Frequent Urination and Difficulty Urinating Without Inflammation: Causes and Solutions

Frequent urination and difficulty urinating without inflammation?

On January 27th of this year, I woke up on the morning of the third day of the Lunar New Year and felt too cold, so I held my urine while using my phone in bed.
Since then, I have experienced the following symptoms:
1.
Frequent urination and nocturia.
During the day, I have frequent urination, feeling that my bladder capacity has significantly decreased.
When I have a strong urge to urinate, it is about 150 ml or less; if I hold it until I feel slightly uncomfortable, it is about 250 ml or less.
However, before this issue, I could easily fill a plastic bottle with over 250 to 300 ml.
For nocturia, I do not drink any water for two hours before bedtime and go to the bathroom again before sleeping, but I still wake up at night due to bladder discomfort.
When I go to the bathroom, I also experience delayed urination, weak urine flow, and a total urine volume that may be less than 100 ml.
2.
Difficulty urinating and reduced urine flow (I feel like I can't exert enough force, but before this issue, I could produce a strong and large stream with effort).
On February 5th, I visited a nearby urology clinic for a urinalysis, which showed no issues, no bacteria, and no signs of inflammation.
The doctor prescribed anti-inflammatory medication and antibiotics, but there was no improvement.
On February 15th, I returned for a follow-up and underwent a digital rectal exam (the doctor pressed several times, which caused a sensation of needing to urinate, but there was no pain or warmth).
The doctor suggested it might be prostatitis.

On February 17th, during a follow-up visit, the urinalysis showed 1+ bacteria (I am unsure if this was due to the digital rectal exam pressing on the prostate, but I had been continuously taking the antibiotics prescribed by the doctor, so could this be a contamination of the urinalysis?).
However, there were still no signs of inflammation (no white blood cells).
I researched prostatitis and found that it can cause perineal pain and scrotal pain, but I do not have those symptoms; I only have frequent urination, difficulty urinating, and occasional bladder discomfort.
My erections and ejaculation are normal.

As of today, there has been no improvement in my frequent urination, nocturia, and difficulty urinating.
I visited a medical center where they expedited a urinalysis, which came back completely normal, and the doctor criticized me for going to a clinic and taking antibiotics first, stating that this would prevent accurate testing.
I asked if I needed to have my prostate examined, but he said I was too young for that.
However, I clearly have significant symptoms, with the onset date being January 27th.

I have three questions:
1.
What condition might I be experiencing?
2.
What further tests should I undergo to clarify my condition?
3.
How should I communicate with the doctor to facilitate the arrangement of relevant tests?
Thank you very much!

Te si la, 20~29 year old female. Ask Date: 2020/02/19

Dr. Li Xinyi reply Urology

Holding in urine while using a smartphone is a fundamental source of problems.
I hope this experience makes you aware that improper use of your body can come at a significant cost.
Issues related to the prostate or pelvis can sometimes follow us for a lifetime and are often difficult to diagnose and treat.
This can lead to varying opinions and treatment approaches among different doctors.
It is not accurate to say that one physician is right and another is wrong, which can indeed be confusing.
My advice is to have a blood test to check your PSA and CRP levels to assess whether there is significant inflammation in the prostate, and then decide on the treatment direction accordingly.

Reply Date: 2020/02/19

More Info

Frequent urination and difficulty urinating can be distressing symptoms that significantly impact your quality of life. Based on your description, it seems you have been experiencing these symptoms since January 27, following a period of holding your urine while using your phone. Here’s a comprehensive analysis of your situation, potential causes, and suggested next steps.

Possible Causes
1. Bladder Dysfunction: Your symptoms suggest a possible bladder dysfunction, which could be due to several factors, including overactive bladder syndrome. This condition is characterized by a sudden urge to urinate frequently, often with little urine produced each time. The fact that you feel a significant urge at lower volumes (150 ml) indicates that your bladder's capacity may have changed.

2. Prostatitis: Although you mentioned that you are young, prostatitis (inflammation of the prostate gland) can occur in younger men and can lead to symptoms such as frequent urination, difficulty urinating, and pelvic discomfort. The absence of pain during the digital rectal exam is a positive sign, but it does not completely rule out prostatitis.

3. Urinary Tract Infection (UTI): While your urine tests have shown no signs of infection, it is worth noting that some infections can be subtle and may not always present with typical symptoms. The presence of bacteria in your urine after a prostate exam could indicate contamination rather than an active infection.

4. Nerve Issues: Sometimes, nerve-related issues can affect bladder control. If there was any trauma or nerve compression, it could lead to symptoms like difficulty urinating and changes in bladder sensation.

5. Psychological Factors: Anxiety or stress can also manifest as urinary symptoms. If you have been particularly anxious about your health or other life events, this could contribute to your symptoms.

Suggested Next Steps
1. Further Testing: Since initial tests have not provided clear answers, consider asking for additional evaluations:
- Urodynamic Testing: This test assesses how well your bladder and urethra are storing and releasing urine. It can help identify issues with bladder function.

- Transrectal Ultrasound: This can help visualize the prostate and rule out any abnormalities.

- Cystoscopy: If bladder dysfunction is suspected, a cystoscopy can allow direct visualization of the bladder lining.

2. Communicate with Your Doctor: When discussing your symptoms with your healthcare provider, be clear and specific about:
- The onset and duration of your symptoms.

- Any changes in your urinary habits (e.g., frequency, urgency, volume).

- Any associated symptoms (e.g., pain, discomfort, changes in sexual function).

- Your concerns about prostatitis or other underlying conditions.

3. Lifestyle Modifications: While awaiting further evaluation, consider making some lifestyle changes:
- Fluid Management: Monitor your fluid intake and try to avoid excessive consumption of caffeine and alcohol, which can irritate the bladder.

- Bladder Training: Gradually increase the time between urinations to help retrain your bladder.

- Pelvic Floor Exercises: Strengthening your pelvic floor muscles can help improve urinary control.

4. Follow-Up: Ensure you have regular follow-ups with your healthcare provider to monitor your symptoms and adjust your treatment plan as necessary.

Conclusion
Your symptoms of frequent urination and difficulty urinating warrant further investigation to determine the underlying cause. While prostatitis and bladder dysfunction are potential culprits, additional tests and a thorough evaluation are essential for accurate diagnosis and effective treatment. Communicate openly with your healthcare provider about your concerns and symptoms, and advocate for the necessary tests to clarify your condition. Remember, you are not alone in this, and with the right approach, relief is possible.

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