Dear Dr. Gott: I had gynaecology surgery in December 2009 because I was having heavy menstrual cycles. An ultrasound showed a buildup of the uterine lining, so my gynaecologist performed a D&C and a colposcopy, and biopsied a few spots. All the results were normal.

After the surgery, I was able to urinate a few times a day but retained two pounds of fluid for two days. On the third day after the surgery, I was finally able to eliminate all of the retained fluid and I urinated every 20 minutes all day long. Since then, I have noticed that my urine stream is weak. It has been five months since the surgery, and lately, when my bladder is full in the morning, I am not able to empty it fast enough, and it causes pelvic pressure and pain and sometimes cramping until it slowly empties. I do not have a fever, blood in my urine or a burning sensation. I do not have a history of kidney stones and have only had one UTI, which was 11 years ago. The only medication that I currently take is atenolol in the morning. The night prior to the surgery, I was given misoprostol to ripen my cervix. The procedure required a catheter, which was removed before I regained consciousness.

Could this change in my ability to empty my bladder quickly be a result of general anaesthesia or the catheter? What tests and treatment should I seek? Will this go away, or is it something I have to live with? I now urinate frequently to intentionally prevent my bladder from getting too full, but I'm not sure what else I could or should be doing. Many thanks for sharing knowledge and expertise.

Reply: A catheter is a thin, flexible tube that is inserted into the body to either introduce or withdraw fluids. The word catheter is most often used to describe a tube that is used to empty the bladder. This can be achieved by insertion directly into the urethra, which leads to the bladder, or in some instances, a special opening is created within the abdomen for the catheter to be placed.

Dilation and curettage (D&C) is a surgical procedure in which a physician dilates the cervix and then scrapes the uterine lining. This is done for a number of reasons, including following abortion or miscarriage, heavy menstrual cycles or as a diagnostic tool for determining the presence of certain gynaecologic disorders.

Now, to your specific concerns.

First, because of the proximity of the vagina to the urethra and bladder, your question is whether either or both were inadvertently damaged. This is fairly unlikely; however, it is a possibility that should be looked into.

Next, a catheter can cause scarring of the urethra if inserted improperly and repeatedly over time. Since you mentioned its use only once, during your surgery, this is probably not your problem, but I can't rule it out entirely.

Request a referral to a urologist for further examination and testing. He or she can then determine whether your problem is directly related to the D&C or some other condition, such as a urinary-tract infection. While it's uncommon, some people don't experience any symptoms or have only mild ones that go unnoticed.

To provide related information, I am sending you a copy of my Health Report 'Urinary Tract Infections'. Other readers who would like a copy should send a self-addressed stamped number ten envelope and $2 cheque or money order to Newsletter, PO Box 167, Wickliffe, Ohio 44092-0167 Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Dr. Peter H. Gott is a retired physician and the author of several books, including 'Live Longer, Live Better', 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook'.