Frequent Urination with Low Volume: Exploring Possible Causes and Treatments

Q: Frequent Urination with Low Volume: Exploring Possible Causes and Treatments

Hello： First, the area where I feel pain when I press on my lower abdomen should be closer to the digestive system rather than the bladder, right? --> Yes, but does the bladder's area actually extend that far? --> It’s possible that pressure downwards could affect it; if it’s a d

Frequent urination with low urine volume?

Hello, doctor.
For the past three months, I have been experiencing frequent urination, needing to go to the bathroom almost every hour, with a urine volume of about 100-150 cc each time.
After consulting with a physician and undergoing tests, diabetes insipidus and diabetes mellitus have been ruled out.
Urinalysis showed normal results, and there are no kidney stones.
Additionally, a bladder ultrasound and urinary tract examination revealed that I expelled 450 cc of urine at the time of testing, with a post-void residual of 20 cc, and normal urine flow rate, thus ruling out post-void residual and bladder muscle weakness issues.
Here is the follow-up treatment process:
1.
Initially, a bacterial culture from a penile sample identified Escherichia coli, leading the outpatient physician to suspect a prostate infection.
Antibiotics were prescribed, but after a week of treatment, there was no improvement in my frequent urination.
A different antibiotic was then prescribed, but it also proved ineffective.
The doctor concluded that the bacteria in the prostate should have been eradicated, so the antibiotics were discontinued.
2.
I am currently prescribed medications for overactive bladder, which include three types: Mirabegron 25 mg, Solifenacin (Vesicare) 5 mg, and Tamsulosin 0.4 mg, all taken once daily.
However, after nearly a month of treatment, there has been no significant improvement.
3.
When I press on my bladder, I do not feel significant pain, only a sensation of needing to urinate.
However, about five centimeters below my navel, pressing deeply causes slight pain.
Sometimes, when I feel urgency, the pain in that area seems to be less intense, and light pressure elicits a mild pain sensation.
Based on this, the doctor has scheduled a cystoscopy in two weeks to confirm whether it is interstitial cystitis, which may provide temporary bladder expansion effects, but only for a maximum of two weeks.
4.
After urinating, I sometimes immediately feel tightness in the lower abdominal muscles, as if relaxing would cause me to urinate again.
However, pressing on my bladder does not induce a strong urge to urinate.
I have also noticed that sometimes my urination occurs in two phases; after finishing, if I maintain the same position and relax for about 10 seconds, I may expel a small amount of urine (currently measured between 5 cc and 80 cc).
Additionally, I occasionally experience a dull pain in the area just above the left side of the base of my penis and in the left perineum (near the scrotum), and I also have intermittent soreness in my left lower back.
I inquired with the physician whether this could be related to prostate issues, but the physician believes the prostate infection has resolved and considers the likelihood of benign prostatic hyperplasia at my age to be low, thus ruling out prostate problems.
Currently, I have two concerns: First, the area where I feel pain when pressing on my lower abdomen seems to be closer to the digestive system rather than the bladder.
Does the bladder actually extend into that area? If it is a digestive system issue, would a cystoscopy not be helpful? Secondly, can I truly rule out prostate issues, or are there other avenues for examination that could be pursued? I apologize for the trouble, and thank you for your assistance.

David C, 30~39 year old female. Ask Date: 2022/01/21

Dr. Du Shixi reply Urology

Hello: First, the area where I feel pain when I press on my lower abdomen should be closer to the digestive system rather than the bladder, right? --> Yes, but does the bladder's area actually extend that far? --> It’s possible that pressure downwards could affect it; if it’s a digestive system issue, a cystoscopy probably wouldn’t be helpful, right? --> We still need to rule out urinary issues.
Can I completely rule out prostate problems in my case? --> At this age, the likelihood of prostate issues affecting urination is low, but are there other tests that can be conducted? --> Urodynamics could be considered.

Reply Date: 2022/01/21

More Info

Frequent urination with low volume can be a perplexing issue, particularly when common causes such as diabetes insipidus and urinary tract infections have been ruled out. Based on your detailed description, it seems that you have undergone a thorough evaluation, including urine tests, kidney scans, and bladder ultrasounds, which have not revealed any significant abnormalities. However, the persistent symptoms you are experiencing warrant further exploration of potential causes and treatment options.

Possible Causes
1. Overactive Bladder (OAB): This condition is characterized by a sudden urge to urinate frequently, often with little urine produced. The medications you are currently taking, such as Mirabegron and Solifenacin, are typically prescribed to manage OAB symptoms. However, it is not uncommon for these medications to take some time to show efficacy, or for patients to experience side effects that may not alleviate the underlying issue.

2. Prostatitis: Although your physician has ruled out prostate infection, chronic prostatitis or pelvic pain syndrome could still be a factor. Symptoms can include pelvic pain, urinary urgency, and discomfort in the lower abdomen or perineal area. The pain you describe when pressing on your lower abdomen may suggest that this could be a contributing factor.

3. Interstitial Cystitis (IC): This is a chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain. The bladder may become inflamed, leading to frequent urination with little volume. The planned cystoscopy could help in diagnosing this condition.

4. Psychological Factors: Anxiety and stress can significantly impact urinary habits. If you have been experiencing anxiety, it may contribute to your symptoms. The medication Anxiedin, which you are currently taking, is intended to help with anxiety, but it may take time to notice its effects on your urinary symptoms.

5. Neurological Conditions: Although less common, certain neurological conditions can affect bladder control and sensation, leading to symptoms like frequent urination with low volume.

Treatment Options
1. Medication Adjustment: Since you have been on OAB medications for a month without significant improvement, it may be worth discussing with your physician the possibility of adjusting the dosage or trying alternative medications. Sometimes, a combination of medications may be more effective.

2. Behavioral Therapy: Bladder training and pelvic floor exercises can help improve bladder control. A referral to a pelvic floor physical therapist may be beneficial.

3. Cystoscopy: As planned, undergoing a cystoscopy can provide valuable insights into the condition of your bladder and help rule out interstitial cystitis or other abnormalities.

4. Psychological Support: If anxiety is a contributing factor, consider discussing further psychological support or therapy options with your healthcare provider. Cognitive-behavioral therapy (CBT) can be particularly effective for managing anxiety-related symptoms.

5. Dietary Adjustments: Keeping a diary of your fluid intake and urinary output can help identify any patterns or triggers. It may also be useful to monitor your diet for any irritants that could exacerbate bladder symptoms, such as caffeine or acidic foods.

Conclusion
In summary, while your symptoms are complex and multifactorial, a comprehensive approach involving medication review, behavioral strategies, and further diagnostic testing will be essential in managing your condition. It is crucial to maintain open communication with your healthcare provider and report any changes in your symptoms or new concerns. Your proactive approach to understanding your health is commendable, and with the right support and treatment, improvement is possible.

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