Differential Diagnosis for Chest Discomfort When Need to Urinate

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI) or Urinary Retention: This condition can cause discomfort or pain that may radiate to the chest, especially if the infection has spread to the kidneys or if there is significant urinary retention causing pressure on surrounding structures.

Other Likely Diagnoses

• Gastroesophageal Reflux Disease (GERD): Symptoms of GERD can worsen when lying down or after eating certain foods, and the discomfort can be exacerbated by the need to urinate, especially if the full bladder puts additional pressure on the stomach.
• Overactive Bladder: While primarily causing urinary urgency and frequency, the discomfort associated with a full bladder can sometimes be perceived as chest discomfort due to referred pain or anxiety related to the urgent need to urinate.
• Prostatitis: In men, inflammation of the prostate can cause urinary symptoms along with pelvic or abdominal discomfort that might be perceived as chest discomfort due to the proximity of the prostate to the bladder and the potential for referred pain.

Do Not Miss Diagnoses

• Myocardial Infarction (Heart Attack): Although less likely, chest discomfort is a cardinal symptom of myocardial infarction. The timing of discomfort with the need to urinate could be coincidental, and missing a heart attack could be fatal.
• Pulmonary Embolism: Sudden onset of chest discomfort that worsens with deep breathing (which might occur when trying to hold urine) could indicate a pulmonary embolism, a potentially life-threatening condition.
• Aortic Dissection: Severe, tearing chest pain that might radiate to the back and could be exacerbated by movements or positions, such as those taken when trying to urinate, is indicative of an aortic dissection, which is immediately life-threatening.

Rare Diagnoses

• Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which could be perceived as chest discomfort in rare cases due to the complex nature of pain perception.
• Eosinophilic Esophagitis: A chronic immune system disease in which a type of white blood cell, the eosinophil, builds up in the esophagus in response to an allergen or irritant. This could potentially cause chest discomfort that might be exacerbated by the act of urinating due to increased abdominal pressure.