Female Urethral Syndrome

Symptomatic abacteriuria or Urethral syndrome is a fairly common condition in adult females between 30 and 50 years of age. According to the estimates reported by National Fibromyalgia & Chronic Pain Association (1), urethral syndrome is responsible for the symptoms of lower urinary tract infection in 25% females who reports to primary care clinics.Female urethra is a short tube that is responsible for the expulsion of urine, stored in the urinary bladder. Urethra syndrome is less frequently reported in males due to a longer urethra.

Classic presentation of Female Urethral syndrome is characteristic for these sign and symptoms:

• Lower abdominal pain that may radiate to flank region
• Frequent and painful episodes of urination associated with urgency and burning sensation that is partially relieved in some females by emptying out the bladder
• Irritation of urethra and difficulty in initiating urination
• Suprapubic discomfort
• Pain in the urethral region during or after sexual intercourse
• Uneasiness in vulvar region
• Blood in the urine
• A feeling of incomplete emptying of bladder after urination

What Causes Female Urethral Syndrome?

Despite extensive research, very little is known about the exact pathophysiology of female urethral syndrome. A few possible explanations are:

• Irritation of urethra, caused by excessive use of scented products like bubble bath, soaps, perfumes and sanitary napkins. Some more potential irritants may include spermicidal jellies, excessive intake of dietary irritations like caffeine or exposure to chemotherapeutic agents
• History of a significant injury to the urethra or urethral strictures (such as aggressive bike riding, sexual abuse or inflammation caused by diaphragm and tampons)
• Congenital or acquired anatomical issues like bladder outlet obstruction (reported in up to 30% females according to a study reported in peer reviewed International Urogynecology Journal) or abnormal narrowing of urethral opening
• Undetected or undiagnosed viral or bacterial infection of genital or urethral tract
• Exposure to radiations

Due to these inciting events, the patient may develop dysfunction of pelvic floor musculature, characterized by involuntary tightening of pelvic tissues and involuntary spasmodic episodes.

Risk Factors

The risk of urethral syndrome increases in the setting of these risk factors:

• Bacterial infection of bladder or kidneys
• Use of certain medications that alters the pH or biochemistry of the female urethral tract
• Hormonal imbalance or dysfunction
• Acute or chronic inflammation of paraurethral glands or skene glands (these are small glandular tissues present in female genital tract and mimics the activity of prostate in males)
• Unprotected sexual intercourse with strangers or genital injuries
• History of sexually transmitted infections (STIs)
• Immunodeficiency states (or chronic abuse of immune system modulating drugs)

How to Diagnose Urethral Syndrome?

The diagnostic strategies mainly aims at identifying the cause of symptoms and to rule out other infections (or in other words, urethral syndrome is diagnosed by excluding other possible causes of urethral dysfunction). Your healthcare provider may ask for serological tests in addition to urine sampling for detailed report, culture and sensitivity (C/S).

Urethral Syndrome Treatment

Several therapeutic approaches can be adopted to address urethral syndrome and to minimize the risk of chronic discomfort. Most popular modalities are:

• Medications: Antibiotics, anesthetics, antispasmodics, antidepressants and alpha-blockers are the most frequently used drugs for the management of urethral syndrome.
• Lifestyle changes: Healthcare providers advise lifestyle modification to prevent urethral irritation. Such as avoidance of scented soaps or long bike rides.
• Surgery: In certain cases, surgical intervention is needed to widen urethral opening or lumen. Urethral constriction is a fairly common cause of recurrent urethral syndrome in females secondary to injuries, inflammatory reactions and scar tissue formation.

Urethral Syndrome Prevention

Certain preventive measures can be adopted to minimize the risk of developing female urethral syndrome; these are:

• Avoid products that may irritate urethra (such as female hygiene products, douching, scented sprays etc.)
• Avoid unprotected physical intercourse with strangers/ multiple partners
• Seek medical help and advice if you are manifesting sign and symptoms of a sexually transmitted infection
• Make a habit of emptying your bladder after engaging in sexual intercourse
• Wipe the genitals properly (front to back motion)
• Avoid wearing overly tight jeans or pantyhose
• Prefer cotton underwear over nylon or other irritable materials

The recurrent attacks of painful urethral syndrome can be prevented by consuming certain medications and making lifestyle changes.References:

1. http://www.fmcpaware.org/d-f/female-urethral-syndrome
2. Phillip, H., Okewole, I., & Chilaka, V. (2014). Enigma of urethral pain syndrome: Why are there so many ascribed etiologies and therapeutic approaches?. International Journal of Urology, 21(6), 544-548.
3. Foxman, B. (2014). Urinary Tract Infection Syndromes: Occurrence, Recurrence, Bacteriology, Risk Factors, and Disease Burden. Infectious disease clinics of North America, 28(1), 1-13.
4. Yee, C. H., Ho, L. Y., Hung, H. H., & Chan, W. H. S. (2012). The effect of urethral calibration on female primary bladder outlet obstruction. International urogynecology journal, 23(2), 217-221.