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Re: Constant Urge to Urinate

Posted By HFHS M.D.-AK on July 30, 1998 at 18:10:48:

In Reply to: Constant Urge to Urinate posted by Eileen on July 21, 1998 at 13:24:03:

I am a 40 year old female with no other medical Problems.  About 2 months ago out of the blue I started to feel like I had to urinate constantly.  I go to the bathroom and within minutes I feel like I have to go again, all day long.  When I went to my primary care doctor and the first time I went to the Urologist I had no Urinary tract infection but on subsequent visitsI have had infections that they gave me antibiotics for.  That seemed to help SLIGHTLY with the pressure but I still have the constant urge to urinate.  The urologist did an IVP a cystoscopy and a urodynamics and he says he can't find anything.  I have a friend who said she had the same symptoms and said she had a dilitation that cleared up her problem.  When I mentioned that to my doctor he said that was an archaic procedure. I've just recently made an appt. with another urologist as I am just about going out of my mind.  It's like torture every minute of the day feeling like you have to go to the bathroom.  I could go 10 times every 5 minutes and the feeling would still be there. It seems like the more immobile I am the better it is.  If I'm just laying down it doesn't feel as bad as if I'm walking or driving in the car is the worst.  Any advice you could give would be appreciated.
I sympathize with your condition and plan to provide you with information such that you can understand that you are not alone.  You may have a condition known as interstitial cystitis(IC).  This is a chronic inflammation of the bladder wall.  It differs from common cystitis in that the latter is caused by a bacterial infection, which can be treated by bacterial antibiotic therapy.  Your urologist was correct by performing an IVP and cystoscopy to rule out cancer or anatomic abnormalities which could also be a cause for your irritative symptoms.  Urodynamics was done to make sure your bladder functions properly and that it is not unstable.  It is also important to note that IC is not a psychosomatic disorder nor is it caused by stress.
IC can affect people of any age,race or sex.  It is, however, most commonly found in women.  A 1987 epidemiological study estimated that 450,000 people may be affected by the disease.  The symptoms include:
-Frequency-Day and/or night urination(up to 60 times a day in severe cases.)  In early or very mild cases,frequency is sometimes the only symptom.
-Urgency-The sensation of having to urinate immediately may also be accompanied by pain,pressure or spasms.
-Pain-Can be in the abdominal,urethral,or vaginal area.  Pain is also frequently associated with sexual intercourse.
-Other Disorders-Sometimes patients also report experiencing symptoms such as muscle and joint pain,migraines,allergic reactions,colon and stomach problems as well as the more common symptoms of IC described above.
Diagnosis is very difficult and must follow several steps:
1)Urine cultures must be negative
2)Rule out other associated disease
3)cystoscopy-routine cystoscopy in the clinic may not be sufficient to make a diagnosis of IC. It is usually necessary to distend the bladder under general anesthesia in or to see pinpoint hemorrhages on the bladder wall a hallmark of this disease.  It may even be necessary for a biopsy to be take at that time as well.
1)Bladder distention
2)Oral medication-anti-inflammatory drugs,antispasmotics,antihistamines and muscle relaxants.
3)DMSO(Dimethlyl Sulfoxide)-bladder instillation
4)Elmiron-(Sodium Pentosanpolysulfate)
7)Tens Unit
8)Silver Nitrate
9)Clorpactin WCS-90
10)Self Help- biofeedback
I agree with your first urologists work-up thus far. A urethral dilation is something not performed on a routine basis anymore as done in the past.  It sound like another cystoscopy under anesthesia and might help with a diagnosis, it may also be therapeutic at the same time.
This information is provided for general medical education purposes only.  Please consult your physician for further diagnostic treatments and 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.-AK
*keyword: frequent urination
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