Urination Issues: When to See a Doctor?

Urinary problems

I would like to ask if it is necessary to see a doctor or to pay for an abdominal X-ray or ultrasound? Blood and urine tests have all come back normal, but I feel that there is a significant difference between the amount of water I drink and the amount I urinate.
However, my daily urine output is over 400cc.
It seems that when I have my menstrual period, my urine output decreases, and I do not sweat excessively.
I also want to know if the absence of blood in the urine means that there is still a possibility of kidney stones.
On September 8, my health check showed a creatinine level of 0.9, urine protein (-), and urine occult blood (-).

On September 18, at 8:00 AM, I drank 250cc of water, urinated 240cc at 1:30 PM, drank 300cc at 1:10 PM, urinated 240cc at 12:00 PM, drank 500cc of milk tea at 1:00 PM, drank 550cc of water at 5:00 PM, drank 250cc of water at 8:00 PM, drank 300cc of water at 9:00 PM, and urinated 250cc at 10:30 PM.
My intake was 2150cc and output was 720cc.

On September 19, at 9:00 AM, I drank 550cc of water, urinated 270cc at 1:30 PM, urinated 250cc at 12:30 PM, drank 500cc of milk tea at 1:20 PM, drank 200cc of water at 3:00 PM, drank 350cc of water at 5:20 PM, drank 100cc of soup at 6:20 PM, drank 250cc of water at 8:20 PM, drank 300cc of water at 9:00 PM, and urinated 320cc at 10:00 PM and 60cc at 10:30 PM.
My intake was 2250cc and output was 900cc.
On September 20, at 0:03 AM, I drank 300cc of water, drank another 300cc at 0:30 AM, urinated 240cc at 1:00 AM, urinated 140cc at 1:55 AM, urinated 160cc at 1:40 PM, drank 250cc of water at 1:50 PM, drank 400cc of black tea at 3:00 PM, urinated 70cc at 4:00 PM, drank 300cc of water at 4:30 PM, drank 300cc of water at 8:20 PM, drank 300cc of water at 8:45 PM, urinated 250cc at 9:10 PM, and urinated 210cc at 10:20 PM.
My intake was 2150cc and output was 1070cc.
On September 21, at 10:00 AM, I drank 600cc, urinated 250cc at 1:00 PM, urinated 300cc at 1:20 PM, drank 150cc of water at 2:50 PM, drank 400cc of milk tea at 5:50 PM, drank 350cc of water at 8:30 PM, urinated 200cc at 8:45 PM, drank 550cc of water at 9:20 PM, and urinated 250cc at 10:00 PM and 50cc at 10:20 PM.
My intake was 2150cc and output was 1050cc.

Yiyi, 20~29 year old female. Ask Date: 2021/09/22

Dr. Wu Jiyu reply Internal Medicine

According to the data you provided, a serum creatinine level of 0.9 corresponds to an estimated glomerular filtration rate (eGFR) greater than 60, which falls within the normal range.
Regarding your input/output from 9/18 to 9/21, with an intake of 8700 cc and an output of 3750 cc (+4950 cc = 5 kg), it is important to note that you have not accounted for dietary intake and other fluid losses.
Therefore, we can first observe your weight; if there is no increase of 5 kg, there is no need for concern.
However, if your weight has increased by 5 kg, please schedule an appointment with a physician to discuss this further.
Thank you for your inquiry.
The Nephrology Department at Changhua Hospital is here to support you.

Reply Date: 2021/09/22

More Info

When it comes to urinary issues, understanding when to seek medical advice is crucial. Based on your detailed description of symptoms and fluid intake/output, it appears you are experiencing some concerns regarding your urinary patterns, particularly in relation to your fluid intake and the volume of urine produced.
Firstly, it’s important to note that normal urinary output can vary significantly from person to person, and factors such as fluid intake, physical activity, and even hormonal changes during menstruation can influence this. Your reported daily urine output of over 400cc is generally within the normal range, but the feeling that your urine output does not match your fluid intake can be concerning.
Given that your blood and urine tests have returned normal results—specifically, normal creatinine levels, no protein, and no blood in the urine—this is reassuring. However, it does not completely rule out the possibility of underlying conditions such as kidney stones, especially if you are experiencing discomfort or changes in urinary habits. Kidney stones can sometimes be present without causing immediate symptoms, and they may not always show up in routine urine tests unless there is a blockage or infection.

In your case, the fluctuation in urine volume during your menstrual cycle could be attributed to hormonal changes that affect fluid retention and kidney function. It’s not uncommon for women to notice changes in urinary patterns around their menstrual periods. Additionally, factors such as caffeine intake from beverages like tea and coffee can also lead to increased urination.

To address your concerns effectively, here are some recommendations on how to communicate with your healthcare provider:
1. Document Your Symptoms: Keep a detailed log of your fluid intake and urine output, as you have been doing. Include any associated symptoms such as discomfort, urgency, or changes in the color of your urine. This information will help your doctor understand your situation better.

2. Express Your Concerns Clearly: When you visit your doctor, clearly articulate your concerns about the discrepancy between your fluid intake and urine output. Mention any specific symptoms you are experiencing, such as discomfort or changes in urinary frequency.

3. Ask About Further Testing: Given your ongoing concerns, it may be reasonable to ask your doctor about further diagnostic tests, such as an abdominal ultrasound or a CT scan, especially if there is a suspicion of kidney stones or other abnormalities. These tests can provide more insight into your urinary tract and kidney health.

4. Inquire About Specialist Referral: If your primary care physician is unable to provide satisfactory answers or if your symptoms persist, consider asking for a referral to a urologist. Urologists specialize in urinary tract issues and can offer more targeted evaluations and treatments.

5. Discuss Lifestyle Factors: Sometimes, lifestyle changes can help alleviate urinary issues. Discuss your diet, fluid intake, and any medications or supplements you are taking with your doctor, as these can all impact urinary health.

In conclusion, while your current test results are normal, your symptoms warrant further discussion with your healthcare provider. Effective communication is key to ensuring that your concerns are addressed and that you receive appropriate care. If you feel that your current doctor is not meeting your needs, seeking a second opinion or consulting a specialist may be beneficial. Remember, your health is paramount, and advocating for yourself is an important part of the healthcare process.

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