Urinary Disorders: Causes, Symptoms, and Treatment Options

Q: Urinary Disorders: Causes, Symptoms, and Treatment Options

Hello： If you are experiencing issues with urination despite normal hydration and lifestyle, the doctor will likely recommend further examinations. <br>At only 39 years old, it is probably not a serious issue and may be related to habits. <br>Ensure you are drinking enough water,

Urinary obstruction

Hello, doctor.
At the beginning of last year, I started experiencing frequent urination and intermittent urination, along with a decrease in urine flow.
I visited a doctor at that time, but I felt like there wasn't much improvement.
The frequent urination didn't occur every day; it happened occasionally, and I felt it wasn't causing any significant issues, so I left it alone.
In March of this year, due to back pain along with the frequent urination and slow urine flow, I wondered if I had kidney stones, so I went to a nearby urology clinic for a urinalysis.
The results showed no hematuria, and they suggested that my issues might be due to poor sitting posture.
They prescribed medication for me, and after a week, my back pain improved, but the slow urination issue remained unresolved, although it didn't cause much inconvenience in my daily life.
By the end of September, I thought it wasn't a good idea to keep postponing, so I went to the hospital to see a doctor.
They measured my urine flow rate and performed an ultrasound.
They mentioned that my bladder wall was slightly thickened and that the urethra connecting to the bladder was too narrow.
I asked if this could be due to a viral infection, but the doctor said it was not; it was caused by psychological factors.
They prescribed Oxbutynin ER 5mg and Urokinase 8mg for three months and advised me to do Kegel exercises.
However, after a month of medication and exercises, I still experience intermittent urination and slow urine flow, and there have been a few days with frequent urination.
Additionally, in the past few weeks, I've occasionally felt a slight sensation in my bladder—it's hard to describe, almost like mild pain, but not continuous, and it goes away after a while.
Is this inflammation? I read online that inflammation can cause hematuria, but I don't have blood in my urine, and urination isn't painful.
Could this be a tumor? I also came across information stating that having a habit of urinating at the slightest urge can lead to reduced bladder capacity and even cause interstitial cystitis, resulting in uncontrollable frequent urination.
Is this true? I recently developed a bad habit of using the restroom even when I don't feel much urge, thinking it would prevent urinary retention, but could this lead to a loss of bladder elasticity? Should I only go when I feel a strong urge?
Lastly, I would like to ask if I need to undergo cystoscopy.
I've read online that it can be very painful, which makes me quite anxious...

Xiao Yan, 30~39 year old female. Ask Date: 2020/10/30

Dr. Du Shixi reply Urology

Hello: If you are experiencing issues with urination despite normal hydration and lifestyle, the doctor will likely recommend further examinations.
At only 39 years old, it is probably not a serious issue and may be related to habits.
Ensure you are drinking enough water, limit spicy and irritating foods, reduce consumption of beverages, and get adequate rest.
It is reasonable to urinate only when you feel the urge.
Blood in the urine or hematuria is more commonly associated with cancer, but the likelihood is low.
A cystoscopy involves inserting a rigid endoscope into the urethra; even if the procedure is not painful, you may experience discomfort during urination for several hours afterward.
Wishing you good health.

Reply Date: 2020/10/30

More Info

Urinary disorders can arise from a variety of causes, and understanding these can help in managing symptoms and determining appropriate treatment options. Based on your description, it seems you are experiencing a combination of urinary frequency, hesitancy, and possibly some discomfort, which can be indicative of several underlying issues.

Causes of Urinary Disorders
1. Obstructive Causes: Conditions such as benign prostatic hyperplasia (BPH) in men or urethral strictures can lead to a narrowing of the urinary tract, causing difficulty in urination and a decrease in urine flow. In your case, the ultrasound indicated a thickened bladder wall and a narrowed urethra, which aligns with this possibility.

2. Neurological Factors: Neurological conditions can affect bladder function, leading to symptoms like urgency, frequency, and hesitancy. Stress and anxiety can also play a significant role in how the bladder functions, sometimes leading to overactive bladder symptoms.

3. Infections and Inflammation: While you mentioned not having blood in your urine, urinary tract infections (UTIs) or bladder inflammation (cystitis) can cause discomfort and changes in urination patterns. The intermittent discomfort you feel could suggest some form of irritation or inflammation, even if it is not severe enough to cause blood in the urine.

4. Psychological Factors: As your doctor suggested, psychological factors can significantly impact urinary function. Anxiety about urination can lead to a cycle of increased urgency and frequency, which may not be directly related to physical causes.

5. Behavioral Factors: The habit of urinating frequently, even without a strong urge, can lead to a conditioned response where the bladder becomes accustomed to smaller volumes of urine. This can indeed reduce bladder capacity over time and may contribute to the symptoms you are experiencing.

Treatment Options
1. Medications: The medications you have been prescribed, such as Oxbutynin (Oxbu ER), are anticholinergics that help relax the bladder and reduce urgency. It may take time to find the right dosage or medication that works for you, so ongoing communication with your healthcare provider is essential.

2. Pelvic Floor Exercises: Kegel exercises can strengthen the pelvic floor muscles, which may help improve bladder control. Consistency is key, and it may take several weeks to notice improvements.

3. Behavioral Modifications: It is advisable to avoid the habit of urinating at the slightest urge. Instead, try to establish a regular schedule for urination, allowing your bladder to fill adequately before emptying. This can help restore normal bladder function and capacity.

4. Further Evaluation: Given your ongoing symptoms, a cystoscopy may be warranted to visually inspect the bladder and urethra for any abnormalities. While it can be uncomfortable, it is a valuable diagnostic tool that can provide insights into your condition.

5. Lifestyle Adjustments: Staying hydrated, avoiding irritants (like caffeine and alcohol), and managing stress through relaxation techniques can also contribute positively to urinary health.

Conclusion
Your symptoms are multifaceted and may require a combination of treatments and lifestyle changes to manage effectively. It is crucial to maintain open communication with your healthcare provider and report any changes in your symptoms. If you feel that your current treatment is not effective, do not hesitate to seek a second opinion or ask for further diagnostic tests. Remember, urinary health is an important aspect of overall well-being, and addressing these issues can significantly improve your quality of life.

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