function worsens. Urine specific gravity is usually about 1.010 but may be higher if proteinuria is present. Other effects include irritability, paresthesia, fatigue, nausea, vomiting, diarrhea, drowsiness, anorexia, pyuria and, in late stages, elevated blood pressure.
Sheehan’s syndrome
This syndrome of postpartum pituitary necrosis may cause polyuria of over 5 L/day with a specific gravity of 1.001 to 1.005. Associated findings include polydipsia, nocturia, and fatigue. Reproductive effects include failure to lactate, amenorrhea, decreased pubic and axillary hair growth, and reduced libido.
Sickle cell anemia
This disorder may cause nephropathy, typically producing polyuria of less than 5 L/day with a specific gravity of about 1.020. Additional findings include polydipsia, fatigue, abdominal cramps, arthralgia, priapism and, occasionally, leg ulcers, and bony deformities.
Other causes
Diagnostic tests
Transient polyuria can result from radiographic tests that use contrast media.
Drugs
Diuretics characteristically produce polyuria. Cardiotonics, vitamin D, demeclocycline, phenytoin, lithium, and propoxyphene can also produce polyuria.
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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 incontinence:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Benign prostatic hyperplasia (BPH)
Overflow incontinence is common in this disorder as a result of urethral obstruction and urine retention. BPH begins with a group of signs and symptoms known as prostatism: reduced caliber and force of the urine stream, urinary hesitancy, and a feeling of incomplete voiding. As the obstruction increases, the patient may develop urinary frequency, nocturia and, possibly, hematuria. Examination reveals bladder distention and an enlarged prostate.
Bladder calculus
Overflow incontinence may occur if the calculus lodges in the bladder neck. Associated findings vary but may include those of an irritable bladder: urinary frequency and urgency, dysuria, hematuria, and suprapubic pain from bladder spasms. Pelvic pain may be referred to the tip of the penis, vulva, low back, or heel and may be exacerbated by movement.
Bladder cancer
Urge incontinence and hematuria are common findings in bladder cancer; obstruction by a tumor may produce overflow incontinence. The early stages can be asymptomatic. Other urinary signs and symptoms include frequency, dysuria, nocturia, dribbling, and suprapubic pain from bladder spasms after voiding. A mass may be palpable on bimanual examination.
Diabetic neuropathy
Autonomic neuropathy may cause painless bladder distention with overflow incontinence. Related findings include episodic constipation or diarrhea (which is commonly nocturnal), impotence and retrograde ejaculation, orthostatic hypotension, syncope, and dysphagia.
Guillain-Barré syndrome
Urinary incontinence may occur early in this disorder as a result of peripheral and autonomic nerve dysfunction. The cardinal sign is progressive, profound muscle weakness, which typically starts in the legs and extends to the arms and facial nerves within 24 to 72 hours. Associated findings include paresthesia, dysarthria, nasal speech, dysphagia, orthostatic hypotension, tachycardia, fecal incontinence, diaphoresis, drooling, and pain in the shoulders, thighs, or lumbar region.
Multiple sclerosis (MS)
Urinary incontinence, urgency, and frequency are common urologic findings in MS. Visual problems and sensory impairment are usually the first symptoms. Other findings include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer
Urinary incontinence usually occurs only in the advanced stages of prostate cancer. Urinary frequency and hesitancy, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped, nodular prostate are other common late findings.
Prostatitis (chronic)
Urinary incontinence may occur as a result of urethral obstruction from an enlarged prostate. Other findings include urinary frequency and urgency, dysuria, hematuria, bladder distention, a persistent urethral discharge, dull perineal pain that may radiate to other areas, ejaculatory pain, and decreased libido.
Spinal cord injury
Complete cord transection above the sacral level causes flaccid paralysis of the bladder. Overflow incontinence follows rapid bladder distention. Other findings include paraplegia, sexual dysfunction, sensory loss, muscle atrophy, anhidrosis, and loss of reflexes distal to the injury.
Stroke
Urinary incontinence may be transient or permanent in a stroke patient. Associated findings reflect the site and extent of the lesion and may include impaired mentation, emotional lability, behavioral changes, altered level of consciousness, and seizures. Sensorimotor effects may include contralateral hemiplegia, dysarthria, dysphagia, ataxia, apraxia, agnosia, aphasia, and unilateral sensory loss. Headache, vomiting, visual deficits, and decreased visual acuity may also occur.
Urethral stricture
Partial obstruction of the lower urinary tract due 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 also occur. As the obstruction increases, urine extravasation may lead to formation of urinomas and urosepsis.
UTI
Besides incontinence, a UTI may produce urinary urgency, dysuria, hematuria, cloudy urine and, in males, a urethral discharge. Bladder spasms or a feeling of warmth during urination may occur.
