Urination Issues: Causes, Symptoms, and Next Steps

Urinary issues

Hello, doctor.
I have a slow urinary flow and have undergone urodynamic studies and prostate examinations without any signs of inflammation.
What could be the issue? I often feel an urgent need to urinate, but the amount is not much.
After holding my urine, I experience some lower back discomfort, even though I haven't held it for long.
The urgency feels more like it's in the penis rather than the bladder.
I had a cystoscopy, and the doctor mentioned that my urine was very cloudy.
Many urologists have suggested that I might have overactive bladder syndrome, but after taking some medication, I found it difficult to urinate.
A nephrologist also confirmed that there are no stones or atrophy, and an MRI showed that I have renal cysts, which the doctor said are normal.
However, my glomerular filtration rate has dropped from 94 to 76 within three months, which seems quite concerning given my urinary difficulties, and the cause remains unidentified.

Whenever I feel a slight urgency to urinate, my right hand becomes dry, and applying lotion doesn't help.
I wonder if there could be an issue with my ureters or kidneys.
During the day, I don't urinate much despite drinking water, but I wake up twice at night to urinate, and the amount is more than during the day.
Occasionally, at night, my penis feels like it is swelling, not in an erect sense, but rather as if the urethra cannot relax, and this sensation disappears after urination.
During the day, I now have to exert some effort to urinate, which wasn't the case before.
My ejaculation feels thin, and it seems like I haven't fully ejaculated, almost as if it's still in the bladder.
My erections have also become softer.
Hormone tests have shown no issues.

What further tests can I undergo? Could it be that my foreskin is causing a blockage in the penis? I notice some residual urine when I clean the glans.

Luo Xiansheng, 30~39 year old female. Ask Date: 2021/04/04

Dr. Xu Wencang reply Urology

Chronic pelvic pain syndrome requires patience and follow-up visits for treatment.

Reply Date: 2021/04/04

More Info

It sounds like you are experiencing a complex array of urinary symptoms that are significantly impacting your quality of life. Based on your description, you are dealing with slow urine flow, urgency, and discomfort in the lower back, among other issues. Let's break down your symptoms and potential next steps.

Understanding Your Symptoms
1. Slow Urine Flow and Urgency: These symptoms can be indicative of several underlying conditions. The fact that you have undergone urodynamic studies and cystoscopy without finding inflammation is a good start, but it does not rule out other potential issues.

2. Perception of Urgency: The sensation of urgency not originating from the bladder but rather from the penis could suggest a neurological component or a problem with the urethra. This is sometimes seen in conditions like bladder overactivity or urethral stricture.

3. Back Pain and Urination: The lower back pain you experience when holding urine could be due to bladder distension or referred pain from the urinary tract.
4. Changes in Kidney Function: The decline in your glomerular filtration rate (GFR) from 94 to 76 over three months is concerning and should be monitored closely. This could indicate a developing issue with kidney function, possibly related to urinary obstruction or other renal pathology.

5. Other Symptoms: The sensation of fullness in the penis, difficulty with ejaculation, and erectile issues could all be interconnected. These symptoms may suggest a possible issue with the pelvic floor muscles, nerve function, or even hormonal imbalances, despite your hormone tests being normal.

Potential Causes
Given your symptoms, several potential causes could be considered:
- Bladder Outlet Obstruction: This could be due to an enlarged prostate (even if not inflamed), urethral stricture, or other anatomical issues.

- Neurogenic Bladder: Conditions affecting nerve signals to the bladder can lead to urgency and difficulty in urination.

- Urethral Stricture: A narrowing of the urethra could cause slow flow and difficulty in urination.

- Pelvic Floor Dysfunction: Issues with the muscles that support the bladder and urethra can lead to urinary symptoms.

- Psychogenic Factors: Anxiety or stress can also manifest in urinary symptoms.

Next Steps
1. Consult a Urologist: Since you have seen multiple specialists, it may be beneficial to return to a urologist who specializes in complex urinary issues. They may consider additional tests such as:
- MRI or CT Scan of the Abdomen and Pelvis: To assess for any anatomical abnormalities.

- Urethral Pressure Profile: To evaluate for any strictures or obstructions.

- Pelvic Floor Assessment: A physical therapist specializing in pelvic health can help assess and treat any dysfunction.

2. Consider a Multidisciplinary Approach: Given the complexity of your symptoms, a team approach involving urologists, nephrologists, and possibly neurologists may be beneficial.

3. Lifestyle Modifications: Keep a diary of your fluid intake and urinary patterns. This can help identify any triggers or patterns that may assist your healthcare providers in diagnosing the issue.

4. Further Evaluation of Hormonal Levels: Even though your initial hormone tests were normal, it might be worth re-evaluating testosterone and other related hormones, especially given your erectile dysfunction and changes in ejaculation.

5. Psychological Support: If anxiety or stress is a factor, consider speaking with a mental health professional who can help you manage these aspects, which may indirectly improve your urinary symptoms.

Conclusion
Your symptoms are complex and require a thorough evaluation to identify the underlying cause. It is essential to continue advocating for yourself and seeking the appropriate specialists who can help you navigate this challenging situation. Remember, it’s crucial to address both the physical and psychological aspects of your health to achieve the best outcomes.

Similar Q&A

Understanding Urinary Issues: Common Problems and Solutions

Hello Dr. Lin: I have the following issues with urination: 1. Sometimes I wet my outer pants. 2. Sometimes after urinating, I feel like there is still a little bit of urine left, and when I put my penis back in my underwear, a small amount of urine leaks into my underwear. 3. Som...

Dr. Lin Hexing reply Urology
Hello: Based on your age and symptoms, you may be experiencing symptoms of benign prostatic hyperplasia (BPH). It is advisable to visit a urology clinic for examination and treatment. Wishing you peace and happiness.

Understanding Urinary Issues: Tips for Managing Discomfort and Frequency

Doctor, I have a question. Every time I have a bowel movement at home, I experience intermittent urination. After finishing, I rinse my bottom with water, and I often feel the urge to urinate again. Sometimes the urine volume is quite large, while other times it is minimal, just ...

Dr. Xu Weikai reply Urology
Hello, it seems to be a problem with the autonomic nervous system. You should try to relax a bit. Additionally, you can train your bladder by drinking water at fixed intervals and urinating at scheduled times. For example, drink 100cc of water every hour and urinate every two hou...

Struggling with Frequent Urination: Seeking Relief and Solutions

1. I have a frequent urination problem. 2. I feel a discomfort as if urine is stuck inside my penis, which significantly affects my sleep. It feels like the urge to urinate is constantly present at the urethral opening. Doctor's solution: The doctor prescribed medication for...

Dr. Du Shixi reply Urology
Hello: Drink plenty of water, and your urine should be light yellow or clear. Avoid sitting for long periods, and engage in moderate exercise for 30 minutes each day. Wishing you good health!

Understanding Frequent Urination and Anxiety-Related Symptoms

Hello, doctor. I have been experiencing frequent urination and difficulty urinating. My inability to urinate usually occurs when someone is nearby, so I believe it may be a psychological issue. However, after researching related conditions online, my anxiety has worsened, and the...

Dr. Chen Xiuyi reply Urology
Hello: The causes of frequent urination can be divided into two main categories. The first category involves increased urine production by the kidneys, which can occur due to physiological factors such as excessive fluid intake, consumption of coffee or alcohol, or as a result of...