Urine retention

[mel]

Starting about 2 years ago, I began having difficulty urinating at times, usually once a day.  Basically, I couldn't go when I had to go and had to hold the fluid in for a while before I could finally go.  I mentioned this to my gynecologist about 8 months ago, and she suggested that I drink more fluids and see what happens, since I wasn't the kind of person who drank 8 glasses of water a day.  This actually helped and my problem of retaining urine only occurred about once a month.  During this time, I was not sexually active.  However, I got married a month ago, and after the honeymoon, I began to have problems 3-4 times a day.  My symptoms were kind of similar to a UTI, but not quite.  I was tested anyway and came out negative.  Things calmed down sexually too, so after a week, I only had retention problems once a day every couple days. I went to a urologist and he said it sounded like I had overactive bladder and prescribed Detrol.  I am having more problems now and kind of think that he misunderstood and misdiagnosed me.  Overactive bladder does not make any sense to me.  I am not incontinent in any way.  I just can't go when I need to.  Any kind of sexual activity seems to perturb the problem, and even if I don't feel like I need to go before sex, activity brings on the sensation of having to go.  Any ideas on what could be causing this and how it can be treated?

[HFHS M.D.-BL]

Dear Mel,
I think you need to see a urologist who can do a history and physical and pay close attention to a possible urethral diverticulum.  I don’t know that you have documented that you have retention from the brief history that you provided.  You may have been dehydrated and not making a great deal of urine such that you only needed to urinate once or twice a day.  You should probably keep a voiding diary for three days and document the frequency of your urination as well as the volume of each void.  Also, you need to have a formal post void residual performed by your doctor.  You must first void and then be immediately catheterized after.  If this number is less than say 50cc, I don’t think you have retention.  If it is greater, you may need a formal urodynamic work-up.
Urodynamics is a group of tests to evaluate how your bladder functions as well as pressure studies to evaluate incontinence.  During formal urodynamic, a post void residual is always performed.   Urodynamic catheters are smaller than the traditional urinary catheters and don’t seem to bother patients significantly.  During the study your bladder will be filled slowly.  They will ask you when you first feel like your bladder is filling.  Then, they will continue filling your bladder until you have to go to urinate and mark this amount as your bladder capacity.  For this brief moment you may be uncomfortable.
Also , on many urodynamic machines there is a rectal catheter which is usually not painful but rather uncomfortable.  I’m sure your doctors will provide you with prophylactic antibiotic such to avoid any chance of a iatrogenic infection or an infection caused by a test.
Overall, I cannot diagnose your problem over the internet without a full history and physical.  You should see a urologist who specializes in female urinary problems.  He or she can then make recommendations for your further care.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).


Sincerely,
HFHS M.D.-BL
*keyword:Urinary Retention

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