Other causes
Surgery
Urinary incontinence may occur after prostatectomy as a result of urethral sphincter damage.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Urinary frequency:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Anxiety neurosis
Morbid anxiety produces urinary frequency and other types of genitourinary dysfunction, such as dysuria, impotence, and frigidity. Other findings may include headache, diaphoresis, hyperventilation, palpitations, muscle spasm, generalized motor weakness, dizziness, polyphagia, and constipation or other GI complaints.
Benign prostatic hyperplasia
Prostatic enlargement causes urinary frequency along with nocturia and possibly incontinence and hematuria. Initial effects are those of prostatism: reduced caliber and force of the urine stream, urinary hesitancy and tenesmus, inability to stop the urine stream, a feeling of incomplete voiding, and occasionally urine retention. Assessment reveals bladder distention.
Bladder calculus
Bladder irritation from a calculus may lead to urinary frequency and urgency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. If the calculus lodges in the bladder neck, the patient may have overflow incontinence and referred pain to the lower back or heel.
Bladder cancer
Urinary frequency, urgency, dribbling, and nocturia may develop from bladder irritation. The first sign of bladder cancer commonly is intermittent gross, painless hematuria (often with clots). Patients with invasive lesions commonly have suprapubic or pelvic pain from bladder spasms.
Multiple sclerosis (MS)
Urinary frequency, urgency, and incontinence are common urologic findings in patients with MS, but these effects widely vary and tend to wax and wane. Visual problems (such as diplopia and blurred vision) and sensory impairment (such as paresthesia) are usually the earliest symptoms. Other findings may include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer
In advanced prostate cancer, urinary frequency may occur along with hesitancy, dribbling, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped prostate.
Prostatitis
Acute prostatitis commonly produces urinary frequency and urgency, dysuria, nocturia, and a purulent urethral discharge. Other findings include fever, chills, low back pain, myalgia, arthralgia, and perineal fullness. The prostate may be tense, boggy, tender, and warm. Prostate massage to obtain prostatic fluid is contraindicated. Signs and symptoms of chronic prostatitis are usually the same as those of the acute form, but to a lesser degree. The patient may also experience pain on ejaculation.
Rectal tumor
The pressure that this tumor exerts on the bladder may cause urinary frequency. Early findings include altered bowel elimination habits, commonly starting with an urgent need to defecate on arising or obstipation alternating with diarrhea; blood or mucus in the stool; and a sense of incomplete evacuation.
Reiter’s syndrome
In this self-limiting syndrome, urinary frequency and other symptoms of acute urethritis occur 1 to 2 weeks after sexual contact. Other symptoms of Reiter’s syndrome include asymmetrical arthritis of the knees, ankles, and metatarsophalangeal joints; unilateral or bilateral conjunctivitis; and small painless ulcers on the mouth, tongue, glans penis, palms, and soles.
Reproductive tract tumor
A tumor in the female reproductive tract may compress the bladder, causing urinary frequency. Other findings vary but may include abdominal distention, menstrual disturbances, vaginal bleeding, weight loss, pelvic pain, and fatigue.
Spinal cord lesion
Incomplete cord transection results in urinary frequency, continuous overflow, dribbling, urgency when voluntary control of sphincter function weakens, urinary hesitancy, and bladder distention. Other effects occur below the level of the lesion and include weakness, paralysis, sensory disturbances, hyperreflexia, and impotence.
Urethral stricture
Bladder decompensation produces urinary frequency, urgency, and nocturia. Early signs include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence, urinoma, and urosepsis may develop.
UTI
Affecting the urethra, the bladder, or the kidneys, this common cause of urinary frequency may also produce urgency, dysuria, hematuria, cloudy urine and, in males, a urethral discharge. The patient may report a fever and bladder spasms or a feeling of warmth during urination. Women may experience suprapubic or pelvic pain. In young adult males, a UTI is usually related to sexual contact.
Other causes
Diuretics
These substances, which include caffeine, reduce the body’s total volume of water and salt by increasing urine excretion. Excessive intake of coffee, tea, and other caffeinated beverages leads to urinary frequency.
Treatments
Radiation therapy may cause bladder inflammation, leading to urinary frequency.
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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
Polyuria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Urinary tract infection
❑ Diabetes mellitus
❑ Diuretic therapy
❑ Bladder outlet obstruction
❑ Nephrogenic diabetes insipidus
❑ Central diabetes insipidus
❑ Primary polydipsia
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Source: Field Guide to Bedside Diagnosis, 2007
Proteinuria:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Diabetes
❑ Drugs/toxins
❑ Acute tubular necrosis
❑ Glomerulonephritis
❑ Orthostatic
❑ Systemic lupus erythematosus
❑ Toxemia
❑ Polycystic kidneys
❑ Interstitial nephritis
❑ Renal vein thrombosis
❑ Multiple myeloma
❑ Amyloidosis
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Source: Field Guide to Bedside Diagnosis, 2007
Urinary Incontinence:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Cystitis
❑ Benign prostatic hypertrophy
❑ Pelvic floor relaxation
❑ Drugs
❑ Prostatitis
❑ Diabetes
❑ Cough
❑ Multiple sclerosis
❑ Spinal cord compression
❑ Decreased cortical inhibition
❑ Vesicovaginal fistula
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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 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.
