Hello doctor,
I am a 31 year old woman. This problem started about four years ago around the same time I was diagnosed with Hashimoto's thyroiditis. And, I suffer from a constant and persistent urge to urinate concentrated in my urethra. Sometimes, it is accompanied with pressure, discomfort, slight pain, twitching, or spasming. My urine flow is weak and hesitant, and I have to strain or push to empty my bladder, and sometimes I feel that I have not completely emptied my bladder. The urodynamics study did not show an overactive bladder, and my urogynecologist told me that it showed that my bladder did not mount a good contraction. Please advise.
Hello,
Welcome to icliniq.com.
- You may be suffering from an underactive bladder.
- Tablet Urivoid (Bethanechol) one tablet in the morning and evening should help.
- If possible, send me the urodynamics report with graphs.
For more information consult a urologist online --> https://icliniq.com./ask-a-doctor-online/urologist
Hello doctor,
Thank you very much for your reply. I am attaching my urodynamics report with graphs in a PDF file with eight pages. My urogynecologist here wants me to try the Interstim neuromodulator device but I want to try medications first as you suggested. My symptoms now are, a constant need to urinate centered in my urethra that comes again immediately after urinating, a very weak flow, hesitancy, straining and pushing to empty, a feeling of incomplete emptying. I am currently not taking any medications as the Detrol caused urine retention. Based on the urodynamics report, is it underactive bladder or is there something wrong with my urethral sphincter muscles? I would appreciate any help you can give as I am suffering from this condition.
Hello,
Welcome to icliniq.com.
I have seen the reports and graphs sent by you (attachment removed to protect patient identity).
- It clearly suggests an underactive detrusor. Since you have an underactive bladder, you will suffer from retention if you take Detrol LA (Tolterodine).
- Sorry, but there are not many options for an underactive bladder. Once the bladder muscles get damaged, it is difficult to gain its strength. Strangely, you are very young to have an underactive detrusor.
- You can try Urivoid tablet (Bethanechol) 25 mg in the morning and evening.
- Another option is a clean intermittent catheter. Twice a day, you just need to catheterize and empty your bladder completely. I know it sounds strange, but it is not as difficult as it sounds.
- Interstim is also an option, but how much relief it would give cannot be predicted. If you are going for Interstim, they will do a trial run for two to three weeks. After that, they would keep a permanent implant if you feel better.
- So, I think you can take a trial run and if you feel better, then only go ahead with it.
For more information consult a urologist online --> https://icliniq.com./ask-a-doctor-online/urologist
Hello doctor,
Thank you for your clear response. My doctor here does not want to prescribe the Urivoid for me. I used to hold my urine a lot when I was a teenager, could that have weakened the muscle? When I was a child, I used to stop my urine flow in the middle a lot and then start it again. Could that also be a reason? Could it be related to my underactive thyroid, although I am now taking thyroid hormones and monitoring my dose?
Hello,
Welcome back to icliniq.com.
- Yes, unfortunately, faulty bladder habits (such as prolonged holding, and stopping urine in between the flow) formed during childhood and teenage can cause bladder problems later in life.
- At present, in your urodynamics graph, your voiding pattern looks fine, that is, there is no problem with the pelvic floor or sphincter while voiding, as sometimes a tight pelvic floor during voiding can cause obstructed flow.
- Constipation can also aggravate your problem. I also suggest you avoid constipation completely.
- It is not related to your thyroid for sure.
- But, your bladder is not zero. It has a moderate amount of power still left. So, do not lose hope.
- Urivoid is a safe medicine and I recommend it.
- Also, you should do a timed voiding. You should void every two to three hours even if you do not feel like. Double voiding, which means, after passing once, you should again try one more time to pass the remaining urine.
- All these measures will not improve the flow but will help you to retain less urine behind. I think you should feel better with this and if you get 70 to 80 percent benefit that should be fine.
