Urinary urgency and retention: Causes?

    
      Re: Urinary urgency and retention:  Causes?
    


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Posted by HFHS M.D.-MS on March 05, 1998 at 06:31:45:

In Reply to: Urinary urgency and retention:  Causes? posted by Jana on February 28, 1998 at 00:06:45:

: I have had increasing problems with urinary urgency at least for the past 6-7 years, which is now (since 12/97)under control with Ditropan (2.5 mg TID).  I also have urinary retention of about 5-6 ounces, but have had no UTIs so I don't have to self-cath.  I also had a mildly prolapsed bladder which was surgically corrected 4 years ago, at the same time that I had a laparascopic hysterectomy for fibroid removal. My question is: can urinary urgency and retention be caused by childbirth?  I have two children (ages 9 and 11), and the childbirth for the first was extremely fast and intense.  Forceps were not used for either birth nor was an episiotomy necessary.  However, I wonder if the intensity of the unusually rapid birth could have somehow damaged my bladder and caused the urgency and/or retention?  If so, then would one expect these symptoms to remain the same over time, or to worsen, as mine have?  Also, what are some other likely causes of these symptoms?  I should add that I am 45 and physically fit.  Thank you in advance for your time and consideration.
  Jana  
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Dear Jana
Thanks Jana for your questions.
Birth trauma can cause nerve damage to the bladder and /or  sphincter of the bladder but it is usually seen immediately after the event and with treatment ( self cath) it may get better.  The symptoms you are describing  sound like  an unstable bladder. Urologist call this symptom, urgency. This assumes you have been evaluated for other causes of urinary frequency by your Urologist and there is no other contibuting causes.  See this internet address for a sample work-up for your symptoms. (http://www.medhelp.org/perl6/urology/hfhsur1.gif)
A single cause for an unstable bladder is unknown but is very common.  It has not been associated with birth trauma or  hysterectomy per se, but is associted with pelvic surgery
   As you know, most Urologist try to treat an unstable bladder by behavior modification first, then medications.  This includes the following:  Void frequently on a time schedule before you get the urge.  Void completely even if it takes some time to empty.  Drink fluids in moderation.  Avoid caffeine products.    
Your Ditropan maybe causing some of your problems with frequency and retention.  Ditropan relaxes the bladder so it can not empty as it would without this medication.  This makes the amount left in your bladder after voiding greater. Urologist call this remaining volume in the bladder after voiding, the  post void residual ( PVR).  Your bladder can only hold so much.  The higher the   PVR is, the quicker your bladder fills up to its capacity and thus you  void more frequently.  In this case,   self catheterization will reduce the PVR  and will give you much more time between trips to the bathroom.   With  self cath , the Ditropan can also be continued to help with the unstable bladder symptoms.  .      
The prognosis for an unstable is good in that it would not be expected to becone worse Other systemic and nervous system conditions that  affect bladder emptying deleteriously  are:  diabetes, back injury with a