Suggest treatment for urge incontinence, recurrent UTI and low libido

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Posted on Mon, 18 May 2015 in Women's Health
Question: Hi, I'm a 24 yr old female and I have had trouble holding my bladder (leaking) and sudden feelings of urgency to go for a little more than 2 years now, starting shortly before I got pregnant. I think it was caused by recurring UTIs that started about 3 and a half years ago..I was treated for my last uti 18 months ago when I was still pregnant pregnant for my son. I've tried doing kegals in hopes of fixing it but I noticed any improvement.. I've also noticed within the past few months I have less and less of a libido.. I now almost never feel sexually excited and on the rare occasions I do feel that way, they are short lived and nothing feels good down there. Do you know what could help me and if the two problems might be related?
doctor
Answered by Dr. Nishikant Shrotri 58 minutes later
Brief Answer:
Infection seems to be the cause.

Detailed Answer:
Welcome to the Health Care Magic platform XXXX!
I have gone through your detailed history. You seem to be having urge incontinence where in one cannot hold urine after having the sensation of urination; and moreover, this sensation is too frequent. There are various causes which can give rise to this problem, of which the important and related to your case are:
1. Urinary Bladder infection
2. Crystaluria : undissolved salt crystals in the urine, the commonest being Calcium oxalate. This can in turn lead to recurrent urinary infection.
From your history it appears that you are suffering from recurrent urinary infection. This might have involved now the urinary bladder also. Because of the urinary bladder inflammation, the bladder has become very sensitive and hence gives the feeling of urination frequently. Also because of the inflammation of bladder lining and walls, the capacity of bladder to hold the urine has become less.
Unfortunately these chronic urinary infections become more severe in pregnancy as during pregnancy, due to a hormone called as progesterone, there is relaxation of smooth muscles of urinary system and the urine stagnates for a longer time.
Have you got your urine tested? If so latest when? Please send me all the latest urine reports. Does it show any evidence of infection and/or crystals?
If there is urinary infection, particularly recurrent infection, you have to get your urine tested to find out which organisms have infected your urinary system and to which antibiotics they are sensitive (Culture & Sensitivity Test). Accordingly, your doctor will prescribe you the medicines.
Please remember, urinary infection, particularly chronic and/or recurrent one needs a prolonged antibiotics treatment to be taken repeatedly. If your urine shows infection and the culture and sensitivity test reveals the bacteria and the required antibiotics, you will be put on those medicines by your doctor. The other infections usually are controlled within 5 days while in such urinary infections, the antibiotics may have to be taken for about 2 weeks. Such three courses of one each month may have to be taken to control such a trailing infection. This should give you relief.
If required, your urology specialist may like to examine your urinary bladder from inside by ultrasonography, X-rays and/or by a telescope (cystoscopy). Please, in such case cooperate with him/her to get this examination done. It will reveal if at all there is any unseen pathology inside the urinary bladder.
Meanwhile you can request your doctor to give you urinary analgesics (pain killers) which will bring down the irritability of the bladder lining and give you symptomatic relief. Taking urinary alkalinizers also may help. Please drink plenty of water to dilute the urine so that the irritation will be less.
The Kegels exercises you have tried are more useful in stress incontinence where due to weakness of pelvic muscles, the bladder cannot hold urine whenever there is increased pressure in the abdomen - like sneezing, coughing, etc. For urge incontinence they may not prove to be effective.
Your loss of libido can be attributed to the stress you are having of your urge incontinence. You seem to be continuously worried about leakage of urine even during sex. Once you are relieved of the condition, your sexual problem also will be automatically taken care of. Please do not lose carriage nor lose your confidence. I am sure, with proper urinary system examination, your problem will be clear and with a proper FULL & COMPLETE treatment you will be fine and will lead your normal life in future.
I hope I have answered all your questions. If you furnish me with the reports I have asked for and any other relevant reports you have with you, I may be in a position to give you further more guidance on your condition.
Wish you a speedy recovery and happy married life!

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Nishikant Shrotri 1 hour later
I haven't had a urinary tract infection in 18 months
doctor
Answered by Dr. Nishikant Shrotri 7 hours later
Brief Answer:
Let us investigate for the other causes

Detailed Answer:
I would have like to have your reports seen. However, I beleive in you that no infection is seen in your urine in last 18 months. The question of crystaluria/urinary stone(s) still remains unaltered. Urine examination can tell you about this. What is the information about that? Intravenous Pyelography (X-ray of urinary organs after injeting radio-opaque dye) and/or Ultrasonography can help you diagnose this and many other lesions not visible otherwise. Have you already undergone these investigations? Since you have not posted any of your reports, I am not in a position to go through them to get any clues.
If nothing abnormal is detected in these, I would advice you to get Cystoscopy (exmanination of urinary bladder by a telescoe) done. You may ask your urologist about this.
Till that I would advice you to practce bladder training excercises. This can be done when you are in house to avoid any embarassing situation. Initially start with a period of one hour. Try to hold the urine for one hour. Every one hour you will void the urine. Once you get a good controll go on increasing this period by one hour or a lesser period depending up on your comfort levels.
For any further advice, all these reports in details are required. If you can send them, I will be most happy to discuss with you further to help you out.

Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Nishikant Shrotri

OBGYN

Practicing since :1968

Answered : 2916 Questions

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