Lack of knowledge about urethral diverticulum has lead to this relatively common condition remaining under-diagnosed in women with chronic genitourinary conditions. Over the past 30 to 40 years women with recurrent infections, retro pubic pressure, post-void dribbling and painful sex (without vaginal infection or cystitis), were given the blanket diagnosis of ‘urethral syndrome’.
The urethra is surrounded by microscopic paraurethral glands concentrated around the lower third of the urethra that drain into the Skene ducts, adjacent to the urethral opening. Apparently, infection in these glands is relatively common and under diagnosed. Treatments include surgical excision of periurethral tissue, internal urethral cutting procedures and forceful urethral dilation. These procedures are associated with pain, incontinence and recurrences of symptoms. Muscle relaxants are also prescribed to reduce pelvic floor muscle spasm.
Muscular over activity is a natural reaction of the pelvic floor muscles to pain, infection and urine loss. When symptoms are chronic the muscles react with prolonged tightening and develop heightened resting tone. Treatment with a women’s health physiotherapist to prevent or reduce painful trigger points and restore pelvic stability is indicated when pelvic floor muscles are chronically tight.
Antibiotics are effective for acute infection and hot baths bring soothing relief of muscle spasms. Reduce systemic inflammation by avoiding saturated fat, caffeine, sugar and white flour products and increasing vegetable intake to reduce cellular acidity (an acidic environment allows inflammation to proliferate). Herbalists advise willow bark, meadowsweet, ginger, bromelain (pineapple), licorice, turmeric and ginseng to reduce pain-producing prostaglandins.
This condition is diagnosed by various imaging techniques and careful pinpoint palpation of the urethra through the front vaginal wall. If you have a history of the symptoms associated with paraurethral gland infection, use your index finger to carefully palpate the sides of the urethra up to 4 centimeters along the front vaginal wall. Specific tenderness is an indicator of paraurethral gland infection. Reduction or absence of specific tenderness is in turn associated with a reduction in symptoms. Occasionally, a build up of infected fluids is removed through ‘milking’ the urethra. Relapses may occur months or years later and are confirmed through urethral, vaginal wall palpation.
Forward this article to a friend who may benefit, and prevent the widespread aggressive practices of surgical excision, urethral dilation and prolonged use of muscle relaxants.
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