Urinary Issues: Frequent Urination and Urgency Explained

Q: Urinary Issues: Frequent Urination and Urgency Explained

Hello： Regarding psychiatric medications, please consult a psychiatrist. <br>They do not affect the fields of metabolism or urology, and long-term follow-up is necessary. <br>Wishing you good health.

Post-void dribbling, frequent urination, and urinary retention are very severe?

Since elementary school through high school and into college, I have been afraid to urinate in public.
I have had a pathological urge to hold my urine since childhood, only feeling comfortable to urinate when I am sure no one is in the restroom.
As a result, I have experienced severe urinary retention.
I only realized at the age of 28 that this chronic retention from childhood through college could ruin my life in the latter half.
Now, I am able to use public restrooms, but I suffer from symptoms such as frequent urination, difficulty urinating which requires abdominal pressure, urgency, and a very severe sensation of incomplete bladder emptying.

On January 30, 2013, I had a uroflowmetry report showing the following results: peak flow rate 6 ml/s, time to peak flow 110 seconds, voided volume 186 ml, flow time 112 seconds, voiding time 222 seconds, average flow rate 2 ml/s, and residual urine 40 ml.
My most recent urine report from the hospital indicated a residual volume of 50 cc on December 1, 2011.
A bladder biopsy report diagnosed cystitis glandularis in the urinary bladder neck, with the specimen consisting of two pieces of mucosal tissue measuring up to 0.3 cm in greatest dimension.
The physician indicated that the biopsy findings were due to long-term pathological urinary retention.
In terms of my psychiatric treatment, I take Leeyo (Escitalopram) 10 mg twice daily, Zolpidem 10 mg twice daily, and Flunitrazepam 2 mg once daily.
For dermatological issues, I take Lyrica (Pregabalin) 75 mg twice daily, Doxepin 25 mg twice daily, and Xyzal 5 mg for severe itching that disrupts my sleep.
For metabolic issues, I take Metformin HCL 850 mg.
In urology, I take Tamsulosin 0.2 mg twice daily and Baclofen 5 mg once in the morning and once at night.
My question is: which of the medications I am taking may affect my ability to urinate smoothly, considering I have been on them for a long time? Thank you, doctor, for your patient response.

Niming, 30~39 year old female. Ask Date: 2020/08/19

Dr. Du Shixi reply Urology

Hello: Regarding psychiatric medications, please consult a psychiatrist.
They do not affect the fields of metabolism or urology, and long-term follow-up is necessary.
Wishing you good health.

Reply Date: 2020/08/19

More Info

Frequent urination and urgency can be distressing symptoms that significantly impact daily life and mental well-being. Your history of pathological holding of urine, which you described as a fear of using public restrooms, has likely contributed to the development of these urinary issues. This behavior can lead to a range of complications, including bladder dysfunction, urinary tract infections, and even psychological distress.

From your description, it appears that you have been diagnosed with several conditions related to your urinary symptoms, including cystitis glandularis, which is a type of bladder inflammation. The findings from your uroflowmetry tests indicate a low peak flow rate and a significant amount of residual urine, which suggests that your bladder may not be emptying completely. This can lead to feelings of urgency and frequent urination, as the bladder fills up more quickly due to incomplete voiding.

The medications you are currently taking may have varying effects on your urinary symptoms. Here’s a brief overview of how some of these medications might influence your urinary function:
1. Tamsulosin: This medication is an alpha-blocker commonly used to treat benign prostatic hyperplasia (BPH) and can help relax the muscles in the bladder neck and prostate, potentially improving urine flow and reducing symptoms of urgency.

2. Baclofen: This muscle relaxant may help with bladder spasms, but it can also cause urinary retention in some individuals, which could exacerbate feelings of incomplete voiding.

3. Escitalopram: As an SSRI, it is primarily used for depression and anxiety. While it can help with anxiety that may be contributing to your urinary issues, SSRIs can sometimes lead to urinary retention as a side effect.

4. Pregabalin: This medication is used for nerve pain and anxiety. It can also cause urinary retention in some patients, which might worsen your symptoms.

5. Doxepin: This tricyclic antidepressant can have anticholinergic effects, which may lead to urinary retention and difficulty in urination.

6. Zolpidem and Flunitrazepam: These medications are sedatives and may not directly affect urinary function, but they can influence overall muscle relaxation and bladder control.

Given your complex medical history and the interplay of various medications, it is crucial to have a thorough discussion with your healthcare provider. They can help assess whether any of your current medications may be contributing to your urinary symptoms and consider adjustments if necessary.

In addition to medication management, behavioral strategies can also be beneficial. Gradual desensitization to using public restrooms, bladder training exercises, and pelvic floor muscle training (like Kegel exercises) may help improve your bladder control and reduce urgency. Cognitive-behavioral therapy (CBT) may also be beneficial in addressing the anxiety associated with using public restrooms.

Lastly, it’s essential to monitor your symptoms closely and maintain open communication with your healthcare team. If you experience worsening symptoms or new concerns, don’t hesitate to seek further evaluation. Your mental health is just as important as your physical health, and addressing both aspects will be key to improving your quality of life.

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