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bladder neck?From: Robert J Woolley (wooll005@tc.umn.edu)Thu Feb 3 07:56:51 2000
I have a generally healthy (but highly anxious) young woman (age 24) with urinary urgency and frequency for about 10 days, no dysuria, no hematuria, no vaginal symptoms, not pregnant. Urinalysis completely normal, urine culture negative. She saw one of my partners first and was treated with Bactrim and Pyridium, in spite of the negative UA; no change in symptoms with these two meds for 3 days, no change upon discontinuing them, either. She can hold her urine as long as she needs to (no incontinence), but it requires constant voluntary effort, starting roughly 10 minutes after last urination. Urine volume is proportionate to the duration she waits. No problem at night. The best that I could reason from this was that she was having weakness at the bladder neck, akin to stress incontinence, but constant instead of only with stress, but with sufficient reserve in the pelvic floor muscles (she has never been pregnant) to prevent actual loss of urine. Does this sound plausible? If so, is there a name for it? I tried treating her with pseudoephedrine as an alph agonist, no response. Today I told her to try phenylpropanolamine, for the same reason. If this fails, what would you do next (besides send her to a urologist)?
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