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What causes urge to urinate and decreased urine output?

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Posted on Tue, 22 Sep 2015
Question: Hello Dr,
I am experiencing variable urine output, and have been becoming increasingly concerned and obsessive about my symptoms and have been in the ER numerous times, thinking my kidneys must not be working properly. Every test comes out normal; just two days ago I had CMP, urinalysis with microscope tests, and ultrasound of heart, kidneys, and bladder and everything was normal/negative. Creatinine was .7, BUN 10.

I have seen a urologist and a nephrologist and have been told that with my perfect lab results, there is no need for any further testing. I have done a 24 hour urine volume test and it was 2.6 liters, but I know it's frequently much less. For example, some mornings I will drink 16 oz of water and need to urinate urgently twice and some days, with no difference in sweating/activity, I'll barely have to urinate even once. I understand about "insensible losses" but does that explain the wide variation?

I should explain that I became quite concerned, and now obsessive about fluid intake/output when I had PVC-induced cardiomyopathy which was resolved with an ablation. I had a doctor who was extremely vigilant about fluid and told me I was always going to be in danger of CHF and that if urinated less than every two hours, I needed to go to the ER. He said my body couldn't process water, and even though I've recovered, I'm now terrified about a recurrence or something new happening as I was asymptomatic even with cardiomyopathy. Is this completely irrational? Is it impossible for me to be having pathological water retention when my labs and tests are all perfectly normal? I monitor every drop I drink and am scared all day long when I drink. Thank you so much. Lab work is attached.
doctor
Answered by Dr. Rakesh Madhyastha (5 hours later)
Brief Answer:
Normal kidney function

Detailed Answer:
Hello

Thanks for query

I have gone through the attached reports and all your tests are within normal limits. You do not need to worry about water retention or shortness of breath secondary to it. Your doctor have done a wonderful job of ruling everything that could be the source of water retention and heart issues.

Now to answer your questions one by one

1. There is no need to worry about water retention at the moment. All your systems have recovered
2. It is impossible to have water retention as per the reports attached
3. You dont need to monitor your water intake and output at the moment. All systems are ok

I hope I was of help, if you have any further queries please get back to me

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakesh Madhyastha (15 hours later)
Thank you so much, doctor. I don't know how to stop being so afraid of difference in urine output. I measure some days and the other day I had 3.8 liter output but some days maybe half that even though it seems that input and activity and food were very similar. I just can't believe that that could be normal. But is all ok because all my labs are good? Do I need more than annual check of kidney function? I am always worried that in short period of time, something has changed and my heart/kidneys could be failing. Is this completely irrational and just my anxiety?

Thank you so much, dr.
doctor
Answered by Dr. Rakesh Madhyastha (7 hours later)
Brief Answer:
OCD

Detailed Answer:
Hello

Thanks for getting back

Like all other doctors, even I feel there is no need to worry about urine output as all the organs are functioning normally as per reports.

I suggest you to meet a psychiatrist as you are finding it difficult to stop worrying about fluid retention. It falls under the catergory of obsessive compulsive disorder. Please speak to your doctor regarding the suggestion of mine

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha (17 hours later)
Thank you so much, doctor. I do know I have OCD and PTSD from my prior diagnosis and I am getting therapy from an OCD specialist and also seeing a psychiatrist for medications.

I know that anxiety is causing most of my distress but I also fear thar somehow something is being missed. Would I definitely have other symptoms as well as signs in bloodwork and UA which have been consistently normal?

I suppose no doctor would think I needed any further testing? I so badly want to feel normal again but get so scared to live my life normally.

Thank you so much, doctor, for your knowledge and patience.
doctor
Answered by Dr. Rakesh Madhyastha (2 hours later)
Brief Answer:
Job well done by your doctors

Detailed Answer:
Hello

Thanks you for such kind words, you can always get back to me. I understand your frustration

I have gone through your reports and I can tell you that your doctors have done a wonderful job to rule out all causes for breathlessness. I wouldn't recommend any further testing.

Please speak to your psychiatrist about this, he might want to adjust your prescription

Regards


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4364 Questions

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What causes urge to urinate and decreased urine output?

Brief Answer: Normal kidney function Detailed Answer: Hello Thanks for query I have gone through the attached reports and all your tests are within normal limits. You do not need to worry about water retention or shortness of breath secondary to it. Your doctor have done a wonderful job of ruling everything that could be the source of water retention and heart issues. Now to answer your questions one by one 1. There is no need to worry about water retention at the moment. All your systems have recovered 2. It is impossible to have water retention as per the reports attached 3. You dont need to monitor your water intake and output at the moment. All systems are ok I hope I was of help, if you have any further queries please get back to me Regards