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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.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nocturia:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
Common in men older than age 50, benign prostatic hyperplasia (BPH) produces nocturia when significant urethral obstruction develops. Typically, it causes frequency, hesitancy, incontinence, reduced force and caliber of the urine stream and, possibly, hematuria. Oliguria may also occur. Palpation reveals a distended bladder and an enlarged prostate. The patient may also complain of lower abdominal fullness, perineal pain, and constipation.
Bladder neoplasm
A late sign of a bladder neoplasm, nocturia involves frequent voiding of small to moderate amounts of urine. Besides hematuria, the most common sign, associated characteristics include bladder distention, urinary frequency and urgency, dysuria, pyuria, vomiting, diarrhea, insomnia, and bladder, rectal, flank, back, or leg pain. Signs and symptoms of urinary tract infection (UTI), such as tenesmus, low-grade fever, and perineal pain, may also occur.
Cystitis
All three forms of cystitis may cause nocturia marked by frequent, small voidings and accompanied by dysuria and tenesmus.
Bacterial cystitis may also cause urinary urgency; hematuria; fatigue; suprapubic, perineal, flank, and lower back pain; and, occasionally, low-grade fever. Most common in women between ages 25 and 60, chronic interstitial cystitis is characterized by Hunner’s ulcers (small, punctate, bleeding lesions in the bladder); it also causes gross hematuria. Because symptoms resemble bladder cancer, this must be ruled out.
Viral cystitis also causes urinary urgency, hematuria, and fever.
Diabetes insipidus
The result of antidiuretic hormone deficiency, diabetes insipidus usually produces nocturia early in its course. It’s characterized by periodic voiding of moderate to large amounts of urine. Diabetes insipidus can also produce polydipsia and dehydration.
Diabetes mellitus
An early sign of diabetes mellitus, nocturia involves frequent, large voidings. Associated features include daytime polyuria, polydipsia, polyphagia, frequent UTIs, recurrent yeast infections, vaginitis, weakness, fatigue, weight loss and, possibly, signs of dehydration, such as dry mucous membranes and poor skin turgor.
Hypercalcemic nephropathy
With hypercalcemic nephropathy, nocturia involves the periodic voiding of moderate to large amounts of urine. Related findings include daytime polyuria, polydipsia and, occasionally, hematuria and pyuria.
Hypokalemic nephropathy
With hypokalemic nephropathy, nocturia involves the periodic voiding of moderate to large amounts of urine. Associated findings typically include polydipsia, daytime polyuria, muscle weakness or paralysis, hypoactive bowel sounds, and increased susceptibility to pyelonephritis.
Prostate cancer
The second leading cause of cancer deaths in men, prostate cancer usually produces no symptoms in early stages. Later, it produces nocturia characterized by infrequent voiding of moderate amounts of urine. Other characteristic effects include dysuria (most common symptom), difficulty initiating a urine stream, interrupted urine stream, bladder distention, urinary frequency, weight loss, pallor, weakness, perineal pain, and constipation. Palpation reveals a hard, irregularly shaped, nodular prostate.
Pyelonephritis (acute)
Nocturia is common with acute pyelonephritis and is usually characterized by infrequent voiding of moderate amounts of urine. The urine may appear cloudy. Associated signs and symptoms include a high, sustained fever with chills, fatigue, unilateral or bilateral flank pain, CVA tenderness, weakness, dysuria, hematuria, urinary frequency and urgency, and tenesmus. Occasionally, anorexia, nausea, vomiting, diarrhea, and hypoactive bowel sounds may also occur.
Renal failure (chronic)
Nocturia occurs relatively early in chronic renal failure and is usually characterized by infrequent voiding of moderate amounts of urine. As the disorder progresses, oliguria or even anuria develops. Other widespread effects include fatigue, ammonia breath odor, Kussmaul’s respirations, peripheral edema, elevated blood pressure, decreased level of consciousness, confusion, emotional lability, muscle twitching, anorexia, metallic taste in the mouth, constipation or diarrhea, petechiae, ecchymoses, pruritus, yellow- or bronze-tinged skin, nausea, and vomiting.
Other causes
Drugs
Any drug that mobilizes edematous fluid or produces diuresis (for example, a diuretic or a cardiac glycoside) may cause nocturia; obviously, this effect depends on when the drug is administered.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Polyuria:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute tubular necrosis
During the diuretic phase of acute tubular necrosis, polyuria of less than 8 L/day gradually subsides after 8 to 10 days. Urine specific gravity (1.010 or less) increases as polyuria subsides. Related findings include weight loss, decreasing edema, and nocturia.
Diabetes insipidus
With diabetes insipidus, polyuria of about 5 L/day with a specific gravity of 1.005 or less is common, although extreme polyuria — up to 30 L/day — occasionally occurs. Polyuria is commonly accompanied by polydipsia, nocturia, fatigue, and signs of dehydration, such as poor skin turgor and dry mucous membranes.
