Frequent Urination: Causes, Connections, and Solutions

Q: Frequent Urination: Causes, Connections, and Solutions

Hello： (1) Could the cause of my symptoms be more likely related to "neurogenic bladder dysfunction" as described online, or could there be other reasons? Is it possible that it is also related to symptoms of depression and anxiety? --- It is advisable to seek medical examination

Frequent urination issues?

Doctor, I apologize for bothering you.
I have the following three symptoms that have persisted for at least six months: (1) frequent urination and urgency; (2) I feel the urge to urinate even when the volume is low, leading to a significant increase in the frequency of urination and shorter intervals between trips to the bathroom; (3) it feels like I haven't completely emptied my bladder after urinating.
I drink about 4500 to 5000 cc of water a day and go to the bathroom approximately 10 to 12 times a day.
Additionally, I have been seeing a psychiatrist for over a year for mild depression and anxiety.
After researching online, I came across the following description: "Since the bladder is primarily controlled by the sympathetic and parasympathetic nervous systems, when the bladder volume increases to a certain level, the sensory nerves in the bladder wall generate nerve impulses that are transmitted to the central nervous system, resulting in the sensation of fullness and urgency." I would like to ask you two questions: (1) Are my symptoms more likely due to "dysregulation of the bladder's control nerves" as described online, or could there be other causes? Could this be related to my depression and anxiety symptoms? (2) Should I see a urologist, or would it be better to consult another specialty? (3) Do you have any recommended medications that could help alleviate these issues, so I can discuss them directly with my doctor if I need to seek treatment later? Thank you very much!

Xiao Lu, 20~29 year old female. Ask Date: 2023/07/11

Dr. Du Shixi reply Urology

Hello: (1) Could the cause of my symptoms be more likely related to "neurogenic bladder dysfunction" as described online, or could there be other reasons? Is it possible that it is also related to symptoms of depression and anxiety? --- It is advisable to seek medical examination; if you are drinking that much water, frequent urination is likely to occur.
(2) Should I see a urologist, or would it be better to consult another specialty? --- It is recommended to adjust your water intake to 2500-3000 cc, unless you are engaged in heavy sweating activities or prolonged exercise.
(3) Are there any medications that the doctor would recommend to help alleviate the aforementioned issues, so that I can discuss them directly with the doctor if I need to seek treatment later? --- Typically, some simple tests will be conducted first.
Wishing you good health.

Reply Date: 2023/07/11

More Info

Frequent urination, urgency, and the sensation of incomplete bladder emptying can be distressing symptoms that significantly impact your quality of life. Based on the symptoms you've described, it seems that you are experiencing a complex interplay of physiological and possibly psychological factors. Let's break down your concerns and explore potential causes and solutions.

Understanding Your Symptoms
1. Frequent Urination and Urgency: The sensation of needing to urinate frequently, especially when your bladder is not full, can be indicative of several conditions. One common cause is overactive bladder (OAB), which is characterized by an urgent need to urinate and increased frequency of urination. This condition can occur even when the bladder is not full, leading to the feeling of urgency and frequent trips to the restroom.

2. Incomplete Bladder Emptying: The feeling that you have not fully emptied your bladder after urination can be associated with several issues, including bladder dysfunction or obstruction. In men, this could be related to prostate issues, while in women, it might be linked to pelvic floor dysfunction.

3. Psychological Factors: Your history of mild depression and anxiety may also play a significant role in your urinary symptoms. Anxiety can exacerbate the perception of urgency and frequency, leading to a cycle where the fear of needing to urinate can increase the actual frequency of urination. This is sometimes referred to as "psychogenic" or "functional" urinary frequency.

Potential Causes
Given your symptoms, the following causes could be considered:
- Neurological Factors: As you mentioned, the bladder is controlled by both sympathetic and parasympathetic nervous systems. Any disruption in these pathways can lead to abnormal bladder sensations and function.

- Infection: Urinary tract infections (UTIs) can cause increased frequency and urgency, although you would likely have other symptoms such as burning during urination or cloudy urine.

- Bladder Conditions: Conditions such as interstitial cystitis or bladder inflammation can also lead to similar symptoms.

- Psychological Impact: Anxiety and depression can manifest physically, including in the form of urinary symptoms. The stress of worrying about needing to find a restroom can create a feedback loop that exacerbates the issue.

Recommendations
1. Consult a Urologist: Given the nature of your symptoms, it would be prudent to see a urologist. They can perform a thorough evaluation, including urinalysis, bladder function tests, and possibly imaging studies to rule out any underlying physical conditions.

2. Consider Psychological Support: Since you have a history of anxiety and depression, working with a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) has been shown to help with anxiety-related urinary symptoms.

3. Medication Options: There are several medications that can help manage overactive bladder symptoms. Anticholinergics (like oxybutynin or tolterodine) and beta-3 adrenergic agonists (like mirabegron) are commonly prescribed to help reduce urgency and frequency. Discuss these options with your urologist to see if they are appropriate for you.

4. Lifestyle Modifications: Increasing your water intake is generally good, but if you find that it leads to more frequent urination, you might want to adjust your fluid intake. Additionally, bladder training techniques can help you gradually increase the time between urinations.

5. Pelvic Floor Exercises: Engaging in pelvic floor exercises (Kegel exercises) can strengthen the muscles that support the bladder and may help with symptoms of urgency and incomplete emptying.

Conclusion
Your symptoms are multifaceted and may involve both physical and psychological components. A comprehensive approach that includes evaluation by a urologist, support for your mental health, and potential medication could provide relief. Don't hesitate to discuss all your symptoms and concerns with your healthcare provider to develop a tailored treatment plan. Remember, you are not alone in this, and there are effective strategies to manage and alleviate your symptoms.

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