Urinary Difficulties: Is It Nerve Disorder, Infection, or Anxiety?

Q: Urinary Difficulties: Is It Nerve Disorder, Infection, or Anxiety?

Easily Nervous： Hello, you can drink more water to maintain a daily urine output of 1200-1500 ml. <br>Ureteral stones are relatively easy to diagnose. <br>For autonomic nervous system disorders, the best improvement is through exercise, ideally more than 30 minutes a day, with an

Autonomic nervous system dysfunction

I have a question for Dr.
Hsu.
I am unable to urinate and need to stand for a long time or try various methods, such as being completely undressed, sitting, or soaking in a bathtub, before I can finally urinate.
I would like to know if this is due to urethritis causing the constant urge to urinate but being unable to, or if it could be urinary stones? I also found online that this might be related to autonomic nervous system dysfunction, where anxiety and panic attacks make me feel like I need to urinate even when I don't.
If this is indeed autonomic nervous system dysfunction, which specialty should I consult? Are there any methods or medications to help alleviate my anxiety and improve my ability to urinate?
If it is urethritis, what should I do? Will taking medication resolve it? When I had a urine test, the catheterization showed some inflammation, and the doctor prescribed antibiotics, saying it would help.
However, the doctor also mentioned that antibiotics should be used cautiously to avoid resistance.
What does antibiotic resistance mean? Does it mean that if I take medications related to urination in the future, they might become ineffective?
I apologize for asking so many questions, but not being able to urinate is really uncomfortable, and I want to improve this symptom quickly.
I have had these symptoms for 20 years, and while they improved somewhat, I still need to use the restroom when I go out.
At urinals, I can’t seem to urinate at all.
Now, these old symptoms have returned, and it’s really distressing.
Is this due to urethritis, or could it be an enlarged prostate causing urinary difficulties? Or is it simply that I am overly anxious and mistakenly believe I need to urinate when I actually don’t? I often find myself standing in the restroom, panicking, and when I finally do urinate, the amount is not much.
Please help clarify this for me, thank you.

Rongyi Jinzhang, 40~49 year old female. Ask Date: 2015/07/03

Dr. Xu Weikai reply Urology

Easily Nervous: Hello, you can drink more water to maintain a daily urine output of 1200-1500 ml.
Ureteral stones are relatively easy to diagnose.
For autonomic nervous system disorders, the best improvement is through exercise, ideally more than 30 minutes a day, with an intensity that raises your heart rate above 130 beats per minute for at least 3-5 minutes, and avoid spending long periods in air-conditioned rooms.
Regarding antibiotic resistance, it may be necessary to discuss this with a clinical physician.
In principle, it is important to complete the full course of antibiotics and take the appropriate dosage to avoid developing resistance.
If there are any unclear points, feel free to ask again for further discussion and research.
Online responses can only serve as a reference; if necessary, it is still important to seek medical care at a healthcare facility.
The Ministry of Health and Welfare Taitung Hospital cares about you.

Reply Date: 2015/07/03

More Info

Understanding urinary difficulties can be complex, especially when multiple factors such as nerve disorders, infections, and anxiety come into play. Based on your description, it seems you are experiencing significant challenges with urination, which could be attributed to a combination of physical and psychological factors.

Potential Causes of Urinary Difficulties
1. Nerve Disorders: Nerve damage or dysfunction can significantly impact bladder control and sensation. Conditions such as multiple sclerosis, spinal cord injuries, or peripheral neuropathy can lead to issues with bladder contraction and the sensation of needing to urinate. If you have a history of nerve-related issues, this could be a contributing factor.

2. Infections: Urinary tract infections (UTIs) can cause inflammation and irritation of the urinary tract, leading to symptoms such as urgency and difficulty urinating. If you have been diagnosed with a mild infection, it is essential to follow your doctor's recommendations regarding antibiotics. However, overuse of antibiotics can lead to antibiotic resistance, which means that bacteria can become resistant to the effects of the medication, making future infections harder to treat.

3. Anxiety and Psychological Factors: Anxiety can manifest in various physical symptoms, including urinary difficulties. The feeling of needing to urinate but being unable to do so can create a cycle of anxiety, leading to further difficulties. This is often referred to as "psychogenic urinary retention." In such cases, the body’s stress response can inhibit normal bladder function.

Recommendations for Management
1. Consultation with Specialists: Given the complexity of your symptoms, it would be beneficial to consult both a urologist and a mental health professional. The urologist can assess for any physical issues such as infections or structural problems, while a mental health professional can help address anxiety and its impact on your urinary function.

2. Diagnostic Tests: Your doctor may recommend tests such as urinalysis, urine culture, or imaging studies to rule out infections or anatomical issues. If nerve damage is suspected, further neurological evaluation may be necessary.

3. Medication Management: If anxiety is a significant factor, medications such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines may be prescribed to help manage anxiety symptoms. For urinary issues, medications that promote bladder relaxation or improve bladder contractility may be considered.

4. Behavioral Techniques: Techniques such as biofeedback, pelvic floor exercises, and bladder training can help improve bladder control and reduce anxiety related to urination. Mindfulness and relaxation techniques may also help alleviate anxiety symptoms.

5. Hydration and Diet: Maintaining proper hydration is crucial, but it’s also important to be mindful of irritants such as caffeine, alcohol, and spicy foods, which can exacerbate urinary symptoms.

Understanding Antibiotic Resistance
Antibiotic resistance occurs when bacteria evolve and become resistant to the effects of medications that once effectively treated infections. This can happen due to overuse or misuse of antibiotics, leading to the development of "superbugs." It is essential to use antibiotics only as prescribed and to complete the full course of treatment, even if symptoms improve before finishing the medication.

Conclusion
In summary, your urinary difficulties may stem from a combination of nerve issues, potential infections, and anxiety. A multidisciplinary approach involving urologists and mental health professionals can provide a comprehensive treatment plan. It’s crucial to address both the physical and psychological aspects of your symptoms to achieve the best outcomes. If you have further questions or concerns, don’t hesitate to reach out to your healthcare providers for personalized advice and support.

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