Struggling with Urination Issues: Seeking Solutions After Medication and Doctor Visits

I have been unable to urinate and have seen a doctor and taken medication, but my condition still fluctuates between better and worse?

I previously had an examination by a doctor at the Tri-Service General Hospital, who prescribed medication for me.
I take two tablets of Betaserc in the morning and at noon, and three tablets in the evening, along with one tablet each of Betamethasone and Cuxin.
After starting the medication, my condition improved somewhat, but I still experience intermittent urinary retention.
Specifically, around 2 or 3 AM when I want to sleep, I find it difficult to urinate, and I feel a lot of discomfort in my bladder.
The doctors advised me not to worry if I can't urinate and just go to sleep, but the pressure and pain from the retained urine are quite distressing.
I feel that the medication isn't very effective.

After consulting with a doctor at a major hospital, I was told that my sphincter is too tight, which seems to be causing a dysfunction, making it difficult to urinate when I need to.
The doctor prescribed medication for me, and I have changed medications twice since then.
I have been on the current medication for over a year, and while it was effective in the beginning, my condition has been fluctuating since then.
I also consulted Dr.
Zhong, but the results were slow to manifest.
Recently, I've noticed that my condition has worsened; previously, I could eventually urinate in the early morning hours, but now after urinating just a drop, it feels like the urine retracts, and I have to wait until around 5 or 6 AM to get up and urinate again.
I would like to ask how I should address this situation with my current urologist.
How can I describe my symptoms effectively? Is there a possibility for a cure? I've been on medication for over a year, but there hasn't been much improvement in terms of a definitive solution.

Ke Ye, 40~49 year old female. Ask Date: 2020/06/02

Dr. Wu Shuyu reply Urology

Good afternoon.
Below is the response regarding your question:
Hello, your question can be addressed in two parts:
1.
First, regarding the issue of being unable to urinate at night, the sensation of bladder fullness does not always indicate a large volume of urine.
One possibility is that there is indeed a significant amount of urine in the bladder; another possibility is that it is merely a sensation, where the actual urine volume is low, but the sensory nerves signal the brain that the bladder is full.
In this case, since the actual urine volume is not high, the bladder may not be in the optimal state for contraction, leading to difficulty in urination.
This situation is commonly seen in patients with hypersensitive bladder and overactive bladder syndrome.
It is essential to determine whether the issue lies in urination or bladder sensation before proceeding with different treatments.
2.
The second part concerns the tightness or dysfunction of the sphincter.
Without knowing your past medical history and examination results, my response may have some inaccuracies.
Based on your description, it resembles a condition known as external urethral sphincter dysfunction.
The following treatment options may be considered:
(1) Behavioral therapy: This includes increasing fluid intake to enhance urine volume, reducing bladder irritative symptoms; improving bowel movements to prevent constipation; scheduled voiding to alleviate bladder overdistension and reduce relative sphincter pressure; and modifying urination posture and environment to find a suitable way to relax.

(2) Physical therapy: Engaging in pelvic floor muscle exercises to enhance muscle activity and control for better relaxation.

(3) Electrical stimulation: Utilizing electrical or magnetic stimulation to improve muscle activity.

(4) Pharmacological treatment: Skeletal muscle relaxants or alpha-adrenergic antagonists (which you may have already used).

(5) Botulinum toxin injection into the external urethral sphincter: This can be considered if the above medications and conservative treatments are ineffective, by directly injecting botulinum toxin into the external urethral sphincter to reduce its activity.
The effects of the injection will diminish over time, and re-injection may be needed in six months to a year.
These are the options available for your consideration.
Of course, each patient's condition and expectations are different, and functional issues often fluctuate.
Diagnosis and management can be challenging, so the choice of detailed treatment options should be discussed thoroughly with your physician.
Thank you.

Reply Date: 2020/06/02

More Info

It sounds like you're experiencing significant distress related to your urinary issues, and I want to acknowledge how frustrating and uncomfortable this situation can be. Based on your description, it seems that you have been dealing with a complex set of symptoms that have not improved despite ongoing medication and consultations with various doctors.
From what you've shared, it appears that you have been prescribed medications such as Betamethasone (倍鬆), which is a corticosteroid, and possibly other medications aimed at managing your urinary symptoms. However, it seems that these medications have not provided the relief you were hoping for, particularly during the night when you experience difficulty urinating. This can be particularly distressing, as it not only affects your physical comfort but also your ability to sleep and overall quality of life.

