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Urinary Disorders

Constant feeling of needing to urinate

01/23/2008

Question:

I have had the feeling of needing to urinate for the last 6 weeks. I have had antobiotics for water infection. They have taken specimens that have all come back negative. I have had an ultra sound on my kidneys/bladder which are all fine. I have had a camera in my bladder and that is all fine also. What do you think could be wrong? I am getting to the point where I can no longer cope with this feeling. Help

Answer:

The symptoms you are describing seem to be urinary frequency and urgency. Some of the common causes of this symptoms are urinary infection, overactive bladder, stone in the lowermost portion of the ureter (tube connecting kidney to bladder,bladder stone, bladder tumor, obstruction to bladder drainage (commonly prostate in men) and incomplete emptying of the bladder (retention). I assume that you are emptying your bladder adequately and do not have urinary retention.

You seem to have been evaluated for urinary infection as per the negative urine cultures. The bladder endoscopy (camera) would have evaluated your urethra and prostate (if male patient) and the bladder for any calculus/tumor, which is all negative from your information. The ultrasound also shows your kidneys/bladder to be normal. An additional test done to rule out bladder cancel causing these symptoms is a urine test for cancer cells (urine cytology), in case this has not been performed.

That leaves the possibility of an overactive bladder (more common in women). What this refers to is that the bladder contracts (squeezes) more frequently than normal causing urinary frequency and urge. This can either occur as a result of a underlying neurologic problem (spinal problem, stroke), diabetes, without any specific cause (non neurologic) or age related changes to the bladder musculature. The diagnostic test done to evaluate for this condition is called urodynamics which is a office based test to measure the behavior of the bladder and bladder pressure/emptying while the bladder is filled with a catheter.

An overactive bladder can be treated initially with medications which help to relax the bladder wall (anticholinergics), with other options available if medications fail. Often a trial of this medication may be given based only on the clinical symptoms, before actually proceeding to the urodynamics (you would need to discuss this with your physician/urologist). As I mentioned earlier, it is important to rule out urinary retention as the symptoms you have described can also be a result of urine being retained in your bladder; the other issue is that the anticholinergic medications can worsen the urinary retention rarely.

As you can see from my response above, it is important to know the age and sex of the patient as well as other coexistant medical conditions, as many of the causes of your symptoms are specific to particular patient populations. I hope my response (though not comprehensive) provides you with reasonable information to proceed with your care. You should contact your physician/urologist for further evaluation and treatment based on the clinical circumstances.

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Response by:

Krishnanath  Gaitonde, MD Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati