Persistent Urgency After Urethritis: When to Seek Further Evaluation

Persistent frequency of urination after urethritis?

Hello doctor, last week I experienced some frequency in urination and immediately went to see a doctor for a urinalysis, which showed no signs of inflammation, so the doctor did not prescribe any medication.
A few days later, I went back for another urinalysis, which showed mild inflammation.
After taking antibiotics for a few days, my follow-up urinalysis showed no signs of inflammation, but I still have persistent urinary frequency, which has been worsening.
Over the past two nights, I have also experienced nocturia.
I went back to the doctor, who prescribed medication for overactive bladder, but it has not improved my urinary frequency, and the nocturia has become more severe, averaging once an hour.
This has never happened before; I feel the urge to urinate within about half an hour.
Should I go to a larger hospital for further evaluation? If so, what tests should I undergo? The frequent urination is causing me to have poor sleep at night.

A Cheng, 20~29 year old female. Ask Date: 2019/02/01

Dr. Du Mingyi reply Urology

You can go to a major hospital to have a urine test, X-ray, and ultrasound to check for any other issues.

Reply Date: 2019/02/01

More Info

Persistent urinary urgency, especially following a history of urethritis, can be quite distressing and warrants further evaluation. Given your symptoms of increased frequency of urination, particularly at night (nocturia), and the lack of improvement with initial treatments, it is advisable to seek a more comprehensive assessment at a larger medical facility.

Understanding Your Symptoms
1. Urethritis and Its Aftermath: Urethritis, an inflammation of the urethra, can lead to various urinary symptoms, including urgency and frequency. While your initial tests showed no significant infection, the subsequent mild inflammation suggests that there may still be underlying issues affecting your urinary tract.

2. Persistent Urgency and Frequency: The fact that your urgency and frequency have worsened, especially at night, is concerning. Normal urinary frequency varies, but needing to urinate every hour, particularly at night, can significantly impact your quality of life and sleep.

3. Bladder Overactivity: The medication prescribed for overactive bladder (OAB) typically aims to reduce urgency and frequency. However, if you are not experiencing any relief, it may indicate that the underlying cause is not purely overactive bladder.

When to Seek Further Evaluation
Given the persistence and worsening of your symptoms, it is prudent to seek further evaluation. Here are some steps you might consider:
1. Visit a Urologist: A specialist in urology can provide a more detailed assessment of your urinary symptoms. They can perform a thorough history and physical examination, focusing on your urinary habits and any associated symptoms.

2. Diagnostic Tests: The following tests may be recommended:
- Urinalysis and Urine Culture: To rule out any lingering infections.

- Ultrasound of the Kidneys and Bladder: To check for structural abnormalities, stones, or any other issues.

- Cystoscopy: A procedure that allows the doctor to look inside the bladder and urethra using a thin tube with a camera. This can help identify any abnormalities such as inflammation, strictures, or tumors.

- Urodynamic Studies: These tests measure how well the bladder and urethra are storing and releasing urine. They can help determine if there is a problem with bladder function.

3. Consider Other Conditions: Conditions such as interstitial cystitis (IC), bladder infections, or even neurological issues can cause similar symptoms. A thorough evaluation can help rule these out.

Managing Your Symptoms
In the meantime, here are some strategies that may help manage your symptoms:
- Fluid Management: Monitor your fluid intake, especially in the evening, to see if it helps reduce nocturia.

- Bladder Training: Gradually increasing the time between urinations can help train your bladder.

- Avoid Irritants: Caffeine, alcohol, and spicy foods can irritate the bladder and worsen symptoms.

Conclusion
Persistent urinary urgency and frequency after urethritis can indicate a more complex issue that requires further investigation. Seeking evaluation from a urologist and undergoing appropriate diagnostic tests will help identify the underlying cause and guide effective treatment. Your quality of life is important, and addressing these symptoms is crucial for your overall well-being.

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