Urinary Frequency and Urgency Problems
Frederick R. Jelovsek MD
   
Overactive bladder
Overactive bladder is not uncommon in women. We do not know what causes it but the end result is bladder contractions that occur on their on without the stimulation of an actual full bladder. Most of the time you have urgency symptoms but not bad pain. Then you have to go to empty your bladder; otherwise you will probably leak. If you have a full feeling all the time with no real urgency or you just have the feeling that the urethra (as opposed to the bladder) is starting the urge, you may have something other than just overactive bladder. For example, ovarian cysts or bowel spasticity can cause a full feeling and urethral syndrome can cause a urethral urgency.
The hallmarks of interstitial cystitis are:
Be sure to see our disease profile about interstitial cystitis. The key difference between overactive bladder and interstitial cystitis is at night. Overactive bladder will have 4 or less voids per night while interstitial cystitis will have many more episodes of nocturia.
Overactive bladder is treated by anti cholinergic or anti-muscarinic agents. Popular ones are oxybutrin (Ditropan®, Ditropan XL®, tolterodine (Detrol®), imipramine, dicyclomine, and propantheline. Flavoxate does not appear to be very effective.
Bladder frequency, urethral discomfort and low estrogen
Yes. When estrogens are low, the urethral mucosa gets quite thin and more prone to infection and irritation. Estrogen usually helps this by thickening the skin (mucosa) lining the inside of the urethra making it less sensitive to drying out, rubbing or even vaginal bacteria.
The small bulge could be a cystocele which is the bladder itself or the end of the vagina, i.e., vaginal prolapse. If this is the case and you are having pressure symptoms or any difficulty voiding or initiating stool, then surgical repair will usually cure or decrease symptoms.
Symptoms of interstitial cystitis
I assume you have had a urine culture which is negative. Next you should see a urologist for a cystoscopy and biopsy which is the only way to rule out interstitial cystitis. While frequency is one symptom of multiple sclerosis (MS), that is a rare disease. It is more probable that you have a bladder infection, an overactive bladder or interstitial cystitis than MS. Detrol® usually does not help the pain of interstitial cystitis but sometimes it can decrease the frequency and "full feeling". I would not use response to Detrol® as a way of ruling out interstitial cystitis.
Frequency unknown etiology Over a period of about a week I started feeling like I had to go to the bathroom all of the time. It got worse as the week went on. I seen a Dr. and had urine cultures for a UTI but everything came back fine. I don't have any pain. Just the feeling of a full bladder? Can Interstitial cystitis (IC) come on all of a sudden or is it a gradual thing? Is there always pain associated with I.C.? What else could this be?
Usually there is always pain with interstitial cystitis. The pain is relieved by voiding. The symptoms of interstitial cystitis can come on subacutely but usually over several weeks or so. Then it stays at the same level.
Urinary frequency can sometimes be from something pressing on the bladder like the uterus or an ovary. It could still be that there is some infection there even though the urine dip test was negative. Mycoplasma and ureaplasma are not always picked up on standard dip test screens and many doctors will give a treatment with tetracycline or an equivalent to see if these relatively acute symptoms go away before starting an expensive work-up for IC.
If your symptoms persist, you will need to go back for reexam.
Can endometriosis cause urinary frequency?
Urine can be collected and sent for cytological analysis to look
for possible cancer cells. Also, a cystoscopy can be performed to
look on the inside of the bladder for cancer or endometriosis or
any inflammatory process that can produce blood in the urine.
Usually this is done by a urologist or a urogynocologist.
The doctor can suspect it because cancer may often have a
characteristic appearance in the bladder but the proof is in a
biopsy which has to be done and then read by a pathologist. Endometriosis of the bladder would also need to be biopsied.
Can endometriosis get on the inside of the bladder?
The current thinking as to how endometriosis develops is from
retrograde menstruation. That means that when you menstruate, a
portion of the uterine lining bleeds back through your tubes and
enters the abdomen, settling often on ovaries and in the
dependant portions of your pelvis. Therefore, any endometriotic
implants would normally be on the outside of your bladder rather than the
inside.
Rarely, endometriosis can work it's way to the inside of the
bladder. You might lightly bleed when you urinated every month if it
were on the inside. A cystoscopy (looking at the inside of the
bladder) is needed to diagnose endometriosis on the inside of the
bladder.
Sciatica and urinary frequency
If you are having bladder nerve irritation from a back injury, an MRI (magnetic resonance imaging) is the best way to see if the disc(s) are compressing on nerves.
The next highest yield is likely to be from a cystometrogram (not
cystoscopy) which is part of a urodynamic series of studies. The
doctor would be looking for uninhibited bladder contractions that
are causing you urgency. That is treatable by medicine. If the
cystometrogram is negative, then a cystoscopy might be needed to
rule out any interstitial cystitis or bladder stones, which can be associated with
previous trauma.
Sciatica often gives urinary frequency due to nerve stimulation
of the detrusor muscle of the bladder.
Urologist or urogynecologist for the urinary frequency and a
neurosurgeon for the back problems.
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