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Difficulty Urinating
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dcbrian posted:
I'm making this post to describe a lifelong struggle I've had with doing something completely mundane: urinating.

I turn 36 years old next month, and I'm an otherwise healthy individual. I exercise regularly and work in an office environment that has not given me too much stress.

Growing up, I always seemed to have to go to the bathroom more frequently than my peers. If I went to a movie and bought a large soft drink, I'd have to slip away to the bathroom 3-4 times during the movie whereas my friends did not.

When I was 15 years old in one specific instance, I had the inability to pass my urine. I was on a cross country trip with my family, and we made a pit stop, but I couldn't go. Further down the road, I tried again, but no luck. After several hours and multiple attempts to strain myself, I finally was able to pass my water. After this event, my urinary abilities returned to normal.

When I was 18, I had a sudden intense itching sensation occur in the tip of my penis. I had not yet had any sexual contact at that point in my life, so I knew it wasn't STD related. Two different urologists each diagnosed it as prostatitis. I took bactrim, but that did little to affect it. Through my years in college, I just suffered through the itching as it would come and go over periods of time.

When I entered the working world at age 23, I decided to see a doctor about the itching problem again. I was on a HMO, so I had to go to a primary care physician first. He also diagnosed my problem as prostatitis and prescribed bactrim. This did very little to change anything, so he finally referred me to a urologist. This urologist decided to perform a cystoscopy, and he identified a great deal of inflammation in my bladder around the opening to the urethra and noted that the opening was narrow. However, he didn't know what to make of that so he referred me to another urologist.

At this point, I'm 25 and about to visit my fourth urologist. He performed a cystocopy and made the same observations as did the previous, but he concluded that the inflammation in my urethra opening was the cause of my itching. He concluded that due to my narrow urethral opening (I've seen the term bladder neck too) that my bladder wall muscles were pushing extra hard to pass water and causing the inflammation. He prescribed Flowmax to make the opening relax during urination, and this helped dramatically with the itching.

At this point, still at the age of 25, I had begun consuming alcohol and caffeine regularly. Believe it or not, I didn't drink much of either through my college years. At this time, I began noticing the difficulty to even pass urine, not just having to make frequent trips, but not even able to go at all. Alcohol seemed to accentuate the problem. I would sometimes have to sit down and breathe for several minutes to make myself go. But I was still able to make do and get by only using Flomax when the itching would return. The doctor mentioned bladder neck incision surgery, but said I'm too young for that because it causes retrograde ejaculation.

A couple of years ago, my ability to go started to become much, much harder. I now go even far more frequently, take Flomax, and strain myself. I'm now on my fifth urologist, and my last prostate exam shows that it has grown some, but not enough to cause a problem. He did another cystoscopy, but to my surprise he found no inflammation and no abnormal narrowness of the urethra. He's got me scheduled for a bladder study. He suspects that my urethra muscles won't relax.

I've read about something called Paruresis, where anxiety issues prevent someone from being able to go, and I do notice that I have more difficulty when I'm not alone.

I'm really at a loss of what to do. This is severely affecting my quality of life and my ability to function on a daily basis.

I'd really appreciate any insight. Thanks!
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counterso responded:
Yes, a urethral stricture can result in the symptoms you describe, and it's typically one of those physical anomalies that some people suffer from. Unfortunately ALL urinary issues are aggravated by anxiety.

Back to the Flomax, if you're taking a medication for urinary flow, you should never be consuming caffeine or alcohol. These interfere with the urination process and should be avoided.

There are two separate issues here, one is physical, and one is not. The fact is that you likely have a restricted bladder neck. There aren't a lot of treatment options for this because it must open and close on its own, and if you place a stent or make an incision, this automated function ceases to work. That said, you can do many things to eliminate factors that aggravate the condition, such as choosing water as your beverage rather than a soda or a cocktail. And while you may not have other symptoms of anxiety, you do have this one. Clearly the anxiety is there, even if you do not have other outward symptoms of such.

First, I would recommend you try some acupuncture treatment which may help with some of the symptomatic issues. Second, hopping from one urologist to another is not likely to provide new information, nor will it be pleasant to keep being re-examined from scratch. Remember, there are several different medications like Flomax that you can try with your urologist's help, and you have the right to direct your doctor that you'd like to avoid surgery and explore other options. And of course worrying about the situation just amplifies the low-level anxiety that aggravates the condition, a tough cycle to break.

