Urethritis

• Nongonococcal urethritis

• 590.9 Infection of kidney, unspecified
• Associated ICD-9-CM PT diagnoses/treatment diagnosis that may be directly related to urogenital (UG) disorders or consequences from bed rest, surgery, or inactivity or directly related to UG disorders specifically
  • 315.4 Developmental coordination disorder
  • 718.45 Contracture of joint; pelvic region and thigh
  • 719.70 Difficulty in walking
  • 728.2 Muscular wasting and disuse atrophy
  • 728.89 Other disorders of muscle, ligament, and fascia
  • 729.9 Other and unspecified disorders of soft tissue
  • 780.7 Malaise and fatigue
  • 781.2 Abnormality of gait
  • 782.3 Edema
  • 786.0 Dyspnea and respiratory abnormalities
  • 786.05 Shortness of breath

• N15.9 Renal tubulointerstitial disease, unspecified

• As of January 2013, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, the associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns would be indicated.

Description

• Swelling and Inflammation of the urethra
• Males and females frequently asymptomatic1
• Females present with symptoms of urinary tract infection: burning with urination
• Males present with a clear or purulent discharge1
• If spread to kidneys, symptoms more severe and pain is located in the low back with possible tenderness to palpation of the kidneys

Essentials of Diagnosis

• Difficulty urinating
• Painful urination
• Malodorous urine
• Pelvic pain in women
• Change in color of urine
• Positive cultures

General Considerations

• Most infections of the urethra are sexually transmitted
• Most common bacterial causes in males1
  • N gonorrhoeae
  • C trachomatis
  • Coliforms in males practicing insertive anal intercourse
• May refer pain to back, pelvic region
• May result in secondary problems such as
  • Reiter syndrome
  • Epididymitis or Prostatitis
  • Aerobic capacity and muscle endurance impairment
  • Sarcopenia
  • Weakness/impaired muscle performance
  • Neuromuscular problems
  • Weight loss or weight gain indicating the need for PT intervention depending on severity
• May mimic colon cancer or tumors, irritable bowel, colitis, or gynecological problems in females such as endometriosis, uterine fibroids, or ectopic pregnancies
• There are specific UG pathologies that may be appropriate for PT, but PT usually does not have a role specifically in the treatment

Demographics

• Women more susceptible to cystitis, secondary to the anatomical proximity of the urethra to the anus and the urethra to the bladder
• Frequently associated with sexual intercourse
• E. coli is common bacterial cause
• Women more susceptible to urethritis because of anatomical proximity of urethra to vagina and can be caused by sexually transmitted diseases such as herpes, gonorrhea, and chlamydia

Signs and Symptoms

• Symptoms are frequently referred to the back and abdominal area; it may be more common than previously identified for patients to be inappropriately referred to PT
• Urethra (urethritis) main symptom
  • Severe pain with or without attempts at urination in males and females, or no pain at all, especially in the elderly and children
  • Burning with urination
  • Discharge from ...