Pain in lower abdomen - urinary hesitancy

[Deepblue]

Am a 35 year old 170 pound male with a history over the past 7 - 8 years of urinary hesitancy in starting flow, frequency of urination (particularly at night about 3 times), urgency, control, leakage...  This is despite the obvious cutting down on fluids particularly in the late afternoon and evening.  I have been taking Hytrin which seems to help with the problem somewhat. I tried a sample of Detrol at one point but it didn't seem to help as much as the Hytrin.  I have also been taking Propecia for hair loss and daily, year round Allegra antihistamine to control itching (on various areas, arms, legs, torso) for which no cause has been identified.    

I had seen a Urologist about 4 or 5 years ago who completed an endoscope procedure and as best I recall noted a diverticum in the bladder, but nothing else of note at that time.  No biopsy was done of the bladder (although my primary care doctor mentioned that he felt one should have). I was just continued on the Hytin to treat the symptoms.  Over the past 6 months with increasing frequency I have been feeling a sporadic, but sharp pinching feeling just above the pubic bone in my very lower central abdomen. Some days I don't feel anything at all, others I may feel it a few times a day or sometimes up to 10 - 15 times a day. The timing is random and does not correspond with having to urinate.  There is no pain in urination.  Have been married for the past 8 years - no history of sexual diseases.  

I had a physical about 4 months ago with a CBC and nothing came back out of the ordinary.  Prostate felt "normal" and PSA was low. A review of the urine sample from the physical apparently didn't turn up anything unusual at that time, there is no visible discoloration. I have had a mild weight loss over the past half year of about 8 pounds that I can't explain.  I have an upcoming appointment with a Urologist recommended by my doctor but the earliest available date for new patients with this particular doctor was a month and a half away.  

Could you please give me your thoughts as to what some potenial causes for the pain may be and if you feel it might be worth scheduling something sooner with a different Urologist.  

Thanks for your insight! It's greatly appreciated.

[Kevin Pho, MD]

If the cystoscopy was normal (or only showing a diverticulum in the bladder), you may want to consider a GI cause.  There are some GI diseases or masses that can intrude with urinary function.

A first test to consider would be an abdominal/pelvic CT scan to evaluate for any gross masses.  A colonoscopy would be another test to consider.  

If the GI causes are not-revealing, and all the imaging tests remain normal, you can consider more specialized testing.  One such set of tests would be urodynamics.  These are a group of tests used to assess function of the urinary tract by measuring various aspects of urine storage and evacuation. Some specific types of urodynamic testing are:

* Cystometry (or cystometrogram) evaluates bladder function by measuring pressure and volume of fluid in the bladder during filling, storage, and voiding.

* Uroflowmetry measures the rate of urine flow.
* Urethral pressure profile tests urethral function.
* Leak point pressure determines the bladder or abdominal pressure when leakage occurs due to increased abdominal pressure (Valsalva or cough) to assess urethral resistance.

You may want to discuss these options with your personal physician.  

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

Bibliography:
Flesh.  Urodynamics.  UptoDate, 2004.