Diabetes mellitus
With diabetes mellitus, polyuria seldom exceeds 5 L/day, and urine specific gravity typically exceeds 1.020. The patient usually reports polydipsia, polyphagia, weight loss, weakness, frequent urinary tract infections and yeast vaginitis, fatigue, and nocturia. The patient may also display signs of dehydration and anorexia.
Glomerulonephritis (chronic)
Polyuria gradually progresses to oliguria with chronic glomerulonephritis. Urine output is usually less than 4 L/day; specific gravity is about 1.010. Related GI findings include anorexia, nausea, and vomiting. The patient may experience drowsiness,fatigue, edema, headache, elevated blood pressure, and dyspnea. Nocturia, hematuria, frothy or malodorous urine, and mild to severe proteinuria may also occur.
Hypercalcemia
Elevated plasma calcium levels may lead to nephropathy, usually producing polyuria of less than 5 L/day with a specific gravity of about 1.010. Accompanying signs and symptoms include polydipsia, nocturia, constipation, paresthesia and, occasionally, hematuria, and pyuria. With severe hypercalcemia, the patient’s condition worsens rapidly and he experiences anorexia, vomiting, stupor progressing to coma, and renal failure.
Hypokalemia
Prolonged potassium depletion may lead to nephropathy, which results in polyuria — usually less than 5 L/day with a specific gravity of about 1.010. Associated findings include polydipsia, circumoral and foot paresthesia, hypoactive deep tendon reflexes, fatigue, hypoactive bowel sounds, nocturia, arrhythmias, and muscle cramping, weakness, or paralysis.
Postobstructive uropathy
After resolution of a urinary tract obstruction, polyuria — usually more than 5 L/day with a specific gravity of less than 1.010 — occurs for up to several days before gradually subsiding. Bladder distention and edema may occur with nocturia and weight loss. Occasionally, signs of dehydration appear.
Pyelonephritis
Acute pyelonephritis usually results in polyuria of less than 5 L/day with a low but variable specific gravity. Other findings include persistent high fever, flank pain (usually unilateral), hematuria, costovertebral angle tenderness, chills, weakness, dysuria, urinary frequency and urgency, tenesmus, and nocturia. Occasionally, nausea, anorexia, vomiting, and hypoactive bowel sounds occur.
Chronic pyelonephritis produces polyuria of less than 5 L/day that declines as renal function worsens. Urine specific gravity is usually about 1.010 but may be higher if proteinuria is present. Other effects include irritability, paresthesia, fatigue, nausea, vomiting, diarrhea, drowsiness, anorexia, pyuria and, in late stages, elevated blood pressure.
Sickle cell anemia
Sickle cell anemia may cause nephropathy, typically producing polyuria of less than 5 L/day with a specific gravity of about 1.020. Additional findings include polydipsia, fatigue, abdominal cramps, arthralgia, priapism and, occasionally, leg ulcers and bony deformities.
Other causes
Diagnostic tests
Transient polyuria can result from radiographic tests that use contrast media.
Drugs
Diuretics characteristically produce polyuria. Cardiotonics, vitamin D, demeclocycline, phenytoin, lithium, methoxyflurane, and propoxyphene can also produce polyuria.
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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.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary incontinence:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
Overflow incontinence is common with benign prostatic hyperplasia (BPH) as a result of urethral obstruction and urine retention. The disorder begins with a group of signs and symptoms known as prostatism: reduced caliber and force of urine stream, urinary hesitancy, and a feeling of incomplete voiding. As obstruction increases, urination becomes more frequent, with nocturia and, possibly, hematuria. Examination reveals bladder distention and an enlarged prostate.
Bladder calculus
Overflow incontinence may occur if the stone lodges in the bladder neck. Associated findings vary but may include those of an irritable bladder: urinary frequency and urgency, dysuria, hematuria, and suprapubic pain from bladder spasms. Pelvic pain and pain referred to the tip of the penis, vulva, low back, or heel may occur. Pain may be exacerbated by movement.
Bladder cancer
With bladder cancer, the patient commonly presents with urge incontinence and hematuria; obstruction by a tumor may produce overflow incontinence. Symptoms may be absent during the early stages. Other urinary signs and symptoms include frequency, dysuria, nocturia, dribbling, and suprapubic pain from bladder spasms after voiding. A mass may be palpable on bimanual examination.
Diabetic neuropathy
Diabetic neuropathy may cause painless bladder distention with overflow incontinence. Related findings include episodic constipation or diarrhea (which is commonly nocturnal), impotence and retrograde ejaculation, orthostatic hypotension, syncope, and dysphagia.
