For years, I have had trouble urinating without applying physical pressure to the bladder. I have been to doctors about this, and they said that I may have a bacterial infection and prescribed medication. But the problem persists. Do you have any insights as to how this problem may occur?

E.S.

Inability to void without pressing on the bladder is not a classic sign of an infection. Two possibilities come to mind readily. One is prolapse of the bladder leading to kinking of the urethra and urinary retention. This means the bladder is dropped, possibly as a consequence of childbearing, but the urethra (the tube from the bladder to the outside) has maintained its position; this leads to a kink in the tube that may make it difficult to empty your bladder completely. The other obvious possibility is urethral stricture. That means the urethra is too tight or narrow, again leading to an inability to empty the bladder easily and completely.

Another possibility is nerve damage to the bladder, so that you do not feel normal sensations and urge to urinate. The bladder wall muscle may not contract properly, leading to your having to push on your bladder to empty it.

To find out exactly what is going on and to determine the best treatment, your best bet is to see a urologist for complete evaluation, including urodynamic testing.