Constant need to urinate

[exilesgate]

Hello. I am a 35 year old male.My problem began  Dec 24 - I started to feel like I had to pee  contantly. Urinalysis by my primary doctor showed white blood cells.I tested negative for all STDs. He gave me Cipro -said drink cranberry juice.  seemed to work and I was actually feeling better when , after a long drive on Jan 20, the constant feeling came back. I started taking the Cipro again.went to a Urologist who said there was no sign of infection and that the prostate was fine. She said it was Bladder Sensitivity and it would go away. But she wanted me to do a Ultrasound. When I did, it showed a little urine retention. I had to go to another Urologist, and I did  uroflow, and he said the flow was very abnormal. We did urodynamics and Cystoscopy which ruled out stricutres and polyps. He said maybe the bladder neck is tight from stress and prescribed Flomax. I didn't take it right away. -was feeling a little better. But I think I took too much Advil after the cystoscopy because, on a flight to Japan, I had a lot of blood in my urine very suddenly.Stopped the Advil and the blood went away, but I was pretty much back to square one with the urgency. So I started the Flomax. I think the Flomax helped with the flow, but the urge was and is still constant. I went back to my General doctor who said maybe the sphincter wasn't relaxed and prescribed Valium. Didn't help the urge , maybe the flow was better, but I was so drowsy so I stopped. I went back to my Urologist last week. He did an ultrasound and said my bladder was empty, so he added Ditropan to the Flomax.Again, he said the prostate was normal. I have been on both for a few days. At first it seemed to help, but now I 'm wondering if the Ditropan will make me retain urine again? what can take away the urge? If I am  occupying my mind, i can go for 3 hours between urination. generally I only wake up once or twice during the night.  urodynamics test were normal- bladder size and capacity is normal. But the urge is always there, especially right after I pee. If i am at home, it’s hard to resist going to the toilet constantly.It seems to subside the longer I wait to pee. is this an issue of needing to relax the bladder or is it inflammation/irritation?have tried Prelief and changing my diet, doesn't seem to help. I haven't had anything to drink except water for 2 months. I have stayed way from spicy foods and chocolate, but it doesn't seem to make a difference. I've tried acupuncture, didn't seem to help. It's very frustrating, since I am a travelling musician and I am on long flights and bus rides a lot. Is it possible that this could be prostatitis even though no infection in urinalysis and prostate appears normal? Could Cipro help the inflammation?Also, could the Flomax actually cause the urge, since it relaxes the bladder neck? Maybe I should stop the meds altogether and see what happens? I am at a loss. Is there any specialist in New York or the U.S. that might be able to help?

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation already, including referrals to urologists and a cystoscopy.  

I would focus on the prostate.  Any type of infection can lead to the symptoms you describe - especially in light of a non-revealing cystoscopy.  

A transrectal ultrasound can be considered to image the prostate and evaluate for an abscess.  This can be a more thorough evaluation of the prostate.  

Blood tests can be done to evaluate for diabetes as well - but this has likely already been done.

If there is no infection, it is unlikely that an antibiotic like Cipro would be helpful.  

If there is bladder neck spasm, there is a possibility that Flomax can help.

I would discuss these options with your personal physician - or consider another urology opinion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

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