Urinary Difficulties and Discharge Before Menstruation

Premenstrual discharge and difficulty urinating?

Hello Dr.
Huang: I am currently 44 years old and have irregular menstrual periods.
I have two daughters (both delivered naturally) and experienced infertility due to polycystic ovary syndrome, but I conceived naturally after treatment.
During my first pregnancy, I had gestational diabetes, and during my second pregnancy, I had gestational hypertension.
Due to gestational diabetes, I am currently receiving insulin therapy.

Two years ago, I noticed that I have difficulty urinating before my menstrual period, with a feeling of bladder fullness but unable to urinate.
I consulted a urologist, and an ultrasound showed normal kidneys.
I also visited an obstetrician-gynecologist, who indicated that my symptoms were related to diabetes.
On November 11, 2016, I went to the emergency room due to inability to urinate; blood tests were normal, and after catheterization, I was able to go home.

Recently, I have observed that during episodes of urinary difficulty, I experience very thick vaginal discharge, thicker than mucus.
After this discharge occurs, my urination improves somewhat.
Dr.
Huang, could you please explain what this condition might be? Is there a possibility of a tumor? Which specialty should I consult, and what kind of examinations should I undergo? Thank you, Dr.
Huang!

Tina, 40~49 year old female. Ask Date: 2017/08/03

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Irregular menstrual periods; has two daughters (natural births), experiencing infertility due to polycystic ovary syndrome, and after treatment, conceived naturally.
During the first pregnancy, had gestational diabetes; during the second pregnancy, had gestational hypertension.
Currently receiving insulin therapy due to gestational diabetes.
Two years ago, noticed difficulty urinating before menstruation, with bladder fullness but inability to void.
Consulted a urologist, and an ultrasound showed normal kidneys.
Also visited an obstetrician-gynecologist, who indicated that the issue is related to diabetes.
On November 11, 2016, went to the emergency room due to inability to urinate; blood tests were normal, and after catheterization, was able to return home.
Recently observed that during episodes of difficulty urinating, there is a very thick vaginal discharge, thicker than mucus, and after the discharge occurs, urination improves somewhat.
Dr.
Huang, what could this condition be? Is there a possibility of a tumor? Which specialty should I consult, and what kind of examinations should I undergo? Answer: Consult a neurologist for neurological and urodynamic evaluations.

Reply Date: 2017/08/03

More Info

Understanding urinary difficulties and discharge before menstruation can be quite complex, especially considering your medical history and current symptoms. Based on the information you've provided, it seems that you are experiencing urinary retention or difficulty urinating, which has been associated with your menstrual cycle and possibly linked to your history of diabetes.

Firstly, it's important to recognize that urinary difficulties can arise from various factors, including anatomical changes, hormonal fluctuations, and underlying medical conditions. In your case, the fact that you have polycystic ovary syndrome (PCOS) and a history of gestational diabetes may contribute to hormonal imbalances that could affect bladder function. Hormones such as estrogen and progesterone fluctuate throughout the menstrual cycle, and these fluctuations can impact the urinary tract and bladder.

The thick, mucous-like discharge you are experiencing before your menstrual period could be related to hormonal changes as well. During the luteal phase of your cycle (the time after ovulation and before menstruation), the body produces more progesterone, which can lead to changes in cervical mucus. This mucus can become thicker and more viscous, which may explain the discharge you are noticing. The presence of this discharge may also correlate with your urinary symptoms, as increased pressure from the bladder or changes in the pelvic area due to hormonal shifts could lead to temporary urinary difficulties.

Given your history of diabetes and the urinary issues you've experienced, it is crucial to rule out any potential complications. While your previous evaluations, including ultrasound examinations, have shown normal kidney function, it is still advisable to continue monitoring your symptoms. The fact that you experienced acute urinary retention requiring catheterization is significant and should not be overlooked.

To address your concerns about potential tumors or other serious conditions, it would be prudent to consult with a urologist, as they specialize in urinary tract issues. They may recommend further investigations, such as a urodynamic study, which assesses how well your bladder and urethra are functioning. Additionally, a gynecologist may also be involved to evaluate any possible gynecological causes for your symptoms, particularly given the relationship to your menstrual cycle.

In summary, your urinary difficulties and the associated discharge could be linked to hormonal changes related to your menstrual cycle and your history of diabetes. However, it is essential to consult with a urologist for a thorough evaluation to rule out any serious conditions and to discuss your symptoms in detail. They can provide you with the appropriate tests and guidance to manage your urinary health effectively. In the meantime, keeping a symptom diary that tracks your urinary patterns, menstrual cycle, and any other related symptoms can be helpful for your healthcare providers in diagnosing and treating your condition.

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