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Occasional Difficulty Urinating, Esp. During Menstruation
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ellemus posted:
About 4-5 years ago (I was about 17, had sex once in my life before then) I started experiencing occasional difficulty peeing, like all of my urine would not come out and it would take several tries. A lot would come out (like normal peeing) and I would still feel the urge (not in my bladder, but in my urethra) and could only force a little out at a time. I notice that this tended to happen around or during my period. This has continued with varying frequency and still happens now. I do not have discharge, though I may be itchy more frequently than others (not sure how often is a lot), and urinating does not burn, ever.

Things about me that may or may not be relevant to this:
My periods are not extremely heavy or with frequent cramping. They were when I was younger, but haven't been for four years or more (for two of those years, not in a row, I was on the pill)
When I first began going out with my most recent boyfriend earlier this year, I would experience some bleeding directly after intercourse. This stopped after a couple of months.
I have had two pap smears and one blood test since I was 18 and have never been diagnosed with an STI or found anything abnormal.
I nearly always feel a tightness/close to pain at the beginning of intercourse (lasts only a few seconds if that, this could be common for others for all I know)
I have never been treated for a UTI though I cannot say that I have definitely never had one.
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Jane Harrison Hohner, RN, RNP responded:
Dear ellemus: From your well written history I would suspect a urological condition rather than a purely GYN issue. Many body systems will experiencing worsening symptoms around the time of menstruation (eg asthma, migraine headaches, epilepsy, genital herpes, and MANY more). Thus for a urological problem to be worse around menses is not unheard of.

So the question would be "What is the cause of this voiding difficulty?" Alas, I do not have specific urology expertise so these are only some surmises:

1. Residual volume remains in the bladder after voiding; it can be a common problem.

2. Urethral diverticulum--this is a small pouch or kink in the urethra which allows urine to pool in the urethra after voiding. Then when one gets up off the toilet there can be urine that leaks out.

3. Urethral syndrome--while poorly understood, the symptoms can include urgency/frequency/irritation. Both chlamydia and usual UTI pathogens have to be ruled out before urethral syndrome is considered.

4. A variant of detrusor instability where there is inappropriate firing of the nerves that make the bladder contract.

Ellemus, your best bet is to see a urologist that focuses on women or a uro-gynecologist (trained as both a GYN and a urologist). Some voiding studies might allow for a more "for sure" diagnosis. If you do get a diagnosis would you be kind enough to write us back? Through the miracle of the internet, another women with your symptoms might find your post.

Sincerely,
Jane

PS Here is a link to a discussion of other conditions which can mimic some of the symptoms of a UTI:

http://blogs.webmd.com/womens-health/2011/01/causes-of-the-uti-that-isnt.html


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