Is My Doctor's Diagnosis Correct? Frequent Urination Issues

Is there a possibility of error in the doctor's diagnosis?

Hello Dr.
Du, I have been experiencing frequent urination issues since I caught a cold at the beginning of this year.
The condition fluctuates, and even when I don't drink more than 1000cc of water daily, I still have this problem.
About 3 to 4 days a week, I experience frequent urination, needing to go to the bathroom approximately every 1 to 2 hours, with urine volumes ranging from 100 to 230 ml.
Additionally, if I drink a little more water or beverages, I usually feel the urge to urinate twice within an hour.
My urine is relatively light in color, and I do not experience pain or burning during urination.

In mid-January, I had a check-up at the hospital, and the urine test showed no issues.
However, the urodynamics test indicated a slow flow rate and poor sphincter contraction, so I was prescribed Bethanechol Chloride for a month.
After taking the medication for half a month, there was no improvement in my frequent urination.
During a health check in early February, my urine test revealed a white blood cell count of 20-29, indicating bacteriuria (with no other abnormalities), so I stopped the medication.

Later, due to a busy work schedule, I did not return to the hospital for further checks.
However, I noticed some symptom relief when I increased my water intake.
In April, my frequent urination symptoms suddenly worsened, and I visited a different clinic.
The urine test again showed mild inflammation (white blood cell count of 6-8), but the doctor did not prescribe medication for the inflammation; instead, I was given Ditropan 2.5 mg for one week.
Is this medication for overactive bladder? After taking it, the frequency of urination decreased, but I feel it hasn't completely resolved the issue.

By August, the frequent urination returned, and my white blood cell count increased to 20-25.
The doctor did not specify whether I had cystitis or urethritis (I did not experience any pain when my lower back was tapped) and prescribed a five-day course of Finasteride capsules.
During the medication period, I continued to experience frequent urination and often felt the urge to go.
At my follow-up appointment, although my white blood cell count decreased to 6-8, there was still inflammation.
I was then switched to Bactrim for seven days, but I still felt the same frequent urination issue.

I want to drink more water to flush out the bacteria, but the more I drink, the more frequent the urination becomes, which is really distressing.
Have you encountered patients who keep switching antibiotics but cannot resolve their urinary tract infections? The persistent frequent urination is truly painful, and I am eager to find a treatment method.
Should I ask the doctor for a urine culture at my next follow-up? Thank you.

Xiao Han, 20~29 year old female. Ask Date: 2018/08/29

Dr. Du Mingyi reply Urology

It is indeed possible that chronic inflammation may make treatment more challenging.
A urine culture can be performed for reference.

Reply Date: 2018/08/29

More Info

It sounds like you have been experiencing a challenging and frustrating journey with your urinary symptoms, particularly frequent urination. Based on your description, it appears that you have undergone various evaluations and treatments, yet your symptoms persist. Let's break down your situation and explore some potential avenues for further investigation and management.

Firstly, frequent urination can be caused by a variety of factors, including urinary tract infections (UTIs), bladder overactivity, and even issues related to the prostate in men. Given that your symptoms began after a respiratory illness, it is possible that your urinary symptoms may have been triggered or exacerbated by that event. The fact that your urination frequency varies and is influenced by fluid intake is also noteworthy.

Your previous evaluations, including urinalysis and urodynamic studies, indicated some abnormalities, such as a slow flow rate and poor sphincter contraction. The medication Bethanechol Chloride you were prescribed is typically used to stimulate bladder contractions, which can be helpful in cases of urinary retention or underactive bladder. However, since you did not notice significant improvement, it suggests that your condition may not solely be related to bladder underactivity.

The presence of white blood cells in your urine suggests inflammation or infection, which aligns with your experiences of frequent urination and discomfort. The fact that you have been prescribed antibiotics multiple times without complete resolution of your symptoms raises the possibility of a recurrent or chronic urinary tract infection. It is also important to consider the potential for antibiotic resistance, especially if you have been treated with various antibiotics over a short period.

Regarding your question about whether you should request a urine culture during your next visit, the answer is yes. A urine culture can help identify the specific bacteria causing your infection and determine which antibiotics would be most effective for treatment. This is particularly important if you have been experiencing recurrent symptoms and have not responded well to previous antibiotic treatments.

Additionally, it may be beneficial to explore other potential causes of your symptoms. Conditions such as interstitial cystitis (IC), bladder overactivity, or even pelvic floor dysfunction could contribute to your frequent urination. A referral to a urologist specializing in these conditions may provide you with more targeted evaluations and treatment options.

In summary, your ongoing symptoms warrant further investigation. A urine culture is a crucial next step to identify any underlying infections. Additionally, consider discussing the possibility of other conditions, such as interstitial cystitis or bladder overactivity, with your healthcare provider. It may also be helpful to keep a bladder diary, noting your fluid intake, urination frequency, and any associated symptoms, as this information can assist your doctor in making a more accurate diagnosis.

Remember, you are not alone in this experience, and many patients face similar challenges with urinary symptoms. With the right approach and thorough investigation, you can work towards finding a solution that improves your quality of life.

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