Overcoming Urination Difficulties: Residual Urine and Treatment Options

Q: Overcoming Urination Difficulties: Residual Urine and Treatment Options

Hello： Your issue may be chronic, and the examination was done 7 years ago. <br>It is recommended to consult a urologist at a major hospital, specifically one who specializes in urinary function. <br>The use of baclofen has its effects and is also used for urinary issues; however

Dysuria with a post-void residual of 50 cc?

Since elementary school, middle school, and college, I have been unable to urinate in public when others are nearby.
I have held my urine for long periods, only allowing myself to urinate when the restroom is empty.
This has led to severe urinary retention, and I now realize that I have compromised my quality of life for the latter half of my life.
At 28 years old, I learned that the severe urinary retention I experienced throughout my education could ruin my future.
Now, I can use the restroom in public, but I experience symptoms such as frequent urination, difficulty initiating urination requiring abdominal pressure, and urgency.
Sometimes, if I wait too long to urinate, it becomes difficult to void completely, and I need to rest for a while before I can empty my bladder.
My frequent urination has been severe.

On January 30, 2013, my uroflowmetry results showed a peak flow rate of 6 ml/s, time to peak flow of 110 seconds, voided volume of 186 ml, flow time of 112 seconds, voiding time of 222 seconds, average flow rate of 2 ml/s, and residual urine of 40 ml.
These results were from seven years ago.
Currently, my residual urine is 50 cc.
The doctor mentioned that my urinary flow rate test and urodynamics indicate that I am using abdominal pressure to urinate due to 27 years of pathological urinary retention, which has severely affected my bladder's elasticity and strength.
My bladder's contraction ability has decreased, and its capacity has diminished due to prolonged retention.
The doctor prescribed urology medications: tamsulosin 0.2 mg to be taken once in the morning and once at night, and baclofen 5 mg to be taken once in the morning and once at night.
What are the long-term side effects of taking these medications? Specifically, will long-term use of baclofen 5 mg lead to irreversible effects that further weaken bladder contractions, or is that not the case? Thank you, doctor.

lpoqo, 30~39 year old female. Ask Date: 2020/07/20

Dr. Du Shixi reply Urology

Hello: Your issue may be chronic, and the examination was done 7 years ago.
It is recommended to consult a urologist at a major hospital, specifically one who specializes in urinary function.
The use of baclofen has its effects and is also used for urinary issues; however, for any potential impacts, it is advisable to consult the prescribing physician.
Wishing you good health.
It is recommended not to delay.
Please seek medical attention as soon as possible, as examinations and tests require time.

Reply Date: 2020/07/20

More Info

Overcoming urination difficulties, particularly in the context of residual urine and treatment options, is a complex issue that requires a comprehensive understanding of the underlying causes and appropriate management strategies. Your history of holding urine for extended periods, especially in social situations, has likely contributed to significant bladder dysfunction, as evidenced by your current symptoms of frequent urination, urgency, and difficulty initiating urination.

Understanding Residual Urine and Bladder Dysfunction
Residual urine refers to the amount of urine left in the bladder after urination. In your case, the residual urine of 50cc indicates that your bladder is not emptying completely. This can be attributed to several factors, including decreased bladder elasticity, reduced contractility, and possibly detrusor muscle dysfunction, which is the muscle responsible for bladder contraction. Long-term retention of urine can lead to bladder overdistension, further exacerbating these issues.

The symptoms you describe—frequent urination, urgency, and the need to apply abdominal pressure to urinate—are consistent with bladder dysfunction. The fact that you have been holding urine for many years has likely resulted in a decreased ability of the bladder to stretch and contract effectively, leading to the symptoms you are experiencing now.

Treatment Options
Your physician has prescribed Tamsulosin and Baclofen. Let's discuss these medications:
1. Tamsulosin (0.2mg): This medication is an alpha-1 adrenergic blocker that helps relax the muscles in the prostate and bladder neck, making it easier to urinate. It is commonly used in men with benign prostatic hyperplasia (BPH) and can help alleviate some of the urinary symptoms you are experiencing. Side effects may include dizziness, headache, and retrograde ejaculation, but it is generally well-tolerated.

2. Baclofen (5mg): Baclofen is a muscle relaxant that can help reduce bladder spasms. While it may provide some relief, long-term use can lead to side effects such as sedation, dizziness, and potential dependency. There is a concern regarding the long-term effects of Baclofen on bladder function. While it is unlikely to cause irreversible damage to bladder contractility, it is essential to monitor its effects closely. If you notice increased difficulty in urination or other concerning symptoms, you should discuss this with your physician.

Long-term Management and Prognosis
Given your history of chronic urinary retention and bladder dysfunction, it is crucial to adopt a multifaceted approach to management. This may include:
- Regular Follow-ups: Regular visits to your urologist to monitor bladder function and adjust medications as necessary.

- Bladder Training: Techniques to gradually increase the time between urinations can help retrain your bladder.

- Pelvic Floor Exercises: Strengthening the pelvic floor muscles can improve bladder control and reduce urgency.

- Lifestyle Modifications: Staying hydrated, avoiding bladder irritants (like caffeine and alcohol), and practicing relaxation techniques can also be beneficial.

Conclusion
In summary, your history of holding urine has likely led to significant bladder dysfunction, which is reflected in your current symptoms and residual urine levels. The medications prescribed can help manage your symptoms, but it is essential to monitor their effects closely. Long-term management will require a combination of medication, lifestyle changes, and possibly bladder training techniques. Always consult your healthcare provider before making any changes to your treatment plan, and ensure that you have regular follow-ups to assess your bladder function and overall urinary health.

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