The female urinary system is a complex network that, at times, can be vulnerable to various conditions. One such condition that deserves attention is urethral diverticula (UD). For more information, we'll cover everything you should know about this often misunderstood condition, including what to do if you suspect symptoms.
What is a Urethral Diverticulum?
In women, the urethra, the tube that takes urine out of the body, is only about 4 cm long. This often leads to infections like UTIs because bacteria don't have to travel as far to reach the bladder. However, the female anatomy is also subject to other pelvic issues, such as urethral diverticula (UD), which is a fluid-filled pocket or sac that forms along the urethra. Due to the location within the urinary system, the pocket or sac may be filled with urine or pus, which can increase the risk of several types of infections or other complications.
Symptoms of UD in Women
Many of the symptoms in UD are similar to several other urologic issues that affect female patients. Some of the most common present symptoms include:
- Chronic or recurrent urinary tract infections
- Pain during urination (dysuria)
- Pelvic pain
- Nocturia
- Increased frequency
- Urinary incontinence
- Urinary retention
- Pain during intercourse (dyspareunia)
- Blood in urine (hematuria)
- Irregular vaginal discharge
While your symptoms may seem innocent or mild, it's important to see a urologist to determine the underlying cause and ensure you receive proper treatment.
Is Female Urethral Diverticula Common?
A urethral diverticulum isn't that common at all. In fact, it's a relatively rare condition. The prevalence is only about 1% to 6% of adult females. It affects women between the ages of 30 and 60 most often but can occur in anyone. Thanks to developments in urology imaging technology, this problem is now more accurately diagnosed, which may account for the increase in diagnoses over the years. However, since it's so rare, sometimes urethral diverticula in women is misdiagnosed.
Conditions That Mimic UD
Symptomatic urethral diverticula can mimic several common urologic conditions that affect the urinary tract or female reproductive organs. Some of the most common conditions that contain similar symptoms include:
- Urinary Tract Infections — common bacterial infections that can affect any part of the urinary system, including the bladder, urethra, and kidneys. Symptoms often include painful, frequent urination, a burning sensation, and cloudy or bloody urine. They're usually treated with antibiotics but can lead to more serious complications if left untreated.
- Interstitial Cystitis — a chronic bladder condition characterized by pelvic pain and a frequent, urgent need to urinate. It can significantly impact a person's quality of life due to discomfort and frequent bathroom trips. The exact cause is unknown, but IC treatment may involve lifestyle changes, dietary modifications, physical therapy, and medication.
- Endometriosis — a painful condition in which tissue similar to the lining of the uterus grows outside the uterus. It can lead to severe pelvic pain, painful menstruation, and fertility problems. Treatment options range from pain management and hormonal therapy to surgical removal of the abnormal tissue.
- Vulvodynia — a chronic pain condition characterized by unexplained, persistent pain in the vulvar area. This pain can be triggered by sexual activity, tampon insertion, or even sitting for extended periods. Management often involves a combination of physical therapy, topical treatments, and psychological support to alleviate discomfort and improve quality of life.
Stress urinary incontinence can also mimic some of the symptoms of this condition. The best way to determine the cause of your symptoms is to see your doctor for diagnostic testing.
What Causes UD?
A urethral diverticulum may be congenital (present at birth) or develop over time. Unfortunately, the reason this sac or pocket forms in some individuals is not always known. However, there does seem to be a correlation between individuals with multiple bladder infections and UD. It could be that the recurrence of infections in the urinary tract weakens the urethral lining, but more research is needed, and individual causes may vary. Another potential cause is a vaginal mass or block in glands near the urethra. Your doctor may be able to determine the cause or may simply recommend options to treat a UD.
Risk Factors for a Urethral Diverticulum
Some instances can increase your risk of developing a diverticular in the urethra. The most common risk factors include:
- Recurrent infections that may weaken the urethra wall
- Vaginal delivery
- Frequent UTIs
- Difficulty emptying the bladder
- Hypospadias (in men)
- Trauma to the urethra
Regardless of if the diverticulum is congenital or acquired over time, it's important to seek treatment. Untreated UD may result in certain complications or worsened symptoms over time.
How to Diagnose UD
Oftentimes, women mistake UD as a common urologic symptom that only requires a change in lifestyle habits. In reality, many instances of UD are found during a gynecologic visit or physical exam of the vagina after describing these symptoms. To confirm the diagnosis, your doctor may order a urine test alongside one or more imaging techniques. Some of the most common diagnostic tools include:
- Physical Examination — during a physical, your doctor will feel the vaginal wall to try and see if there are any masses present. If they find the place where the sac forms, they may gently squeeze it to see if any pus or urine comes out.
- Voiding Cystourethrogram — using x-rays, this tests how your bladder functions by taking images of your uterus pre- and post-void.
- Ultrasound — using sound waves, this test will help create an image of the area around the pelvis to help your doctor see whether there is any irritative tissue, swelling, or urine build-up.
- Magnetic Resonance Imaging (MRI) — Ii instances where your doctor suspects UD, they may order an MRI. This uses radio waves to provide clear images of the pelvis and regions next to the urethra for a more accurate diagnosis of any suspected masses.
- Cystoscopy — using a long, thin camera, this test allows your doctor to perform an endoscopic examination of the bladder and urethra.
Treatment for a Urethral Diverticulum
Management of urethral diverticula can go one of two different ways. However, surgical outcomes to remove the sac are often the most effective.
- UD Surgery — a diverticulectomy can be performed to surgically remove the periurethral pocket or sac.
- Active Monitoring — for women who don't want to undergo surgery, active monitoring may be an option. However, if symptoms continue to worsen, surgery is the only option.
Patients who had surgery on the periurethral tissue tend to experience greater relief from symptoms. However, it is still possible to experience complications or other instances of UD, so it's important to stay in touch with your doctor regularly.
Recovering from UD Surgical Treatment
If you underwent surgical intervention to treat a urethral diverticulum, it's important to follow your doctor's post-op plan in detail. This will likely include taking antibiotics for at least 24 hours, using a catheter, and getting plenty of rest. Follow-up visits will be required to monitor your progress and ensure no complications.
If you recently underwent surgery and need to use a catheter, Byram Healthcare can help. We offer a wide selection of high-quality urologic supplies that can be discreetly delivered to your door. Our product guide includes various incontinence products to help offer support throughout the day. Browse our product catalog today or contact one of our representatives for more information.
