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Q. Is the diagnosis of overactive bladder for bladder pain in me correct?

Answered by
Dr. Karthik Rajan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 13, 2018

Hello doctor,

I have a problem with overactive bladder and bladder pain. My doctor prescribed me Lioresal. Is the diagnosis correct and can I try with Lioresal? I am afraid of side effects and full urine retention. This is my last medical report showing on palpation, the prostate was not suspicious. The prostate was soft and not sore. On ultrasound, the upper urinary tract was normal, the renal outflow down to the bladder on both sides free. No sign of stones or tumor in the area of the kidneys or urethra.

On transrectal ultrasound, the prostate was found with minor calcifications as remainings of former inflammatory processes. Otherwise, the tissue was homogeneous. The prostate volume about 28 cc. The transrectal longitudinal section of the prostate showed a suspicion of anarrow bladder outlet. There also just in the outlet the calcification was seen. Residual urine was about 120 cc. The bladder wall showed a hypertrophy of the muscular fibers.

On urethrocystoscopy, a normal exterior urethra was found. The passage to the prostatic urethra showed in the bladder outlet some inflammation processes of the mucosa. The mucosa started to bleed even on soft touching. The bladder outlet was stiff and narrowed. The bladder itself showed some hypertrophic muscle fibers. Otherwise, the bladder was uneventful.

#

Hi,

Welcome to icliniq.com.

I have gone through your query and would like to know a few more details about your symptoms.

1. Is your predominant complaint that of increased frequency or weak urinary stream?

2. Do you have any discomfort in the region between your scrotum and anal opening?

From your doctor's report, his findings on examination, scans, and cystoscopy, it appears that you have sequelae of prostatitis where the prostate gland becomes fibrotic and hard not relaxing to allow normal urine flow. It is common that in patients with obstructed flow especially due to prostate inflammation, the symptoms of urgency and frequency usually resolve.

However, in your case, since you have had the symptoms for more than two years, I would like to do a urodynamic study to identify the overactive bladder and also if there is a definite obstruction. As you are already on Silodosin, I do not think that adding Lioresal (Baclofen) will help in the improvement of your symptoms significantly. If Silodosin does not give you any relief, based on the cystoscopy findings, I would rather recommend surgery after a urodynamic examination.

Thank you doctor,

1. My biggest problem is frequent urination and bladder pain when the bladder is full or starting to fill. I urinate 10 to 12 times during the day and 3 to 4 times during the night. I think I urinate much more than I drink water. When I empty the bladder I feel really good. Also, walking and running helps me. It gets much worse when I lay down or sleep.

2. No.

#

Hi,

Welcome back to icliniq.com.

If the frequency is the predominant concern along with increased urine production, then it would be necessary to check the bladder capacity and urine production with a frequency volume chart if you have not already done it. It is basically a chart in which you note down your fluid intake, timing of urination and the volume passed each time over a 24 hour period. Usually, we do it for 3 days at least in a week. It will show us whether the frequency is because of excessive urine production as you have mentioned or a bladder overactivity.

As I had mentioned before, I would advise a urodynamic test to establish whether you have obstruction to urine flow before planning for surgery. Depending on the findings in both, a treatment plan can be identified.


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