Urgency and Incontinence: Prostatitis or Overactive Bladder?

The issues of urinary urgency, inability to hold urine, and incontinence could be related to prostatitis or overactive bladder?

Hello, I have been experiencing issues with urgency, incontinence, and difficulty holding urine for about 5 to 6 years.
I checked my urine volume with a medium cup of milk tea, which was about 80% full.
I typically wake up 1 to 2 times at night during winter, while in summer, it’s almost negligible.
In the afternoon, between 3 to 5 PM, I drink about 500 to 600 mL of water per hour.
On average, I urinate every 25 to 30 minutes after drinking 2 cups of water every 15 minutes.
I always ensure to drink at least 1600 to 2000 mL of water daily, and I consume very little coffee, tea, or spicy food.
1.
Initially, when I experienced urgency, I consulted a doctor and underwent ultrasound, X-rays, urinalysis, and blood tests.
I was prescribed anticholinergics for one week, but there was no significant improvement.
2.
I then switched to traditional Chinese medicine and followed treatment for a year, taking herbal medicine and acupuncture.
However, the physician believed it was an issue with the bladder detrusor muscle, and there was no improvement.
3.
This year, the incontinence has worsened significantly, affecting my quality of life, prompting me to seek medical attention again.
Previously, I only had annual health check-ups at work or checked for glomerulonephritis when I was younger.
I have been undergoing blood and urine tests at the same hospital every year, including X-rays and blood tests for prostate cancer markers.
The first physician prescribed Betanecol 25 mg for 28 days, but honestly, I did not notice much improvement.
After finishing the medication, I consulted another physician who suspected prostatitis but did not specify whether it was acute or chronic, so a digital rectal exam was performed.
I only felt a slight soreness and mild pain; I am unsure if this is normal.
The physician then prescribed four medications: levofloxacin *1, oxybutynin *1, ibuprofen 400 mg after meals, and doxazosin *1.
I specifically informed the physician about my history of glomerulonephritis with biopsy results over the past three years, and my tests at work and the hospital show that my glomerular filtration rate is between 90 and 78, which I believe is low for someone my age.
Last year, my white blood cell and red blood cell counts were slightly below the normal range.
My white blood cell count was around 39XX, while the normal value is 4000, but I have no proteinuria, hematuria, hypertension, or diabetes.
It seems that these medications, especially ibuprofen, could harm the kidneys.
I do not feel any pain in that area; why was a non-steroidal anti-inflammatory drug (NSAID) prescribed? Can I avoid taking it? If anti-inflammatory medication is necessary for treatment, would acetaminophen be a better option? Some physicians online mention that NSAIDs are not suitable for patients with renal failure and can harm the glomeruli.
I have read many articles about this, and it seems that many people with urgency and incontinence do not find relief.

I wonder if the physician has any other suggestions regarding additional tests to determine the issue or if switching to traditional Chinese medicine and herbal treatments would be better.
Should I consider dietary supplements like pumpkin seed oil or lycopene for gradual improvement? My main concern is to prevent further damage to my kidneys and glomeruli.
Thank you.

Bao Bao, 30~39 year old female. Ask Date: 2024/03/01

Dr. Xu Wencang reply Urology

It is recommended to visit a nephrology outpatient clinic for evaluation regarding medication or daily health care.
Please discuss this with your attending physician.
Thank you.

Reply Date: 2024/03/01

More Info

Hello! Thank you for sharing your detailed medical history and concerns regarding your urinary symptoms. It sounds like you've been through a lot over the past several years with your urinary urgency, incontinence, and the various treatments you've tried. Let's address your questions and concerns systematically.

Understanding Your Symptoms
1. Prostatitis vs. Overactive Bladder (OAB):
- Prostatitis, which can be acute or chronic, often presents with symptoms such as pelvic pain, urinary urgency, frequency, and sometimes pain during urination. Given your history of mild discomfort during the digital rectal exam, it is possible that you may have chronic prostatitis or pelvic pain syndrome.

- On the other hand, overactive bladder is characterized by a sudden urge to urinate that may be difficult to control, often leading to increased frequency and urgency. It can occur without any underlying infection or inflammation.

2. Urinary Frequency and Volume:
- Your reported urinary frequency of approximately every 25-30 minutes, especially after consuming a significant amount of fluids, is indicative of a possible bladder dysfunction. The fact that you are maintaining a high fluid intake is good for overall health, but it may exacerbate your symptoms if your bladder is not functioning optimally.

Treatment Options
1. Medications:
- You mentioned being prescribed medications like levofloxacin (an antibiotic), oxybutynin (an anticholinergic for OAB), ibuprofen (an NSAID), and doxazosin (an alpha-blocker).
- Ibuprofen: While it is effective for pain relief and inflammation, it can have renal side effects, especially in patients with pre-existing kidney issues. If you are concerned about its impact on your kidneys, discussing alternatives like acetaminophen (Tylenol) with your physician is a good idea, as it is generally considered safer for the kidneys.

- Oxybutynin: This is appropriate for managing OAB symptoms. If you find it ineffective, you might want to discuss other medications in the same class or different classes with your doctor.

2. Non-Pharmacological Approaches:
- Pelvic Floor Exercises: Strengthening the pelvic floor muscles can help manage urinary incontinence and urgency. A physical therapist specializing in pelvic health can guide you through appropriate exercises.

- Bladder Training: This involves gradually increasing the time between urinations to help retrain your bladder.

3. Alternative Therapies:
- You mentioned considering Traditional Chinese Medicine (TCM) and supplements like pumpkin seed oil and lycopene. While some patients report benefits from these, it's essential to approach them as complementary to conventional treatments rather than replacements. Always discuss these options with your healthcare provider to ensure they won't interfere with your current medications.

Further Investigations
1. Additional Testing:
- If your symptoms persist despite treatment, further evaluations may be warranted. This could include urodynamic studies to assess bladder function, cystoscopy to visualize the bladder directly, or even imaging studies to rule out any anatomical abnormalities.

2. Second Opinion:
- If you feel uncertain about your current treatment plan or diagnosis, seeking a second opinion from a urologist or a specialist in pelvic health can provide additional insights and options.

Conclusion
Your concerns about kidney health are valid, especially given your history of glomerulonephritis. It's crucial to maintain regular follow-ups with your healthcare provider to monitor your kidney function and adjust your treatment plan as necessary. Open communication with your doctor about your concerns regarding medications, especially NSAIDs, and exploring alternative therapies can help you find a more effective management strategy for your urinary symptoms.

Remember, managing chronic urinary issues often requires a multifaceted approach, and what works for one person may not work for another. Stay proactive in your healthcare, and don't hesitate to advocate for yourself in discussions with your medical team. Thank you for your inquiry, and I wish you the best in your journey toward better health!

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