Differential Diagnosis for a 51-year-old Woman with Urinary Symptoms

Single Most Likely Diagnosis

• Urinary Retention due to Pelvic Floor Dysfunction: This condition is suggested by the patient's symptoms of an urge to urinate followed by an inability to do so, feeling like urine is stuck inside, and the history of a cesarean section which might have affected pelvic floor muscles. The intermittent nature and normal peeing otherwise support this diagnosis.

Other Likely Diagnoses

• Overactive Bladder (OAB): Characterized by a sudden urge to urinate, which aligns with the patient's symptoms. However, OAB typically involves urinary frequency and urgency, with or without urge incontinence, which isn't fully detailed here but could be considered given the urge and intermittent inability to urinate.
• Urethral Stricture or Obstruction: Although less common in women, any obstruction in the urethra could cause difficulty urinating and a feeling of urine being stuck. This would be more consistent with a constant rather than intermittent problem but should be considered.
• Neurogenic Bladder: Given the patient's age and symptoms, a neurogenic cause (e.g., due to diabetes, spinal cord issues) could be a consideration, especially if there are other neurological symptoms not mentioned.

Do Not Miss Diagnoses

• Urinary Tract Cancer: Although rare, cancers of the bladder or urethra could cause obstructive symptoms and must be ruled out, especially with persistent or worsening symptoms.
• Stones in the Urethra or Bladder: While more common in men, stones could cause obstructive urinary symptoms and severe pain.
• Infection or Sepsis: A severe urinary tract infection could cause significant discomfort and difficulty urinating, and if not treated promptly, could lead to sepsis.

Rare Diagnoses

• Fowler's Syndrome: A rare condition characterized by urinary retention in young women, often associated with polycystic ovary syndrome (PCOS) and idiopathic or related to a variety of factors including hormonal influences.
• Multiple Sclerosis or Other Demyelinating Diseases: These could cause neurogenic bladder symptoms, including urinary retention, but would typically be accompanied by other neurological symptoms.

Each of these diagnoses should be considered and investigated based on the patient's full clinical picture, including a thorough history, physical examination, and appropriate diagnostic tests.