The issue of urinary retention or difficulty urinating can stem from various causes, including overactive bladder, bladder outlet obstruction, or issues with the pelvic floor muscles. You mentioned that a doctor noted your sphincter muscle might be too tight, which could indeed contribute to your symptoms. This condition, known as detrusor-sphincter dyssynergia, occurs when the bladder and sphincter muscles do not work in harmony, leading to difficulties in urination.

Here are some steps you might consider taking to address your situation:
1. Open Communication with Your Urologist: It's crucial to have an open and honest conversation with your current urologist about your symptoms. Describe your experiences in detail, including when the symptoms occur, how they affect your daily life, and any changes you've noticed over time. Be specific about the times you struggle to urinate and the pain or discomfort you feel. This information can help your doctor understand the severity of your condition and adjust your treatment plan accordingly.

2. Consider a Comprehensive Evaluation: If you haven't already, ask your urologist about conducting a urodynamic study. This test can provide valuable insights into how well your bladder and urethra are functioning and can help identify any underlying issues that may not have been previously diagnosed.

3. Explore Physical Therapy: Pelvic floor physical therapy can be beneficial for individuals experiencing urinary retention or dysfunction. A specialized physical therapist can help you learn exercises to relax the pelvic floor muscles, which may alleviate some of the tightness and improve your ability to urinate.

4. Medication Review: Since you have been on medication for over a year without significant improvement, it may be worth discussing alternative medications or treatment options with your doctor. There are various classes of medications that can help manage urinary symptoms, and your doctor may suggest trying something different.

5. Lifestyle Modifications: Sometimes, lifestyle changes can also play a role in managing urinary symptoms. Staying well-hydrated, avoiding bladder irritants (such as caffeine and alcohol), and practicing timed voiding (urinating at regular intervals) may help improve your situation.

6. Seek a Second Opinion: If you feel that your current treatment plan is not effective, consider seeking a second opinion from another urologist. Different doctors may have different approaches and insights that could lead to better management of your symptoms.

7. Mental Health Support: Dealing with chronic health issues can take a toll on your mental well-being. If you're feeling overwhelmed, consider seeking support from a mental health professional who can help you cope with the emotional aspects of your condition.

In summary, it's essential to advocate for yourself and communicate openly with your healthcare providers. Your symptoms deserve thorough investigation and a tailored treatment approach. Don't hesitate to express your concerns and seek the care you need to improve your quality of life.

Similar Q&A

Understanding Psychological Factors Behind Urination Difficulties and Treatment Options

Previously, I raised a question about how I have been scared to use the restroom after a particular incident, and now I tend to go to a farther restroom to urinate. The doctor mentioned that I might be experiencing psychological stress, leading to difficulty in urination, and sug...

Dr. Lai Ronghao reply Urology
Hello: There are many types of medications for treating urinary system disorders, and their effects can be completely opposite. Self-medication may lead to side effects, so it is best to consult a urologist for assistance.

Struggling with Urination: When Medication Isn't Enough

I feel the urge to urinate when I go to the bathroom, but I have difficulty passing urine and often have to strain for a while before it comes out. I visited a doctor at the hospital, and they prescribed medication for me, but after taking it for two weeks, I still have to exert ...

Dr. Chen Zhihong reply Urology
How long have you been experiencing urinary issues? Given your age, the likelihood of bladder dysfunction is quite low (unless you have a history of spinal cord injury). If you tend to be anxious or have a hurried personality, the most probable cause is stress-induced bladder hyp...

Understanding Urination Issues: Tips for Managing Urinary Anxiety

Hello! I am 17 years old this year, but I have been troubled by a problem since middle school. Whenever I am in the restroom and there are other people around or if I feel any pressure (like someone waiting for me), I find it difficult to urinate. Only on very rare occasions can ...

Dr. Lin Wenxu reply Urology
Hello, based on your description, you may be suffering from what is known as "chronic pelvic floor muscle syndrome" or "chronic prostatitis." Improvement methods can include pelvic floor muscle exercises, oral medications, and reducing the intake of certain ir...

Struggling with Nighttime Urgency: Alternatives to Costly Medications

Hello, I have given birth to two children, and recently I've been experiencing the urge to urinate at night. However, when I sit on the toilet, I can't seem to urinate. I visited a doctor who prescribed me an expensive medication costing over a thousand NT dollars per d...

Dr. Dong Yuhong reply Obstetrics and Gynecology
Hello, Ami: Regarding the issue of having urine at night but being unable to urinate, I recommend seeking help from a urologist or a gynecologist with a specialization in female urology. It is important to identify the underlying cause of the symptoms for appropriate treatment. T...