post-myomectomy no urge to urinate

I am 42 years old and in excellent health. 2 years ago I started having very heavy periods which increasing became worse and unable to live with. Fibroids appeared to be the issue so after a year and a half of exams (d&c hysteroscopy, ultrasound, etc.) and trying various birth control pills to control the bleeding I came to the decision to have an abdominal myomectomy (my fibroids were intramural).

I had the surgery 17 days ago. Everything seemed to go great. I had a catheter for approx. 24 hours. They gave me 5 hours to urinate when it was removed (or else they would put it back in). After 4 or so hours I was having some pain and pressure and couldn't tell if it was just pain or if I needed to urinate. I tried urinating and was able to with no problem. Through the remaining 2 day hospital stay, my "urges" continued in the form of pain and pressure but I was able to urinate whenever I wanted to.

After being home for a few days and recovering very quickly I realized I had lost my urges to urinate. After several hours I would sometimes feel pressure and maybe a little bloated so I would urinate.

It seemed really odd, so I called my doctor (obgyn). She thought it could be a UTI so she ordered a 1 week prescription for nitro-furantoin (generic for Macrobid - at least that is what it says on the bottle). I have completed the full course of antibiotics and there is still no difference. I talked with my doctor again and she seems to have no concern. She thinks it could still be an issue with the anesthesia or just part of the healing process. She told me to time my urination and watch and wait.

I do sometimes feel a little pressure in the abdomen (not the same feeling as an urge at all) and when I attempt to urinate there is a little hesitation before it begins. I have no burning, no strange colors or odors. I am able to urinate and empty my bladder. I have not had a fever at all during these 17 days. I am still experiencing some pain in my abdomen above where the cut is. It's a pressure/bloating thing and the area can be extremely sensitive to touch at times (it can hurt when even a t-shirt touches it). I will be talking to my doctor about this soon, but I'm including it here in case it could be related.

Thanks in advance for any opinion you may have.

[Kevin Pho, MD]

I would suggest a urology referral.  All the scenarios that you describe are possible - including infection, or neurogenic bladder leading from the anesthesia.  Another possibility may be some nerve damage that arose from the procedure.  

Testing the urine to evaluate for infection was presumable the first step.  Ensure that the bacteria is sensitive to the antibiotic you were described.

Urodynamic testing can also be considered for a more thorough evaluation.  This refers to a group of tests used to assess function of the urinary tract by measuring various aspects of urine storage and evacuation. Some specific types of urodynamic testing are:

* Cystometry (or cystometrogram) evaluates bladder function by measuring pressure and volume of fluid in the bladder during filling, storage, and voiding.

* Uroflowmetry measures the rate of urine flow.

* Urethral pressure profile tests urethral function.

* Leak point pressure determines the bladder or abdominal pressure when leakage occurs due to increased abdominal pressure (Valsalva or cough) to assess urethral resistance.

These options can be discussed with your personal urologist.  I would also ensure there wasn't any nerve damage stemming from the surgery.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Flesh.  Urodynamics.  UptoDate, 2004.