Guillain-Barré syndrome
Urinary incontinence may occur early in Guillain-Barré syndrome as a result of peripheral and autonomic nerve dysfunction. The most prominent sign is progressive, profound muscle weakness, which typically starts in the legs and extends to the arms and facial nerves within 24 to 72 hours. Associated findings include paresthesia; dysarthria; nasal speech; dysphagia; orthostatic hypotension; fecal incontinence; diaphoresis; drooling; pain in the shoulders, thighs, or lumbar region; and tachycardia.
Multiple sclerosis
Urinary incontinence, urgency, and frequency are common urologic findings in multiple sclerosis. In most patients, vision problems and sensory impairment occur early. Other findings include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer
Urinary incontinence usually appears only in the advanced stages of prostate cancer. Urinary frequency and hesitancy, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped, nodular prostate are other common late findings.
Prostatitis (chronic)
Urinary incontinence may occur as a result of urethral obstruction from an enlarged prostate. Other findings include urinary frequency and urgency, dysuria, hematuria, bladder distention, persistent urethral discharge, dull perineal pain that may radiate, ejaculatory pain, and decreased libido.
Spinal cord injury
Complete spinal cord transection above the sacral level causes flaccid paralysis of the bladder. Overflow incontinence follows rapid bladder distention. Other findings include paraplegia, sexual dysfunction, sensory loss, muscle atrophy, anhidrosis, and loss of reflexes distal to the injury.
Stroke
Urinary incontinence may be transient or permanent in stroke patients. Associated findings reflect the site and extent of the lesion and may include impaired mentation, emotional lability, behavioral changes, altered level of consciousness, and seizures. Headache, vomiting, visual deficits, and decreased visual acuity are possible. Sensorimotor effects include contralateral hemiplegia, dysarthria, dysphagia, ataxia, apraxia, agnosia, aphasia, and unilateral sensory loss.
Urethral stricture
Eventually, overflow incontinence may occur with urethral stricture. As obstruction increases, urine extravasation may lead to formation of urinomas and urosepsis.
Urinary tract infection
Besides incontinence, a UTI may produce urinary urgency, dysuria, hematuria, cloudy urine and, in males, urethral discharge. Bladder spasms or a feeling of warmth during urination may occur.
Other causes
Surgery
Urinary incontinence may occur after prostatectomy as a result of urethral sphincter damage.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Urinary frequency:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Benign prostatic hyperplasia
With benign prostatis hyperplasia (BPH), prostatic enlargement causes urinary frequency, along with nocturia and possibly incontinence and hematuria. Initial effects are reduced caliber and force of the urine stream, urinary hesitancy and tenesmus, inability to stop the urine stream, a feeling of incomplete voiding, and occasionally urine retention. Assessment reveals bladder distention.
Bladder calculus
Bladder irritation may lead to urinary frequency and urgency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. The patient may have overflow incontinence if the calculus lodges in the bladder neck. Greatest discomfort usually occurs at the end of micturition if the stone lodges in the bladder neck. This may also cause overflow incontinence and referred pain to the lower back or heel.
Bladder cancer
Urinary frequency, urgency, dribbling, and nocturia may develop from bladder irritation; however, the first sign of bladder cancer commonly is gross, painless, intermittent hematuria (usually with clots). Patients with invasive lesions commonly have suprapubic or pelvic pain from bladder spasms.
Multiple sclerosis
Urinary frequency, urgency, and incontinence are common urologic findings in patients with multiple sclerosis. Typically, visual problems (such as diplopia and blurred vision) and sensory impairment (such as paresthesia) are the earliest symptoms. Other findings may include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer
In advanced stages of prostate cancer, urinary frequency may occur, along with hesitancy, dribbling, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped prostate.
Prostatitis
Acute prostatitis commonly produces urinary frequency, along with urgency, dysuria, nocturia, and purulent urethral discharge. Other findings include fever, chills, low back pain, myalgia, arthralgia, and perineal fullness. The prostate may be tense, boggy, tender, and warm. Signs and symptoms of chronic prostatitis are usually the same as those of the acute form, but to a lesser degree. The patient may also experience pain on ejaculation.
Rectal tumor
The pressure exerted by a rectal tumor on the bladder may cause urinary frequency. Early findings include changed bowel habits, commonly starting with an urgent need to defecate on arising or obstipation alternating with diarrhea; blood or mucus in the stool; and a sense of incomplete evacuation.
Reiter’s syndrome
Reiter’s syndrome is a self-limiting syndrome in which urinary frequency occurs with symptoms of acute urethritis 1 to 2 weeks after sexual contact. Other symptoms include asymmetrical arthritis of knees, ankles, and metatarsophalangeal joints; unilateral or bilateral conjunctivitis; and small painless ulcers on the mouth, tongue, glans penis, palms of the hands, and soles of the feet.
Reproductive tract tumor
A tumor in the female reproductive tract may compress the bladder, causing urinary frequency. Other findings vary but may include abdominal distention, menstrual disturbances, vaginal bleeding, weight loss, pelvic pain, and fatigue.
