Constant Urge to Urinate: and Managing Your Symptoms

I have the urge to urinate 24 hours a day, and I'm going crazy?

I have been experiencing difficulty urinating for a longer time than usual since about a year or two ago, possibly due to my tendency to get nervous.
However, this is not what is currently troubling me.
On the morning of September 14, I woke up needing to urinate but was completely unable to do so.
After waiting for half an hour, I finally managed to go, but I was still concerned and decided to see a doctor.
The doctor mentioned that my difficulty urinating might be due to taking cold medication (which I took on September 12 and 13).
The doctor prescribed medication for benign prostatic hyperplasia, and after taking it, my condition improved somewhat.
A day or two later, during masturbation, I experienced orgasm without ejaculation (retrograde ejaculation), which startled me.
After researching online, I found that this could be a side effect of the medication for benign prostatic hyperplasia, so I stopped taking it immediately.
On the same day that retrograde ejaculation occurred, I felt discomfort in my bladder.
After urinating several times, I gradually noticed that I felt the urge to urinate again just a few minutes after finishing.
When I went to the bathroom, I found I could not urinate, and this sensation has continued.
The urge is not urgent, but I constantly feel the need to urinate, which is very uncomfortable.
I can only manage to urinate a little, and I have to press on my bladder to see if there is actually any urine.
The only time I do not feel this urge is when I am asleep, which is extremely distressing.
I do not always wake up at night to urinate, but after vigorous exercise, the sensation seems less pronounced until I go to the bathroom again, at which point it feels like everything resets and starts again.
I have seen five doctors, and my urine tests have come back normal.
X-rays showed no stones.
After being given medication to relax the bladder sphincter, the urge to urinate seemed to diminish somewhat, but it is still very noticeable.
The doctor later increased the dosage, but I did not feel any difference.
These past three months have been incredibly painful for me.
I am afraid that the problem will not be diagnosed, that the medication will be ineffective, and that this sensation will follow me for the rest of my life.
I envy my past self who did not have this issue; I can no longer concentrate on anything.
The only time I feel comfortable is for a few minutes after urinating.
Aside from needing to take time to urinate, my current symptom is just that constant urge to urinate.
Doctor, what is wrong with me?

Jiu wo, 10~19 year old female. Ask Date: 2015/12/26

Dr. Xu Weikai reply Urology

Hello, you may be experiencing autonomic nervous system dysfunction.
During normal urination, the bladder should contract while the urethra relaxes; however, your body is not communicating properly in this area, leading to urinary difficulties.
If possible, you could undergo a "urodynamic study." A more convenient approach would be to engage in regular exercise, ideally at a moderate to vigorous intensity.
It is generally recommended to exercise 3-5 times a week for at least 40-60 minutes each session, aiming to reach a heart rate of 140-150 beats per minute for 2-5 minutes (depending on individual fitness levels).
If done consistently, you may start to see improvements in about 1-2 weeks.
Additionally, it is advisable to keep a record of your fluid intake and urination patterns: note when you drink water, how much you consume, and when you urinate, including the volume.
For example: 104-12-27 6:00 AM urination 250 mL, 7:00 AM water intake 300 mL.
Try to maintain this record for at least three days and bring it to your outpatient visit for your physician's reference, which may help identify the underlying issue (you can skip nighttime entries).
If you have any further questions or need clarification, feel free to ask for further discussion.
Please remember that online responses should only serve as a reference; it is essential to seek medical attention at a healthcare facility if necessary.

Sincerely,
Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2015/12/26

More Info

It sounds like you are experiencing a very distressing situation with your urinary symptoms, and I want to assure you that you are not alone in this. Many individuals face similar challenges, and it is crucial to approach this issue with a comprehensive understanding of the potential causes and treatment options available.

From your description, it seems that you are dealing with a combination of urinary urgency, difficulty initiating urination, and possibly some psychological factors that may be contributing to your symptoms. The fact that you have been to multiple doctors and undergone various tests, including urine analysis and X-rays, is a positive step toward identifying the underlying issue.

One potential cause of your symptoms could be related to the medications you have taken, particularly the cold medicine. Some over-the-counter medications, especially those containing antihistamines, can lead to urinary retention or difficulty urinating as a side effect. Additionally, medications for benign prostatic hyperplasia (BPH) can also cause retrograde ejaculation, which you have experienced. This occurs when semen enters the bladder instead of exiting through the penis during ejaculation, and while it can be alarming, it is generally not harmful.

The sensation of constant urgency to urinate, even when the bladder is not full, can be attributed to a condition known as "overactive bladder." This condition can cause a frequent and sudden urge to urinate, often accompanied by discomfort. Stress and anxiety can exacerbate these symptoms, leading to a cycle of worry that makes the situation feel even more overwhelming. It’s important to recognize that psychological factors can play a significant role in urinary symptoms, and addressing these through therapy or counseling may be beneficial.

In terms of management, there are several strategies you can consider:
1. Medication Adjustment: Since you have already tried medications to relax the bladder sphincter, it may be worth discussing with your doctor the possibility of adjusting your current medications or trying different ones. There are specific medications designed to treat overactive bladder that may help alleviate your symptoms.

2. Behavioral Techniques: Bladder training and pelvic floor exercises (Kegel exercises) can help improve bladder control and reduce urgency. These techniques involve gradually increasing the time between urinations and strengthening the pelvic floor muscles.

3. Lifestyle Modifications: Keeping a bladder diary to track your fluid intake, urination patterns, and any triggers for your symptoms can provide valuable insights. Additionally, reducing caffeine and alcohol intake, which can irritate the bladder, may also help.

4. Psychological Support: Given the anxiety and distress you are experiencing, seeking support from a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) has been shown to help individuals manage anxiety and related symptoms effectively.

5. Follow-Up with Specialists: If your symptoms persist despite treatment, consider seeking a referral to a urologist who specializes in bladder disorders. They may offer additional diagnostic tests or treatment options that have not yet been explored.

It’s understandable to feel frustrated and anxious about your situation, especially when it seems like the problem is not resolving. However, with the right approach and support, many individuals find relief from their symptoms. Remember, you deserve to feel comfortable and confident in your body, and there are professionals who can help you achieve that. Don’t hesitate to reach out for further assistance and advocate for your health.

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