Urgency and Frequency in Urinary Issues: Causes and Solutions

Regarding urinary urgency and frequency issues?

Hello Dr.
Yan! For the past 2 to 3 years, I have been experiencing sudden urges to urinate, so intense that I sometimes can't make it to the bathroom in time.
This occurs quite frequently, leading me to need to use the restroom approximately once an hour, and sometimes even within just 10 minutes of my last visit.
I have seen a doctor who conducted tests including urodynamics, bladder imaging, blood tests, and urinalysis, all of which came back normal.
The doctor suspects I have overactive bladder syndrome and prescribed medication for me.
I was advised to train my detrusor muscle and to try to hold my urine for a bit longer when I feel the urge.
However, sometimes when I try to hold it, I experience a sharp pain or even severe pain around the perineal area, especially when the weather is cold.
I am unsure why this has developed, but I read that overactive bladder syndrome can be related to spinal issues and nerve damage.
Not long before these symptoms began, I underwent surgery to correct pectus excavatum, during which a titanium plate was placed in my sternum.
I still experience bruising pain and discomfort in the area around the bones and nerves.
After the surgery, I was unable to get up and had a catheter inserted.
Could it be possible that the surgery caused damage to the bones and nerves? Or could it be a complication from the catheterization? I am very concerned that if this does not improve, it could lead to serious health issues, as these symptoms are entirely new to me.
I have seen many doctors without resolution, and this greatly impacts my daily life and social interactions, even leading me to have suicidal thoughts.
I sincerely plead for your help, Dr.
Yan.

Ke lian de nan ren, 20~29 year old female. Ask Date: 2010/02/16

Dr. Yan Dawei reply Urology

It is recommended to visit an outpatient clinic for further examination as soon as possible to understand the underlying cause.
If you have thoughts of suicide, you can seek help from a psychiatrist.

Reply Date: 2010/02/16

More Info

Hello! Thank you for reaching out with your concerns regarding urinary urgency and frequency. It sounds like you've been experiencing a challenging situation that has significantly impacted your daily life. Let's break down the potential causes and solutions based on your symptoms and medical history.

From what you've described, your symptoms of sudden urgency, frequent urination (approximately every hour), and the associated pain, particularly in the perineal area, suggest a possible diagnosis of overactive bladder (OAB). OAB is characterized by a sudden urge to urinate that may be difficult to control, often accompanied by increased frequency of urination. This condition can be quite distressing and is often exacerbated by stress, anxiety, or even physical changes in the body.

Given your recent surgery for pectus excavatum and the insertion of a urinary catheter, it is plausible that these factors could have contributed to your current urinary issues. Surgical interventions can sometimes lead to nerve irritation or damage, particularly if the surgery involved manipulation of the thoracic area where nerves that innervate the bladder and pelvic floor originate. Additionally, the use of a catheter can sometimes lead to urinary tract infections or irritation of the urethra, which could explain the pain you are experiencing.

Your mention of experiencing sharp pain during episodes of urgency, especially in colder weather, could also indicate that your bladder is reacting to environmental stimuli or stressors. Cold weather can lead to increased muscle tension, which may exacerbate bladder symptoms.
Here are some potential strategies and solutions to consider:
1. Behavioral Techniques: Bladder training can be beneficial. This involves gradually increasing the time between bathroom visits to help your bladder hold more urine. You can start by delaying urination for a few minutes when you feel the urge and gradually increase this time.

2. Pelvic Floor Exercises: Strengthening the pelvic floor muscles through Kegel exercises may help improve bladder control. These exercises involve contracting and relaxing the muscles that control urination.

3. Medications: Since your doctor has already prescribed medication for OAB, it’s essential to follow up with them regarding the effectiveness of the treatment. There are various medications available that can help relax the bladder and reduce urgency.

4. Lifestyle Modifications: Keeping a bladder diary can help identify triggers for your symptoms. Additionally, reducing caffeine and alcohol intake, which can irritate the bladder, may also be beneficial.

5. Physical Therapy: If nerve damage or pelvic floor dysfunction is suspected, consulting a physical therapist who specializes in pelvic health could provide targeted exercises and treatments to alleviate your symptoms.

6. Psychological Support: Given the emotional toll this condition has taken on you, it may be helpful to seek counseling or therapy. Mental health professionals can provide coping strategies and support to help manage anxiety and depression related to your symptoms.

7. Follow-Up with Specialists: If your symptoms persist, consider seeking a second opinion from a urologist or a specialist in pelvic floor disorders. They may recommend further testing or alternative treatments.

It's crucial to communicate openly with your healthcare providers about your symptoms and any changes you experience. If you ever feel overwhelmed or have thoughts of self-harm, please reach out to a mental health professional or a crisis hotline immediately. Your well-being is paramount, and there are people who can help you through this difficult time.

In conclusion, while your symptoms are understandably distressing, there are various avenues for treatment and management. By working closely with your healthcare team and exploring these options, you can find a path toward relief and improved quality of life. Remember, you are not alone in this, and support is available.

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