Prolonged Urination and Enlarged Bladder Issues

Prolonged urination time and issues related to bladder size?

Due to a long-standing habit of holding in urine since childhood, I only urinate twice a day, and my urination time is significantly longer than others.
Recently, I heard that a urination time greater than one minute could indicate benign prostatic hyperplasia.
After undergoing an ultrasound examination, it was found that my prostate is not enlarged; instead, my bladder is much larger than normal, but there is no residual urine after urination.
Here are the ultrasound images of my bladder: https://imgur.com/DSOZUk8 https://imgur.com/PHyuabF.
I have recently recorded my urine output, which exceeds 1000cc each time.
Should I seek further evaluation?

Lin, 30~39 year old female. Ask Date: 2022/03/20

Dr. Ye Qianyu reply Family Medicine

Hello! Long-term urinary retention may lead to bladder elasticity fatigue, resulting in subsequent issues such as bladder weakness and secondary urinary tract infections.
Fortunately, the current examination results are still normal.
It is recommended that you increase your urination frequency by 2-3 times if possible, adjust your fluid intake to be about half an hour before urination, and aim to keep each urination volume at no more than 400-500 milliliters.

Reply Date: 2022/03/20

More Info

Prolonged urination and an enlarged bladder can be concerning symptoms, especially when they deviate from what is considered normal. In your case, it appears that you have developed a habit of holding your urine for extended periods, which can lead to various complications over time.
Firstly, it is important to understand that the bladder is a muscular organ that can adapt to certain conditions. When you consistently hold your urine for long periods, your bladder may stretch and accommodate larger volumes. This can lead to a condition known as bladder hypertrophy, where the bladder muscle thickens and becomes more efficient at storing urine. However, this adaptation can also have negative consequences, such as decreased bladder sensitivity and potential urinary retention issues.

The fact that your ultrasound revealed an enlarged bladder but no residual urine after voiding is a positive sign. It indicates that your bladder is functioning well in terms of emptying. However, consistently voiding over 1000cc at a time is significantly higher than the average bladder capacity, which typically ranges from 400cc to 600cc in adults. This could suggest that your bladder has adapted to accommodate larger volumes, but it also raises questions about the underlying cause of this adaptation.

Given your history of prolonged urination and the current findings, it would be prudent to pursue further evaluation. Here are some steps you might consider:
1. Urodynamic Testing: This test assesses how well your bladder and urethra are functioning. It can provide insights into bladder pressure, capacity, and the ability to empty completely. This information can help determine if there are any functional abnormalities.

2. Cystoscopy: A cystoscopy allows a doctor to look inside your bladder and urethra using a thin tube with a camera. This can help identify any structural abnormalities, inflammation, or other issues that may not be visible on an ultrasound.

3. Bladder Diary: Keeping a detailed record of your urination patterns, including frequency, volume, and any associated symptoms (such as urgency or discomfort), can provide valuable information to your healthcare provider.

4. Consultation with a Urologist: Given your symptoms and ultrasound findings, a referral to a urologist may be beneficial. They can provide specialized care and further investigate any potential underlying conditions.

5. Lifestyle Modifications: While awaiting further evaluation, consider modifying your habits. Aim to urinate more frequently and avoid holding your urine for extended periods. This can help prevent potential complications, such as urinary tract infections or bladder dysfunction.

In conclusion, while your current situation does not appear to indicate immediate danger, the combination of prolonged urination, an enlarged bladder, and high voiding volumes warrants further investigation. Early intervention can help prevent potential complications and ensure that your bladder health is maintained. Always consult with your healthcare provider for personalized advice and recommendations based on your specific situation.

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