Urinary Incontinence: Seeking Solutions for Persistent Symptoms

Q: Urinary Incontinence: Seeking Solutions for Persistent Symptoms

Hello： Your condition does not seem to require urodynamic studies, as the results are very likely to show no significant findings. <br>Please maintain a regular lifestyle, drink water evenly, and engage in moderate exercise. <br>If you are taking medications from other specialtie

Due to several instances of urinary leakage?

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 the urine volume is only a little over 200 ml.
Other times, it doesn't feel full, but after drinking about 1000 ml of water, I go four to five hours without urinating, only to find that I can pass over 300 ml when I do go.
(3) In mid-March, urodynamic tests were normal, and on May 10, both urine analysis and kidney function were normal.
By mid-June, the urine flow rate was normal.
(4) However, by late March, the volume of urine per void gradually decreased.
(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 urine volume of about 160 to 180 ml.
Throughout the day, my urine volume rarely exceeds 240 ml, resulting in a total daily volume of about 1020 to 1400 ml.
I have seen several doctors, but no one has been able to help me, and I feel a deep sense of helplessness.
Could you please give me some advice? *The doctors are unwilling to perform urodynamic imaging, and my mother says we have to pay for everything ourselves to avoid being seen as wasting healthcare resources—thank you very much.

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

Dr. Du Shixi reply Urology

Hello: Your condition does not seem to require urodynamic studies, as the results are very likely to show no 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, your urine may appear yellow, which is an exception.
Wishing you good health.

Reply Date: 2023/06/29

More Info

Urinary incontinence can be a complex and distressing condition, particularly when it is accompanied by other symptoms such as frequent urination, urgency, and difficulty in fully emptying the bladder. Your experience, as described, suggests a multifaceted issue that may involve both physical and psychological components. Here, I will address your concerns and provide some insights into potential solutions.

Understanding Your Symptoms
1. Pelvic Floor Muscle Tension: It seems that your Kegel exercises, which are intended to strengthen pelvic floor muscles, may have inadvertently led to increased tension in those muscles. This can result in a condition known as pelvic floor dysfunction, where the muscles do not relax properly, leading to symptoms such as urinary urgency and frequency, as well as discomfort in the lower abdomen. It is important to learn how to relax these muscles as well as strengthen them.

2. Bladder Sensitivity: The sensation of a full bladder with minimal urine output can be indicative of bladder overactivity or hypersensitivity. This can occur even when the bladder is not physically full, leading to a feeling of urgency. Your reports of varying urine output despite significant fluid intake could suggest that your bladder is not functioning optimally.

3. Normal Test Results: It is reassuring that your urine tests and kidney function have returned normal, and that your urodynamic studies showed normal results. However, the persistence of your symptoms despite these normal findings indicates that there may be other underlying issues that need to be addressed.

Recommendations for Management
1. Pelvic Floor Physical Therapy: Consider consulting a pelvic floor physical therapist who specializes in urinary issues. They can help you learn techniques to relax your pelvic floor muscles, as well as provide guidance on proper Kegel exercises. This therapy can be very effective in managing symptoms of pelvic floor dysfunction.

2. Bladder Training: Implementing a bladder training program may help. This involves scheduling bathroom visits at regular intervals and gradually increasing the time between visits. This can help retrain your bladder and reduce urgency.

3. Fluid Management: While it is important to stay hydrated, monitoring your fluid intake and timing can also be beneficial. Keeping a diary of your fluid intake and urinary output can help identify patterns and triggers for your symptoms.

4. Medication Review: If you are currently on medications, it may be worth discussing with your healthcare provider whether any of them could be contributing to your symptoms. Certain medications can affect bladder function and urinary frequency.

5. Psychological Support: Given the emotional distress you are experiencing, it may be helpful to seek support from a mental health professional. Anxiety and stress can exacerbate urinary symptoms, and addressing these factors can lead to improvement.

6. 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 may provide new insights or treatment options.

Conclusion
Urinary incontinence and related symptoms can significantly impact your quality of life, but there are various avenues for treatment and management. It is crucial to approach this condition holistically, considering both physical and psychological aspects. By working with healthcare professionals who understand the complexities of urinary issues, you can find a tailored approach that addresses your specific needs. Remember, you are not alone in this, and there are effective strategies to help you regain control and improve your well-being.

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