Bladder Dysfunction: The Impact of Chronic Urinary Retention

Poor bladder elasticity, bladder weakness, reduced bladder capacity, long-term retention leading to damage?

Since elementary school, through middle school and college, I have been unable to urinate in public restrooms if there are others nearby.
I have had a pathological urge to hold my urine since childhood and would only urinate if I was certain no one was in the restroom, leading to severe urinary retention.
I only realized at the age of 28 that this chronic retention would ruin my life in the latter half.
Now, I can urinate in public, but I experience symptoms such as frequent urination, difficulty initiating urination, abdominal straining to urinate, urgency, and a significant feeling of incomplete bladder emptying.
On January 30, 2013, I had a uroflowmetry report showing the following results: 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.
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 from a transurethral biopsy of the urinary bladder neck.
The specimen consisted 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.
The doctor mentioned that my uroflowmetry and urodynamics tests showed abdominal straining during urination, poor bladder elasticity, bladder weakness, and reduced bladder capacity, all resulting from prolonged urinary retention.
I am currently on several medications:
Psychiatry:
- Leeyo (Escitalopram) 10 mg, 2 tablets at bedtime
- Mirtazapine 50 mg
- Zolpidem 10 mg, 2 tablets at bedtime
- Flunitrazepam 2 mg, 1 tablet at bedtime
Dermatology:
- Lyrica (Pregabalin) 75 mg, 2 tablets at bedtime
- Doxepin 25 mg, 2 tablets at bedtime
Otolaryngology:
- Loratadine 10 mg
- Xyzal (Levocetirizine) 5 mg (choose one of these two)
Metabolism:
- Metformin HCL 850 mg
Urology:
- Tamsulosin 0.2 mg, 2 tablets
- Baclofen 5 mg, one tablet in the morning and evening
- Bethanechol chloride 25 mg, three times a day
My questions are: 1.
Which of the medications I am taking may affect the smoothness of urination if taken long-term? 2.
Which medications should I consider tapering off? Thank you, doctor, for your patience in answering my questions.

Niming, 30~39 year old female. Ask Date: 2020/08/20

Dr. Cai Zhuorong reply Urology

The medications you mentioned from psychiatry, dermatology, and otolaryngology may all potentially affect urination.
However, based on your description, the impact of these medications may not be the primary cause.
It is recommended that you visit a urology department at a medical center for a video urodynamics study and consider further treatment.

Reply Date: 2020/08/20

More Info

Chronic urinary retention can have significant impacts on bladder function and overall urinary health. Your experience of pathological urinary retention, stemming from anxiety about using public restrooms, has likely contributed to the bladder dysfunction you are currently facing. This condition can lead to a variety of symptoms, including frequent urination, difficulty initiating urination, a sense of urgency, and the feeling of incomplete bladder emptying (residual urine).
The bladder is a muscular organ that stores urine until it is convenient to void. When you consistently hold urine for extended periods, it can lead to changes in the bladder wall and muscle function. Over time, the bladder may become less elastic and less capable of contracting effectively, resulting in decreased bladder capacity and increased residual urine. Your uroflowmetry results indicate a significantly low peak flow rate and prolonged voiding time, which are consistent with bladder dysfunction.

The diagnosis of cystitis glandularis from your transurethral biopsy suggests that chronic irritation or inflammation of the bladder lining may be present, likely exacerbated by your history of urinary retention. This condition can lead to further complications, including urinary tract infections (UTIs) and potential kidney issues if left untreated.

Regarding the medications you are currently taking, it is essential to understand how they may affect your urinary function:
1. Tamsulosin: This medication is an alpha-blocker commonly prescribed for benign prostatic hyperplasia (BPH) and can help improve urine flow by relaxing the muscles in the bladder neck and prostate. It is generally beneficial for urinary symptoms.

2. Baclofen: As a muscle relaxant, Baclofen can help with bladder spasms, but it may also contribute to urinary retention in some individuals. Long-term use should be monitored by your physician, especially if you notice worsening urinary symptoms.

3. Bethanechol Chloride: This medication stimulates bladder contractions and can be helpful for individuals with urinary retention. However, it should be used cautiously and under medical supervision.

4. Escitalopram and other psychiatric medications: Some antidepressants and anxiolytics can have anticholinergic effects, which may lead to urinary retention or difficulty urinating. It is crucial to discuss any changes in urinary symptoms with your prescribing physician.

5. Pregabalin and Doxepin: These medications can also have sedative effects and may influence bladder function. Monitoring for any changes in urinary patterns is advisable.

Given your situation, it may be beneficial to gradually review and potentially adjust your medication regimen with your healthcare provider. They can help identify which medications might be contributing to your urinary difficulties and suggest alternatives if necessary.

In terms of self-management, consider implementing strategies to improve bladder health. This includes:
- Scheduled voiding: Try to establish a regular schedule for urination, even if you do not feel an immediate urge. This can help retrain your bladder.

- Pelvic floor exercises: Strengthening the pelvic floor muscles can improve bladder control and reduce symptoms of urgency and frequency.

- Hydration: Ensure adequate fluid intake to help flush the urinary system and prevent infections.

Lastly, it is essential to maintain open communication with your healthcare team. Regular follow-ups with your urologist can help monitor your bladder function and adjust treatment as needed. If you continue to experience significant urinary issues, further interventions, such as intermittent catheterization or other bladder management strategies, may be necessary.

In summary, chronic urinary retention can lead to significant bladder dysfunction, and your current medication regimen may influence your urinary symptoms. Working closely with your healthcare provider to review your medications and implement bladder health strategies can help improve your quality of life and urinary function.

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