Spinal cord lesion
Incomplete spinal cord transection results in urinary frequency, continuous overflow, dribbling, urgency when voluntary control of sphincter function weakens, urinary hesitancy, and bladder distention. Other effects occur below the level of the lesion and include weakness, paralysis, sensory disturbances, hyperreflexia, and impotence.
Urethral stricture
Bladder decompensation produces urinary frequency, along with urgency and nocturia. Early signs include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence may occur. Urinoma and urosepsis may develop.
Urinary tract infection
UTI is a common cause of urinary frequency. It may also produce urgency, dysuria, hematuria, cloudy urine and, in males, urethral discharge. The patient may report bladder spasms or a feeling of warmth during urination and a fever.
Other causes
Diuretics
Diuretics, which include caffeine, reduce the body’s total volume of water and salt by increasing urine excretion. Excessive intake of coffee, tea, and other caffeinated beverages leads to urinary frequency.
Treatments
Radiation therapy may cause bladder inflammation, leading to urinary frequency.
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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.
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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.
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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
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Proteinuria:
Principal Causes of Proteinuria
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Functional/transientproteinuria
- Fever
- Strenuous exercise
- Extreme cold
- Cardiac failure
- Seizures
- Emotional stress
- Postural proteinuria (orthostatic)
- Nephrotic syndrome
- Tubulointerstitial disease
- Refluxnephropathy
- Tubulointerstitial nephritis
- Fanconi syndrome
- Ischemic tubular injury
- Benign persistent proteinuria
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Urinary Incontinence:
Principal Causes of Urinary Incontinence
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Maturationaldelay
- Stress-related causes
- Urinary tract disorders
- Urinarytract infection
- Dysfunctional voiding disorders
- Lower urinary tract obstruction
- Ectopic ureter in girls
- Neurologic disorders
- Mentalretardation
- Neurogenic bladder
- Abdominal or pelvic mass
- Polyuria
- Primary psychologic disturbance
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Polyuria and Polydipsia:
Principal Causes of Polyuria and Polydipsia
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Diabetesmellitus
- Diabetes insipidus
- Antidiuretichormone deficiency (central diabetes insipidus)
- Antidiuretic hormone resistance (nephrogenicdiabetes insipidus)
- Primary polydipsia
- Compulsivewater drinking
- Hypothalamic thirst center defect
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Urine cloudiness:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
UTI.Cloudy urine is common with UTI. Other urinary changes include urgency, frequency, hematuria, dysuria, nocturia and, in males, urethral discharge. Urinary hesitancy; bladder spasms; costovertebral angle tenderness; and suprapubic, lower back, or flank pain may occur. Other effects include fever, chills, malaise, nausea, and vomiting.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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.
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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.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Nocturia:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).BPH produces nocturia when significant urethral obstruction develops. Typically, it causes frequency, hesitancy, incontinence, reduced force and caliber of the urine stream and, possibly, hematuria. Oliguria may also occur. Palpation reveals a distended bladder and an enlarged prostate. The patient may also complain of lower abdominal fullness, perineal pain, and constipation. Obstruction may lead to renal failure.
Cystitis.All three forms of cystitis may cause nocturia marked by frequent, small voidings and accompanied by dysuria and tenesmus.
Bacterial cystitis may also cause urinary urgency; hematuria; fatigue; suprapubic, perineal, flank, and lower back pain; and, occasionally, a low-grade fever. Most common in women between ages 25 and 60, chronic interstitial cystitis is characterized by Hunner's ulcers—small, punctate, bleeding lesions in the bladder; it also causes gross hematuria. Because symptoms resemble bladder cancer, this must be ruled out.
Viral cystitis also causes urinary urgency, hematuria, and fever.
Diabetes insipidus.The result of antidiuretic hormone deficiency, diabetes insipidus usually produces nocturia early in its course. It's characterized by periodic voiding of moderate to large amounts of urine. Diabetes insipidus can also produce polydipsia and dehydration.
Diabetes mellitus.An early sign of diabetes mellitus, nocturia involves voiding frequent, large amounts of urine. Associated features include daytime polyuria, polydipsia, polyphagia, frequent urinary tract infections, recurrent yeast infections, vaginitis, weakness, fatigue, weight loss and, possibly, signs of dehydration, such as dry mucous membranes and poor skin turgor.
Hypercalcemic nephropathy.With hypercalcemic nephropathy, nocturia involves the periodic voiding of moderate to large amounts of urine. Related findings include daytime polyuria, polydipsia and, occasionally, hematuria and pyuria.
Prostate cancer.Prostate cancer usually produces no symptoms in the early stages. Later, it produces nocturia characterized by difficulty voiding. Other characteristic effects include dysuria (most common symptom), difficulty initiating a urine stream, an interrupted urine stream, bladder distention, urinary frequency, weight loss, pallor, weakness, perineal pain, and constipation. Palpation reveals a hard, irregularly shaped, nodular prostate.
