Womens Health

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:

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

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.


Symptoms of interstitial cystitis

I have a constant feeling of pressure on my bladder like my bladder is full and I have to go to the bathroom. When it started these symptoms came on all of a sudden within about a week and it was so severe I could hardly sleep. I was placed on Detrol® which helped but I recently went off this and now the symptoms are returning. My doctor has said that I could have interstitial cystitis or that it could be a neurological problem such as Multiple Sclerosis. I have no other symptoms for M.S. The doctor has not done any scopes or anything to rule out the interstitial cystitis, but does not think it is that because my symptoms were better on the Detrol.

What are the chances of this being multiple sclerosis? Is this a common symptom of M.S.?

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?

My bladder does not feel like it completely empties. I do not have an STD or UTI; I've been checked. I do not urinate a large amount it is small amounts all day long. I do not have leakage during the night or when I wake up. I have a past history of 2 operations for endometriosis. Each time my doctor removed endometriosis off the bladder. I am bleeding in my urine.

How would you check to see if you have cancer, endometriosis, etc. on the inside of the bladder?

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.

I was hoping you could expand on cystoscopy. Just by looking at the bladder w/cystoscope a doctor can tell if you have bladder cancer?

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?

Is there any way that if you had endometriosis and had a laparoscopy that showed that you didn't have endometriosis on the outside of your bladder, could there be endometriosis on the inside of your bladder? How could a doctor check for this? MRI? What types of tests would one need to check?

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

I've had problems with my back for two years. I had an auto accident and suffered from whip lash and lower back pains. I've only had x-rays of left and right sides of my body as well as chest x-rays. Ever since this auto accident I've had to urinate every 45 minutes for the past year. I've gone through all the urinary tract tests they came out negative and also had sexually transmitted disease tests run they were also negative. I do not have blood in my urine and there is no burning or pressure pain. When I sit for even 20 minutes I have to use the bathroom I have tingling and numbness from the back of my legs which extend to the ankles. My behind sometimes aches as well as sharp stabbing pains in my rectum. What type of test should be run?

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.

What type of Doctor do I need to go see. This has been going on for too long. Also I'd like to add I have muscle spasms in the lower back.

Urologist or urogynecologist for the urinary frequency and a neurosurgeon for the back problems.


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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?
2 months ago
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.
2 years ago
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