Could You Have A Urethral Diverticulum?

When Carla, a 46-year old mother of two, noticed that she needed to go to the bathroom more and more often and yet didn't seem able to empty her bladder completely, she assumed that she had caught a urinary tract infection and made sure to drink lots of cranberry and apple juice. Things didn't get better when she did though, and just as she thought she would need to see her doctor for some antibiotics, she began experiencing startling new symptoms that couldn't be explained away by a UTI.

There was the slight "leakage" and the pain during sex, which could still indicate a urinary tract infection, but there was also something else — Carla had the definite feeling that something was coming out of her vagina. What was wrong? Could it be related to the perimenopause that she could now expect any time, or was she dealing with a pelvic prolapse of some kind? Carla had no idea and didn't particularly relish the thought of going to the doctor. One day, feeling brave, she decided to take a look at her vagina with a makeup mirror. Something was definitely up there that shouldn't be.

What Is A Urethral Diverticulum?

"Urethral diverticulum" — the name itself gives some clues, suggesting that part of the urethra is "diverted". The urethra is, of course, the small tube through which urine is emptied from the bladder. When a "pouch" forms along the way, you end up with a urethral diverticulum. Urine can build up in this pocket, causing an uncomfortable bulge that can be felt from within the vagina, as Carla noticed. As you can imagine, such pockets can lead to frequent urinary tract infections, difficulties with urinating, and pelvic pain.

First described in the medical literature in 1805 by William Hey, it's hard to know how common urethral diverticula really are because many women remain asymptomatic. Men do occasionally get them too, but so rarely that focusing this article on women is more than justified. Urethral diverticula occur mostly in women between the ages of 40 and 70, and research suggests that they are present in approximately 16 percent of those who have suffered from frequent urinary tract infections. (Though one study found urethral diverticula in 4.7 percent of women who didn't have symptoms at all, the small sample size of 129 participants makes it impossible to say that this figure represents the prevalence of the condition within the general population.)

READ Mucus In Urine And Other Urinary Tract Symptoms: When You Need To Go To The Doctor

Though the cause of urethral diverticula is not clear right now, risk factors include frequent UTIs, having been pregnant and given birth, and a blockage of the glands surrounding the urethra. All of these things weaken the urethral wall.

Urethral Diverticulum: Symptoms, Diagnosis And Treatment

Urethral Diverticulum: Symptoms

As we've already seen, it's possible to have a urethral diverticulum without also experiencing symptoms, or to have symptoms that are so vague that they won't alarm you enough to seek medical attention. Those who have symptoms, however, are most likely to notice problems with urination.

Research suggests that somewhere between 40 and 100 percent of women with urethral diverticula will notice urinary urgency and need to pee rather often. Up to 70 percent of patients, meanwhile, will experience pain while urinating or will find it hard to urinate (dysuria). Frequent urinary tract infections are a common warning sign of urethral diverticula as well, experienced by up to half of patients, and those with urethral diverticula are also likely to notice some urine "leakage" right after they finish using the bathroom. 

Other symptoms include painful sex, blood in the urine, pelvic pain, pain around the perineum, and a feeling that your bladder was not quite emptied after urination. Finally, some patients will notice a bulge within the vagina.

Should these symptoms sound familiar to you, it is of paramount importance to seek medical attention as soon as possible, though you should remember that the same symptoms can be caused by other conditions as well. If your doctor doesn't consider the possibility of a urethral diverticulum and you believe that you may have one, mentioning this to your doctor is more than justified.

How Are Urethral Diverticula Diagnosed?

Carla was lucky: her urethral diverticulum was diagnosed shortly after she started experiencing symptoms. Many women are first misdiagnosed, commonly simply with urinary tract infections. The fact that the clinical signs of this condition may not be obvious at all plays a large part in this, however, urethral diverticula can also present with rather clear physical signs.

How Are Urethral Diverticula Treated?

Surgery is only indicated if you have symptoms. Should your symptoms be mild, you may also choose to take a wait-and-see approach rather than immediately moving towards surgery, in close consultation with your medical team. Because surgery can create some of the same complications that urethral diverticulum presents to begin with, namely frequent UTIs and incontinence, as well as having the potential to lead to a fistula, it is important to weigh the risks and advantages of surgery with your healthcare provider in detail. The fact that it is possible to develop cancer within the urethral diverticulum needs to be taken into account when making this decision.

READ Blood in Urine: Causes & Treatment

Due to the delicate nature of the surrounding tissues, it is also very important that the surgery be carried out by a urologist with extensive experience in treating this problem.

If you do have surgery for a urethral diverticulum, you can expect to be able to go home on the same day. You will, however, need a catheter for approximately 10 days, as well as a course of antibiotics to prevent infection. It is normal to experience urinary leakage in the period after the surgery. This should subside with time.