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bladder retains too much urine..why????

  I am a 27 year old female with severe chronic asthma, I also cough a great deal.  Over the last 1 1/2 have had leakage everytime I sneeze, cough, or laugh.  In the beginning it did not happen often, only once in awhile.  On occasion, also experienced what seemed to be bladder pain or lower pelvic pain.  Then three months ago, had an UTI, that was pretty bad,  took Bactrim DS, and did not clear it up, was changed to Trovan, and the infection finally went away.  But, the urge, frequency and pain has remained.  The leakage has gotten a lot worse, now sometimes happens when I stand up or walk.  I go to the bathroom all the time, I feel as if my bladder is always full, but when I go to the bathroom, sometimes I am able to go a lot and sometimes it seems I cannot go at all.  Went to a urologist.  Gave them a urine sample and then proceeded to urinate in toliet, thought my bladder was empty, but the doctor drained out 180cc of urine from my bladder, I felt empty.  thought I was done.  He is not sure what is wrong,
  has anyone experienced these symptoms..did you ever get any answers.  The doctor gave me Urised to take 3 times daily, been taking it for 3 days and no improvement,  I am scheduled to go back in two weeks, doctor said that I may have to have a test called urodynamics.  What type of test is that?  What can it show?  Is it painful?  I have never in my life experienced the type of pain and discomfort I feel now, my bladder has been so painful that I have actually doubled over in pain.  I am getting scared.  Is it possible that my bladder has weakened or fallen or something?  any suggestions would be greatly appreciated.  thank you.
Dear Karen,
I agree with your doctor wanting to  perform urodynamics. This process involves filling your bladder slowly to see if it contracts at low volumes and measures pressure.  This test may reveal why you leak when you cough and laugh.  It will also tell the capacity of the bladder and how well the bladder muscle can relax.  A catheter is placed in the bladder to measure the pressure changes and you are asked when you feel your bladder is full.  This can be uncomfortable but is usually tolerated well by our patients.  You then urinate and the computer can help the Urologist determine if you are obstructed as well as determine a post void residual (PVR).  The PVR at your last office visit was 180 cc, this is a little high.  The residual urine left in the bladder gives bacteria time to proliferate and may be responsible for your urinary tract infection(UTI).  Urodynamics will hopefully give you a reason why you have residual urine.
I sympathize with your condition and plan to provide you with information such that you can understand that you are not alone.  Many women have urinary leakage and painful urination.  Another thought is that you may have a condition known as interstitial cystitis(IC).  This is a chronic inflammation of the bladder wall and unfortunately there is not a known cure.  It differs from common cystitis (UTI) in that the later is caused by a bacterial infection which can be treated by bacterial antibiotic therapy.  You have been treated successfully with Trovan yet your symptoms remain.  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, bladder cancer, stone disease, anatomic abnormalities
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 order to see pinpoint hemorrhages on the bladder wall a hallmark of this disease.  It may even be necessary for a biopsy to be taken at that time as well.
4)Diagnostic radiology-IVP, KUB
1)Bladder distention
2)Oral medication-anti-inflammatory drugs,antispasmotics, antihistamines and muscle relaxants.
3)Self Help- biofeedback
4)Elmiron-(Sodium Pentosanpolysulfate)
7)Tens Unit
8)Silver Nitrate
If after the work-up I have suggested above, you are determined to have a functioning bladder an chronic inflammation you may wish to try some of the treatments I have mentioned.  If you bladder muscle is weak or you are determined to have an obstruction.  You may have to catheterize yourself, after each void to make sure you are empty.  Your urologist can help you learn this.
The next step is to perform the test that your urologist is comfortable with and determine what your diagnosis is.  Then treatment plans can be discussed.  I agree with you doctors next step of urodynamics and depending on the result, the other studies can be done.
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).
*keyword: Bladder dysfunction, interstitial cystitis

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