Morning Urination Pain: Symptoms and Seeking Solutions

Sharp pain in the lower abdomen when urinating in the morning?

Hello, I would like to ask about a situation.
In the morning, when I get up to urinate (I feel a bit full but not urgently), as soon as I sit on the toilet, I don't immediately urinate.
Instead, I first experience a sharp pain in my lower abdomen before I start to urinate.
During urination, I still feel the sharp pain in my lower abdomen, and the urine volume is about 60 to 100 cc.
Generally, when I use the restroom, it’s fine, but occasionally I have sharp pain.
I previously thought it was a gynecological issue and consulted a doctor.
I underwent urinalysis and blood tests, all of which were normal.
Eventually, I had urodynamic testing and an ultrasound, and the doctor diagnosed me with urethral stricture and noted that my urinary pressure was somewhat high.
They prescribed muscle relaxants for me, but after taking them, I did not notice any improvement, and the situation continues.
I am very troubled and do not know what to do… I am unsure what direction to take for further examination.

Fang, 30~39 year old female. Ask Date: 2016/05/06

Dr. Li Xinyi reply Urology

A cystoscopy may be necessary, and urethral dilation may be performed if needed.

Reply Date: 2016/05/06

More Info

Morning urination pain can be a distressing symptom that affects your quality of life, and it’s understandable that you are seeking answers and solutions. Based on your description, it seems that you are experiencing a sharp pain in your lower abdomen when you attempt to urinate in the morning, which is accompanied by a feeling of urgency but without the typical sensation of a full bladder. This pain persists even after you start urinating, and you have already undergone various medical evaluations, including urinalysis, blood tests, and ultrasound, which returned normal results.

Given your diagnosis of urethral stricture, it’s important to understand how this condition can contribute to your symptoms. Urethral stricture refers to a narrowing of the urethra, which can impede the flow of urine and lead to increased pressure during urination. This increased pressure can cause discomfort or pain, particularly if the bladder is contracting forcefully to push urine through the narrowed passage. The fact that you experience pain primarily in the morning may be related to the bladder being fuller after a night’s sleep, leading to a stronger urge to urinate and potentially more discomfort due to the stricture.

You mentioned that you were prescribed muscle relaxants, but you did not notice significant improvement. Muscle relaxants can help alleviate some discomfort associated with bladder spasms, but they may not address the underlying issue of the stricture itself. It might be beneficial to discuss with your healthcare provider the possibility of other treatment options, such as:
1. Urethral Dilation: This procedure involves gradually widening the urethra to relieve the stricture. It can provide temporary relief and may need to be repeated periodically.

2. Urethroplasty: This is a surgical procedure that aims to remove the narrowed section of the urethra and reconnect the healthy ends. It is often considered for more severe strictures and can provide a more permanent solution.

3. Botulinum Toxin Injections: In some cases, injecting Botox into the bladder muscle can help reduce spasms and improve comfort during urination.

4. Pelvic Floor Physical Therapy: If there are underlying pelvic floor issues contributing to your symptoms, physical therapy may help strengthen and relax the pelvic muscles, potentially alleviating pain.

5. Further Urodynamic Studies: If your symptoms persist, additional urodynamic testing may be warranted to assess bladder function and pressure more comprehensively.

It’s crucial to maintain open communication with your healthcare provider about your ongoing symptoms and the impact they have on your daily life. If you feel that your current treatment plan is not effective, do not hesitate to seek a second opinion or ask for a referral to a urologist who specializes in urethral conditions. They may offer insights or treatment options that have not yet been explored.

In the meantime, consider keeping a symptom diary to track when the pain occurs, its intensity, and any other associated symptoms. This information can be valuable for your healthcare provider in determining the best course of action.

In conclusion, while urethral stricture may be the primary cause of your morning urination pain, it’s essential to explore all potential avenues for treatment and management. With the right approach, you can find relief and improve your quality of life.

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