Bladder Issues: Insights and Solutions for Patients

Q: Bladder Issues: Insights and Solutions for Patients

Hello： Your condition seems not to require urodynamic studies, as the results are highly unlikely to reveal any significant findings. <br>Please maintain a regular lifestyle, drink water evenly, and engage in moderate exercise. <br>If you are taking medications from other special

Bladder issues

Hello Doctor: If I weren't at my wit's end, I wouldn't be saying so much...
(1) At the end of February, I experienced some urinary leakage.
One night, I performed Kegel exercises about five or six times, holding each for 15 seconds.
A day or two later, the muscles on both sides of my pubic bone began to tighten intermittently, leading to frequent urination with a small volume; after a while, the frequency decreased, but the muscles remained tense, and my lower abdomen started to feel hard.
(2) Sometimes my bladder feels very full, but I only urinate a little over 200 ml; other times, it doesn't feel full, but after drinking around 1000 ml of water, I go four to five hours without urinating, only to find that I can pass over 300 ml when I finally do.
(3) In mid-March, my urodynamic tests were normal, and on May 10, my urine and kidney function tests were normal.
By mid-June, my urinary flow rate was also normal.
(4) However, by late March, my urine volume gradually decreased with each void.
(5) Now, after June 11, my morning urine volume ranges between 140 to 180 ml.
I make sure to drink 800 ml of water before 10:00 AM and a total of 1500 ml before 11:30 AM, yet I only go to the bathroom for the second time between 12:30 and 1:45 PM, with a volume of about 160 to 180 ml.
Throughout the day, my urine volume rarely exceeds 240 ml, totaling around 1020 to 1400 ml per day.
I've seen several doctors, but no one can help me, and I feel deeply helpless.
Could you please give me some advice? *The doctors are unwilling to perform urodynamic video studies, and my mother says we should pay for everything ourselves to avoid being seen as wasting healthcare resources—thank you very much.

pigbaby, 20~29 year old female. Ask Date: 2023/06/26

Dr. Li Minghui reply Urology

Hello: Your condition seems not to require urodynamic studies, as the results are highly unlikely to reveal any significant findings.
Please maintain a regular lifestyle, drink water evenly, and engage in moderate exercise.
If you are taking medications from other specialties, please inform your physician.
The amount of water intake should be sufficient if your urine color is light.
However, if you are taking B-complex vitamins, it is normal for your urine to appear yellow.
Wishing you good health.

Reply Date: 2023/06/26

More Info

Understanding bladder issues can be quite complex, especially when symptoms are inconsistent and difficult to manage. Based on your description, it seems you are experiencing a range of urinary symptoms that could be related to several underlying factors. Let's break down your situation and explore potential insights and solutions.

Symptoms Overview
1. Urinary Incontinence and Frequency: You mentioned experiencing leakage and frequent urges to urinate, which can be indicative of overactive bladder (OAB) or pelvic floor dysfunction. The Kegel exercises you performed are typically aimed at strengthening pelvic floor muscles, but if done excessively or incorrectly, they might lead to muscle tension rather than relaxation.

2. Pelvic Muscle Tension: The tightness in your pelvic muscles and the hardening of your lower abdomen suggest that you may be experiencing pelvic floor muscle dysfunction. This can lead to urinary retention or incomplete emptying, which might explain why you feel the urge to urinate without producing a significant volume.

3. Urine Output Variability: Your reports of fluctuating urine output, where you sometimes feel the bladder is full but only pass a small amount, could indicate a problem with bladder compliance or function. It’s also possible that anxiety or stress could be contributing to these symptoms, as they can affect bladder function.

Diagnostic Considerations
You mentioned that several tests, including urine flow studies and kidney function tests, returned normal results. This is a positive sign, but it does not rule out functional issues with the bladder or pelvic floor. Urinary dynamics can be complex, and sometimes standard tests do not capture the full picture.

Recommendations
1. Pelvic Floor Physical Therapy: Since you are experiencing muscle tightness, working with a pelvic floor physical therapist could be beneficial. They can provide targeted exercises to help relax the pelvic floor muscles and improve bladder function. This therapy often includes biofeedback, which can help you gain awareness of your muscle tension and learn to relax those muscles effectively.

2. Behavioral Modifications: Keeping a bladder diary can help you track your fluid intake, urinary frequency, and volume. This data can be useful for healthcare providers to understand your patterns and make informed recommendations. Additionally, consider scheduled voiding, where you attempt to urinate at regular intervals, which can help train your bladder.

3. Medication Consultation: If you haven’t already, discussing medication options with a urologist or a specialist in bladder disorders could be worthwhile. Medications for overactive bladder, such as anticholinergics or beta-3 agonists, may help manage your symptoms if they are indeed related to OAB.

4. Stress Management Techniques: Since anxiety can exacerbate bladder issues, incorporating stress management techniques such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) may help alleviate some of the psychological burdens that accompany your physical symptoms.

5. Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from a urologist or a specialist in female pelvic medicine and reconstructive surgery could provide new insights or alternative treatment options.

Conclusion
Bladder issues can be frustrating and isolating, especially when multiple healthcare providers are unable to offer a clear solution. It’s important to advocate for your health and seek out specialists who are willing to explore all avenues of treatment. Remember, you are not alone in this journey, and there are professionals who can help you navigate these challenges. Your symptoms are valid, and with the right support and treatment, improvement is possible.

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