Urinary Frequency and Urgency Problems
Frederick R. Jelovsek MD
Overactive bladder
I have the feeling of having to urinate constantly. I do not have leakage and all urine cultures and tests have come back fine. My doctor says I have a hyper-active or over-active bladder.
Can you tell me how common is this, what causes it, and how do you distinguish between over-active bladder and other causes such as interstitial cystitis? Also, please tell me the treatment.
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:
- urgency without incontinence
- daytime frequency more than 8 voids per day
- nighttime frequency more than 4 voids per night
- bladder pain relieved by voiding
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
Is there a connection between uncomfortable bladder symptoms and the use of IM depotestadiol. After an injection (every other month) or when my estrogen drops too low, I have frequent urination, sense of fullness or pressure in the bladder and an uncomfortable sensation at the entrance of the urethra, maybe the Skene's glands? Pyridium and/or NSAIDs help.
Also, I have noticed a small bulge in the lower portion of my vagina (behind the bladder)about the size of a walnut. Do you know what this could be?
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.
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Many years ago I had a routine checkup with my internist, who was the husband of one of my tennis teammates. He found blood in my urine and sent me to a urologist. The urologist tested for cancer, infection, found nothing, but put me on antibiotics. This began nearly a year of antibiotics and then infections of urinary tract or reproductive system. During this time the urologist suggested a cystoscopy. At the time I was doing graduate work at Radcliffe Seminars. There were several older women in the seminars and they said: Whatever you do, don't let him use the steel rods. It actually narrows the urethra with scar tissue. I told the urologist no rods. He did it anyway, as I lay there helpless with feet in stirrups. My classmates were right, it only got worse and I began peeing in many directions. At the end of a year I had jury duty and did not play tennis for a month. For the first time, no blood in the urine. Now the internist could have figured that out, considering I played 15 hours a week for tennis with his wife. But now I was having these rounds of infections as an aftermath of antibiotics. I quit seeing urologist, taking antibiotics, and read every book I could find by women and women doctors on the subject of cystitis. I followed their practical advice: cotton panties, cranberry juice and NO ANTIBIOTICS. I have not had the urgency or infections since. I do have a narrowed urethra thanks to the steel rods, and get burned skin from my urine spraying my legs when I am away from home and can't bathe the area properly. Aren't docs wonderful?
My bladder feels full all the time, I have a contant feeling like I need to pee but its not painful and there is no strong urgency. I usually only pee about 1/3 cup. I started measuring it. All my urine tests come back negative. There has been blood found in my urine and I sometimes see it once or twice a month on my underwear and when I wipe. Pink in color. I cannot sleep on my back anymore b/c I wake up with pain that is on both sides from front to back. Once I get up and pee I feel better. I am waiting to see my doctor again and I am going crazy waiting to see a specialist. I have to wait six months to see a gynocologist and I am goaing back to stress I want to see a urologist. It is so frustrating.