Pyelonephritis (acute).Nocturia is common with acute pyelonephritis and is usually characterized by voiding of moderate amounts of urine, which may appear cloudy. Associated signs and symptoms include a high, sustained fever with chills, fatigue, unilateral or bilateral flank pain, CVA tenderness, weakness, dysuria, hematuria, urinary frequency and urgency, and tenesmus. Occasionally, anorexia, nausea, vomiting, diarrhea, and hypoactive bowel sounds may also occur.
Renal failure (chronic).Nocturia occurs relatively early in chronic renal failure and is usually characterized by voiding of moderate amounts of urine. As the disorder progresses, oliguria or even anuria develops. Other widespread effects of chronic renal failure include fatigue, an ammonia breath odor, Kussmaul's respirations, peripheral edema, elevated blood pressure, a decreased level of consciousness, confusion, emotional lability, muscle twitching, anorexia, a metallic taste in the mouth, constipation or diarrhea, petechiae, ecchymoses, pruritus, yellow- or bronze-tinged skin, nausea, and vomiting.
Other causes
Drugs.Any drug that mobilizes edematous fluid or produces diuresis (for example, a diuretic or cardiac glycoside) may cause nocturia; obviously, this effect depends on when the drug is ingested.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Polyuria:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute tubular necrosis (ATN).During the diuretic phase of ATN, polyuria of less than 8 L/day gradually subsides after 8 to 10 days. Urine specific gravity (1.010 or less) increases as polyuria subsides. Related findings include weight loss, decreasing edema, and nocturia.
Diabetes insipidus (DI).Polyuria of about 5 L/day with a specific gravity of 1.005 or less is common with DI, although extreme polyuria—up to 30 L/day—occasionally occurs. Polyuria is commonly accompanied by polydipsia, nocturia, fatigue, and signs of dehydration, such as poor skin turgor and dry mucous membranes.
Diabetes mellitus (DM).With DM, polyuria seldom exceeds 5 L/day, and urine specific gravity typically exceeds 1.020. The patient usually reports polydipsia, polyphagia, weight loss, weakness, frequent urinary tract infections and yeast vaginitis, fatigue, and nocturia. The patient may also display signs of dehydration and anorexia.
Glomerulonephritis (chronic).Polyuria gradually progresses to oliguria with chronic glomerulonephritis. Urine output is usually less than 4 L/day; specific gravity is about 1.010. Related GI findings include anorexia, nausea, and vomiting. The patient may experience drowsiness, fatigue, edema, headache, elevated blood pressure, and dyspnea. Nocturia, hematuria, frothy or malodorous urine, and mild to severe proteinuria may occur.
Postobstructive uropathy.After resolution of a urinary tract obstruction, polyuria—usually more than 5 L/day with a specific gravity of less than 1.010—occurs for up to several days before gradually subsiding. Bladder distention and edema may occur with nocturia and weight loss. Occasionally, signs of dehydration appear.
Psychogenic polydipsia.Psychogenic polydipsia usually produces dilute polyuria of 3 to 15 L/day, depending on fluid intake. The patient may appear depressed and have a headache and blurred vision. Weight gain, edema, elevated blood pressure and, occasionally, stupor or coma may develop. With severe overhydration, signs of heart failure may present.
Other causes
Diagnostic tests.Transient polyuria can result from radiographic tests that use contrast media.
Drugs.Diuretics characteristically produce polyuria. Cardiotonics, vitamin D, demeclocycline, phenytoin, lithium, methoxyflurane, and propoxyphene can also produce polyuria.
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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.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary incontinence:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia (BPH).Overflow incontinence is common with BPH as a result of urethral obstruction and urine retention. BPH begins with a group of signs and symptoms known as prostatism: reduced caliber and force of urine stream, urinary hesitancy, and a feeling of incomplete voiding. As obstruction increases, urination becomes more frequent, with nocturia and, possibly, hematuria. Examination reveals bladder distention and an enlarged prostate.
Bladder cancer.With bladder cancer, the patient commonly presents with urge incontinence and hematuria; obstruction by a tumor may produce overflow incontinence. The early stages may not produce symptoms. Other urinary signs and symptoms include frequency, dysuria, nocturia, dribbling, and suprapubic pain from bladder spasms after voiding. A mass may be palpable on bimanual examination.
Diabetic neuropathy.Autonomic neuropathy may cause painless bladder distention with overflow incontinence. Related findings include episodic constipation or diarrhea (which is commonly nocturnal), impotence and retrograde ejaculation, orthostatic hypotension, syncope, and dysphagia.
Multiple sclerosis (MS).Urinary incontinence, urgency, and frequency are common urologic findings in MS. In most patients, vision problems and sensory impairment occur early. Other findings include constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, ataxic gait, dysarthria, impotence, and emotional lability.
Prostate cancer.Urinary incontinence usually appears only in the advanced stages of prostate cancer. Urinary frequency and hesitancy, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped, nodular prostate are other common late findings.