For more information consult a urologist online --> https://icliniq.com./ask-a-doctor-online/urologist
Hello doctor,
Thanks again for giving me a clear diagnosis and steps to follow. I have used a catheter before when I was unable to empty my bladder fully, and it helps me empty two cups sometimes. I do not have a problem with doing that twice a day. The symptom that bothers me very much is feeling like I need to urinate all the time. This feeling is constant and it comes back immediately after voiding. Is this typical with an underactive bladder? Is there anything I can do to get rid of that constant feeling of needing to go? It is not urgency because I can ignore it for an hour or two but it is there all the time in my urethra. I also want to mention that yesterday I had this feeling that I need to urinate, but I could not urinate at all and when I used a catheter, nothing came out. So, I still get this feeling even when my bladder is empty. Why is that? Is there anything that could be done about the constant feeling that I feel in my urethra that I need to urinate? It is annoying me very much and has almost destroyed my life.
Hello,
Welcome back to icliniq.com.
I can understand your suffering.
- Your above symptoms are not related to underactive detrusor. It is basically urethral syndrome.
- Apart from the medicines, you also need to change your bladder habits.
- Avoid food and liquids which make urine more acidic.
- Drink adequate water.
- Void every two to three hours.
- Practice double voiding.
- Prevent constipation.
- Apart from Urivoid, I also suggest taking tablet Urispas (Flavoxate) one tablet three times a day and syrup Cital (Disodium hydrogen citrate) 10 ml in the morning and 5 ml at bedtime. It is to make the urine more alkaline.
For further queries consult a urologist online --> https://icliniq.com./ask-a-doctor-online/urologist
Hello doctor,
I am so grateful for your clear response and your extensive knowledge. I just have a few questions: Two days ago, that constant need in my urethra was intense. So, I went to an urgent care clinic and they found out that I have leukocytes and some blood in my urine and they prescribed Nitrofurantoin 100 mg twice a day. Is there an antibiotic that I can take long term in a low dose to prevent infections with this underactive bladder? By the way, I will start the Urecholine today. My bladder muscle was working fine and I was voiding big amounts with a strong flow about a year and a half ago. So, could the muscle become underactive suddenly like that?
Concerning that constant feeling in my urethra that I need to urinate, could it be that the muscles around the urethra are tight or something like that? I am saying this because sometimes I feel spasms around the urethral opening. Could Urispas cause the bladder muscle to relax more? I read that it relaxes the urinary tract. Or does it only affect the urethra? Is this urethral syndrome curable by medications and good habits with a non-acidic diet? Will it go away? It is driving me crazy. Thanks a lot. I am looking forward to your response, as you are the only doctor who really gives me satisfying responses and who really cares.
Hello,
Welcome back to icliniq.com.
- Yes, you will have an infection due to the urine retention as urine is a nidus for infection. Regarding antibiotics, any antibiotic is harmful in the long term. But, you can take a low dose Nitrofurantoin 100 mg once daily for a long term. Consult your specialist doctor, discuss with him or her and take the medicines with their consent.
- Regarding your bladder muscle working good before one and a half years, it is because of a slow damage which occurs in the bladder. Before, you may be voiding good because of abdominal straining plus moderate bladder contractions. Now, as the bladder contractions are decreased, your flow is also reduced.
- Regarding the spasm of urethra muscle, we do not have any objective evidence as your urodynamics did not show any spasm of urethral or pelvic floor muscles. So, I think that can be better appreciated by physical examination of the vagina. I suppose your gynecologist has examined you properly. If there was any problem with the pelvic floor or urethra muscles, then she would have told you.
- Urispas should give relief. It may relax the bladder, but not much and it is not powerful like other drugs.
- I am sorry, but the bladder damage is less likely to recover. In your case, we need to focus on your constant urge and other symptoms. If you get symptomatic relief, that would be great. It is a very tricky disease and requires great patience from your side.
- You can also self-catheterize in the morning and evening so that there is less residual urine and fewer infections.
There are other drugs for your symptoms, but we better go slow.
For more information consult a urologist online --> https://icliniq.com./ask-a-doctor-online/urologist
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