Urinary Difficulties: Causes, Treatments, and Concerns

Q: Urinary Difficulties: Causes, Treatments, and Concerns

Hello： Urinalysis shows no inflammation, so there is no need to prescribe anti-inflammatory medication (normal results can rule out stones and infection). <br>I will not perform a digital rectal exam at this time since it may be uncomfortable; we will wait until the situation imp

Dysuria

Hello Doctor: Recently, I've encountered an issue where there are white spots on the glans and the inner side of the foreskin (similar to a candidiasis infection, but it doesn't hurt and is only mildly itchy most of the time).
This has been present for about a week, but it seems to be improving on its own.
However, for some reason, in the last two days, I've been having difficulty urinating; I have to force it out little by little, and it feels urgent, but when I do urinate, it's only a small amount.
Yesterday, I visited a urologist who examined my genital area and mentioned that the white spots are likely stress-related and will resolve on their own, so no medication was needed for that.
They only prescribed me a medication called Alfuzosin (to improve benign prostatic hyperplasia) and conducted a urinalysis, which showed no signs of inflammation, although they mentioned that there was elevated protein in my urine and recommended seeing a nephrologist.
The last two days, I've experienced a burning sensation with urgency, but today, the main issue is still difficulty urinating (I've only taken one pill so far, as it’s prescribed once a day).
With all this said, I mainly want to ask if one pill of Alfuzosin is sufficient? Is there no need for additional anti-inflammatory medication or anything else? Also, there was no digital rectal exam to check for prostate enlargement or imaging to look for stones.
I feel like the experience at the large hospital was less professional than at a small clinic.
How long might it take for the difficulty in urination to improve? I often feel like I can't urinate, but I can still have bowel movements.

Lin Sen, 40~49 year old female. Ask Date: 2019/03/28

Dr. Du Shixi reply Urology

Hello: Urinalysis shows no inflammation, so there is no need to prescribe anti-inflammatory medication (normal results can rule out stones and infection).
I will not perform a digital rectal exam at this time since it may be uncomfortable; we will wait until the situation improves.
In large hospitals, standard procedures are followed, and if there are urinary issues, it may take several days to see improvement.
Please return for follow-up after finishing the medication.
Additionally, ensure that your fluid intake and diet are normal, avoiding excessive spicy foods and diuretics.
If you are taking any other medications or supplements, please inform your physician.
Wishing you good health.

Reply Date: 2019/03/28

More Info

Urinary difficulties can be a frustrating and concerning issue, often leading to discomfort and anxiety. Based on your description, it seems you are experiencing a combination of symptoms, including white spots on the glans and inner foreskin, urgency, and difficulty urinating. Let's break down the potential causes, treatments, and concerns regarding your situation.

Possible Causes
1. Balanitis or Other Dermatological Issues: The white spots you mentioned could be a form of balanitis, which is inflammation of the glans. This condition can arise from various factors, including irritation, infections, or even stress. While it may not be painful or itchy, it can still lead to discomfort and changes in urination.

2. Prostate Issues: Given that you are experiencing urinary urgency and difficulty, benign prostatic hyperplasia (BPH) could be a contributing factor. BPH is common in older men and can lead to urinary retention and difficulty starting urination. The medication you were prescribed, likely an alpha-blocker, is intended to help relax the muscles in the prostate and bladder neck, making it easier to urinate.

3. Urinary Tract Infection (UTI): Although your urine tests showed no signs of infection, it’s worth noting that some infections can be subtle or not easily detected. Symptoms like urgency and burning can sometimes indicate a UTI, even if the tests are normal.

4. Nerve Issues: Conditions affecting the nerves that control bladder function can also lead to urinary difficulties. Stress and anxiety can exacerbate these issues, leading to a cycle of discomfort.

5. Obstruction: While less likely given your recent tests, urinary obstruction due to stones or other anatomical issues can cause similar symptoms.

Treatment Options
1. Medications: The medication you received (likely an alpha-blocker) is a common treatment for BPH and can help alleviate urinary difficulties. It may take some time for the medication to take full effect, so patience is essential. If you feel that the medication is insufficient, it’s crucial to communicate this with your healthcare provider.

2. Lifestyle Modifications: Staying hydrated, avoiding irritants like caffeine and alcohol, and practicing relaxation techniques can help manage symptoms. Regular physical activity can also improve overall health and potentially alleviate some urinary symptoms.

3. Follow-Up Care: Since you mentioned elevated protein levels in your urine, it’s advisable to follow up with a nephrologist. High protein levels can indicate kidney issues that may need further investigation.

4. Further Evaluation: If your symptoms persist or worsen, further evaluation may be necessary. This could include imaging studies to check for stones or an examination of the prostate to rule out enlargement or other issues.

Concerns and Recommendations
It’s understandable to feel frustrated with the healthcare process, especially if you feel your concerns were not fully addressed during your visit. If you are still experiencing significant urinary difficulties, consider seeking a second opinion or asking for a referral to a urologist who specializes in urinary disorders.
In the meantime, keep track of your symptoms, including any changes in urination patterns, pain levels, and any new symptoms that arise. This information can be invaluable for your healthcare provider in determining the best course of action.

In conclusion, while the medication you received may be appropriate, it’s essential to maintain open communication with your healthcare provider about your ongoing symptoms. Urinary difficulties can take time to resolve, but with the right approach and follow-up care, you can work towards finding relief.

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