You may also try things like herbal (medicinal) teas that address the symptoms of anxiety or soothe the bladder like "Tranquil Person" and "White Embers" tea from Aztec Herbals.

You do have options, but it's also clear you haven't had very much support in figuring this situation out. Feel welcome to keep this conversation going as you move forward.
 
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dcbrian replied to counterso's response:
counterso,

thank you for your thorough reply.

Hopping between urologists over the past 20 years has resulted mostly from moving locations and most recently from one retiring. I had visited him for the past 10 years, and now I'm visiting another one working in the same office.

They haven't told me to give up alcohol, but one did suggest reducing my caffeine intake. Eliminating each has at times made a noticeable difference, but not consistently. There have been some times, mostly up until 2 years ago, that I consumed high quantities of both in the same day and experienced no problems at all. And there have been times that I've consumed almost nothing but water and had problems voiding. For most of my life this problem has seemed to ebb and flow (pardon the pun), but the last two years have become increasingly difficult.

I've taken a break from the Flowmax for the last two weeks, and thus far, I have not noticed any difference. Either there is still some of the drug in my system, or it's not really been having a strong effect.

I've never considered acupuncture, but I'm entertaining the suggestion. I'm also going to look into Tranquil Person and White Embers.

I've also started taking Saw Palmetto. I'm thinking of taking Nettle Root too. Mostly, this is to get ahead on prostate health so that will be less of a factor as I age.

I'd really rather not entirely give up alcohol and caffeine. I like a nice tall energy drink during the work day as well as a cold one during a football game. But it looks like I may have to give them up.

Thanks again!
 
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counterso replied to dcbrian's response:
Keep in mind that most saw palmetto you can buy in the store is too weak to have a real effect. For urinary symptoms, try something certified like Prostate SR. It takes about 6-8 weeks for the level of saw palmetto to build up in your body and start demonstrating effect, so one 90-day bottle will tell you whether it helps or not.
Nettle root takes about 30 days to have an effect, but be cautious as it can also have some dramatic side effects in some people. Again, you want to make sure you have a certified brand that standardizes the constituents that make this product useful.
As far as the effects of caffeine and alcohol, alcohol is processed by your body quickly and has a typically immediate effect. Caffeine on the other hand is not at all the same. Caffeine lasts in your body half again as many months as you have been consuming it. If you're a daily energy drink consumer and you have one a day for a year, if you stop cold turkey, you will still have that level of caffeine in your body for another 6 months. Stopping for a week or two is not going to result in the change you are thinking. It takes a long time for the body to process this drug out of your system.

Instead of an energy drink, you might try a daily B-complex vitamin, and maybe some Maca Root capsules (an adaptogen like ginseng, but specifically for men) in the morning if you get that drag on your day in the early afternoon. Note: 3pm is the time of day when your body is strongest in the bladder energy (acupuncture meridian), and you're most likely to feel the need to urinate. Same thing at the low point at 3am that's going to wake you up to go too. If this is the time of day you feel tired and need that energy drink, you really should consider acupuncture to get your energy better balanced.
 
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dcbrian replied to counterso's response:
Again, thanks for all this information. I had no idea that caffeine stayed in one's system for so long. I like energy drinks for two reasons: energy taste, but I know there are non-caffeine versions out there. They just aren't as easy to find. Maybe I should look more closely into those.

I'm considering acupuncture too as you suggest.

In my internet searching I also stumbled across something called passion flower. It apparently helps one with anxiety, which seems to be a significant contributer to my problem based on what I've read about Paruresis. Any thoughts on that?

Thanks!
 
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counterso replied to dcbrian's response:
When selecting an herbal remedy, it is ESSENTIAL that you understand the full description of your physical/mental state has a bearing on which remedy will benefit you. Passion flower is more associated with sleep than anxiety, but again, that's way too broad a description of what it does to accurately assess whether it's the right herb for you.

If it's the symptoms of stress that concern you, watch this video which talks about 5 herbs for the different symptoms of stress. All are things someone might recommend for anxiety, however, each works differently, and is only appropriate when the description matches your manifestation of stress.
http://www.youtube.com/watch?v=IiHdRYYyj3w


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