Frequent Urination: Causes, Symptoms, and Solutions

Q: Frequent Urination: Causes, Symptoms, and Solutions

S Penguin： Hello, I believe your issue may be related to psychological factors or chronic cystitis, among other possibilities. <br>I may not be able to provide you with a definitive answer here. <br>My recommendations are as follows： 1. <br>Establish a voiding diary： Include dail

Frequent urination issues?

Symptoms: Since the second year of junior high school (around 14 years old), I have had difficulty urinating due to the limited number of restrooms at my cram school and anxiety that prevents me from urinating.
This has led to a habit of holding my urine and drinking less water.
Over time, I became anxious about using public restrooms, which caused me to continue holding my urine.
Gradually, I felt that my bladder capacity was decreasing.
Now, after drinking about 350cc of water, I feel the urge to urinate approximately every half hour, with a urine output of about 100-150cc.
After finishing, I feel the urge again in about 5-10 minutes, with a slightly reduced volume.
When I drink less water, I experience a burning sensation in the urethra during urination.
When anxious, I also feel soreness in the perineal area.
Duration: Each time I urinate, the volume is about 100-150cc, sometimes even less.
This condition has persisted for at least 2 years, and if considering the onset of increased frequency, it has been at least 6-7 years since I started holding my urine frequently in junior high school.
Additional information: Two years ago, I underwent a check-up at a private hospital in Taipei, where a urinalysis revealed hematuria.
An IVP examination was subsequently performed, which returned normal results.
The doctor diagnosed me with mild anxiety disorder.
Two months ago, I had another urinalysis, which also returned normal results.
I was prescribed anti-anxiety medication.
The doctor assessed that the primary issue was not significant nocturia after I fell asleep.
However, I try to avoid drinking water within two to three hours before bedtime, and I sometimes wake up to urinate two to three times before falling asleep, only going to bed when I feel no urge to urinate and have some thirst.
The first morning urine output is very low, around 100cc or sometimes even less.
Occasionally, my naps or attempts to sleep in will be interrupted by the need to urinate, such as waking up two to three times during a one-hour nap.
Urinary frequency becomes more pronounced when I am anxious.
Occasionally, I experience bladder pain during episodes of frequent urination.
I once noticed hematospermia (having had no sexual partners) which has long affected my willingness to travel, slightly impacting my social activities.
I would like to consult with a physician on what further steps or actions I should take.
(I am about to enlist in the military at the end of November and hope this does not affect my service life.) Currently, my daily water intake is about 2000-2500cc with exercise, and below 1500cc without exercise.

S Qie'e, 20~29 year old female. Ask Date: 2005/10/13

Dr. Xu Weikai reply Urology

S Penguin: Hello, I believe your issue may be related to psychological factors or chronic cystitis, among other possibilities.
I may not be able to provide you with a definitive answer here.
My recommendations are as follows: 1.
Establish a voiding diary: Include daily water intake times, amounts, and contents; as well as daily urination times and volumes.
After recording for a period, provide this documentation to your physician for reference.
2.
The recommended daily water intake is generally around 2500-3000 cc, depending on individual constitution.
More accurately, you should aim for a daily urine output of approximately 1500 cc.
3.
If necessary, a urodynamic study should be conducted to clarify the underlying causes of the condition.
Department of Urology, Taitung Hospital, Ministry of Health and Welfare, Dr.
Hsu Wei-Kai.

Reply Date: 2005/10/13

More Info

Frequent urination, especially when accompanied by discomfort or pain, can be a distressing condition that significantly impacts one's quality of life. In your case, it appears that your symptoms have developed over several years, starting from a young age when you experienced anxiety related to using public restrooms. This has likely contributed to a cycle of holding in urine, which can lead to a reduced bladder capacity and increased urgency over time.

Understanding Your Symptoms
1. Frequent Urination: The urge to urinate frequently, especially after consuming a small amount of fluid, can be indicative of several underlying issues. In your case, it seems to be exacerbated by anxiety and possibly a conditioned response to previous experiences of not being able to urinate in public settings.

2. Burning Sensation: The burning sensation in the urethra when urinating, particularly when you drink less water, suggests that your urinary tract may be irritated. This could be due to concentrated urine, which can occur when fluid intake is low, leading to irritation of the bladder and urethra.

3. Pelvic Pain: The discomfort in the perineal area during urination could be related to pelvic floor muscle tension, which is often associated with anxiety and stress. This tension can make it difficult to relax the muscles necessary for urination, leading to further discomfort.

4. Anxiety: Your history of anxiety, particularly in relation to urination, is significant. Anxiety can manifest physically, leading to symptoms such as increased heart rate, urgency to urinate, and even pelvic pain. It’s important to address both the physical and psychological aspects of your symptoms.

Potential Causes
- Psychological Factors: Anxiety and stress can lead to a condition known as "psychogenic bladder," where the psychological state affects bladder function. This can result in increased frequency and urgency of urination.

- Bladder Dysfunction: Over time, holding urine can lead to changes in bladder function, including decreased capacity and increased sensitivity. This can create a cycle where the bladder becomes more reactive to even small amounts of urine.

- Physical Irritation: Conditions such as interstitial cystitis or chronic pelvic pain syndrome could also be contributing factors. These conditions can cause bladder pain and increased urgency without a clear infection.

Recommended Actions
1. Consult a Urologist: Given your history and symptoms, it would be beneficial to see a urologist who specializes in bladder disorders. They may recommend further tests, such as urodynamic studies, to assess bladder function and capacity.

2. Cognitive Behavioral Therapy (CBT): Since anxiety plays a significant role in your symptoms, engaging in CBT or other forms of therapy could help you manage anxiety related to urination. This could also help break the cycle of fear and discomfort associated with using public restrooms.

3. Bladder Training: Working with a healthcare professional on bladder training techniques can help increase your bladder capacity and reduce urgency. This involves gradually increasing the time between urinations to help retrain your bladder.

4. Hydration Management: While it’s important to stay hydrated, managing your fluid intake, especially before situations that trigger anxiety, can help reduce urgency. Aim for a balanced approach, ensuring you drink enough throughout the day while avoiding excessive intake before stressful situations.

5. Pelvic Floor Exercises: Strengthening and relaxing the pelvic floor muscles through exercises can help alleviate some of the discomfort and improve urination. A physical therapist specializing in pelvic health can guide you through appropriate exercises.

6. Medication Review: If you are currently on anti-anxiety medication, discuss with your doctor whether adjustments are needed or if additional medications could help manage your symptoms.

Conclusion
Your symptoms of frequent urination, discomfort, and anxiety are interconnected and warrant a comprehensive approach to treatment. By addressing both the physical and psychological aspects of your condition, you can work towards improving your quality of life and managing your symptoms effectively. As you prepare for your upcoming service, it’s crucial to seek support and explore these options to ensure that your urinary health does not hinder your experience.

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