Prostatitis (chronic).Urinary incontinence may occur as a result of urethral obstruction from an enlarged prostate. Other findings include urinary frequency and urgency, dysuria, hematuria, bladder distention, persistent urethral discharge, dull perineal pain that may radiate, ejaculatory pain, and decreased libido.
Spinal cord injury.Complete cord transection above the sacral level causes flaccid paralysis of the bladder. Overflow incontinence follows rapid bladder distention. Other findings include paraplegia, sexual dysfunction, sensory loss, muscle atrophy, anhidrosis, and loss of reflexes distal to the injury.
Stroke.With a stroke, urinary incontinence may be transient or permanent. Associated findings reflect the site and extent of the lesion and may include impaired mentation, emotional lability, behavioral changes, altered level of consciousness, and seizures. Headache, vomiting, visual deficits, and decreased visual acuity are possible. Sensorimotor effects include contralateral hemiplegia, dysarthria, dysphagia, ataxia, apraxia, agnosia, aphasia, and unilateral sensory loss.
Urethral stricture.Eventually, overflow incontinence may occur with a urethral stricture. As obstruction increases, urine extravasation may lead to formation of urinomas and urosepsis.
UTI.Besides incontinence, a UTI may produce urinary urgency, dysuria, hematuria, cloudy urine and, in males, urethral discharge. Bladder spasms or a feeling of warmth during urination may occur.
Other causes
Surgery.Urinary incontinence may occur after prostatectomy as a result of urethral sphincter damage.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Urinary frequency:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Benign prostatic hyperplasia.Prostatic enlargement causes urinary frequency, along with nocturia and possibly incontinence and hematuria. Initial effects are those of prostatism: reduced caliber and force of the urine stream, urinary hesitancy and tenesmus, inability to stop the urine stream, a feeling of incomplete voiding, and occasionally urine retention. Assessment reveals bladder distention.
Bladder calculus.Bladder irritation may lead to urinary frequency and urgency, dysuria, terminal hematuria, and suprapubic pain from bladder spasms. The patient may have overflow incontinence if the calculus lodges in the bladder neck. Greatest discomfort usually occurs at the end of micturition if the calculus lodges in the bladder neck. This may also cause overflow incontinence and referred pain to the lower back or heel.
Prostate cancer.In advanced stages of prostate cancer, urinary frequency may occur, along with hesitancy, dribbling, nocturia, dysuria, bladder distention, perineal pain, constipation, and a hard, irregularly shaped prostate.
Prostatitis.Acute prostatitis commonly produces urinary frequency, along with urgency, dysuria, nocturia, and purulent urethral discharge. Other findings include fever, chills, low back pain, myalgia, arthralgia, and perineal fullness. The prostate may be tense, boggy, tender, and warm. Prostate massage to obtain prostatic fluid is contraindicated. Signs and symptoms of chronic prostatitis are usually the same as those of the acute form, but to a lesser degree. The patient may also experience pain on ejaculation.
Rectal tumor.The pressure exerted by a rectal tumor on the bladder may cause urinary frequency. Early findings include changed bowel habits, commonly starting with an urgent need to defecate on arising or obstipation alternating with diarrhea; blood or mucus in the stools; and a sense of incomplete evacuation.
Reiter's syndrome.In Reiter's syndrome, urinary frequency occurs with symptoms of acute urethritis 1 to 2 weeks after sexual contact. Other symptoms of this self-limiting syndrome include asymmetrical arthritis of knees, ankles, and metatarsophalangeal joints; unilateral or bilateral conjunctivitis; and small painless ulcers on the mouth, tongue, glans penis, palms, and soles.
Reproductive tract tumor.A tumor in the female reproductive tract may compress the bladder, causing urinary frequency. Other findings vary but may include abdominal distention, menstrual disturbances, vaginal bleeding, weight loss, pelvic pain, and fatigue.
Spinal cord lesion.Incomplete cord transection results in urinary frequency, continuous overflow, dribbling, urgency when voluntary control of sphincter function weakens, urinary hesitancy, and bladder distention. Other effects occur below the level of the lesion and include weakness, paralysis, sensory disturbances, hyperreflexia, and impotence.
Urethral stricture.Bladder decompensation produces urinary frequency, along with urgency and nocturia. Early signs include hesitancy, tenesmus, and reduced caliber and force of the urine stream. Eventually, overflow incontinence may occur. Urinoma and urosepsis may develop.
Urinary tract infection.Affecting the urethra, the bladder, or the kidneys, this common cause of urinary frequency may also produce urgency, dysuria, hematuria, cloudy urine and, in males, urethral discharge. The patient may report bladder spasms or a feeling of warmth and pain during urination and fever. Women may experience suprapubic or pelvic pain.
Other causes
Diuretics.Diuretics, which include caffeine, reduce the body's total volume of water and salt by increasing urine excretion. Excessive intake of coffee, tea, and other caffeinated beverages leads to urinary frequency.
Treatments.Radiation therapy may cause bladder inflammation, leading to urinary frequency.
» 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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