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Sphincter Cramps/Prolonged Erections
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Sphincter Cramps/Prolonged Erections

I am a 41 yo male, and began experiencing this problem approx 5 years ago along which a host of anxiety related symptoms mostly resulting in insomnia. It manifests itself mostly @ night when I will be woken by what I describe as a cramp or spasm in my groin area, that I believe to my urethra sphincter. At the same time, I have an erection and some urgency to urinate. This can last for several hours and causes some pain, which though bearable, keeps me awake. Sometimes if I concentrate, I can "will" the cramp away, and the erection disappears immediately, although some urgency to urinate remains. Other times, I have to urinate to get relief, although little urine is released. In both cases, there is that muscle relief sensation one feels after delaying urination for some time, before going.

In some cases, there is also some flatulence, or the sensation of oncoming flatulence or pressure. When some gas is released, this too will provide some relief.

When the problem began, I was subjected to the usual tests - ultrsound, cystoscopy and rectal exam. Nothing was found. Over time I have tried several drugs of the sort designed to help both my insomnia and overactive bladder, including tofranil and more recently Endep (amitripyline).

The problem has been somewhat intermittent, which tends to make me think that it's still anxiety related. However, currently it's driving me to despair with lack of sleep and some urgency to urinate is beginning to occur during the day. The latter however seems more prevelant when I begin to think about my predicament - perhaps its all in my head!

The last time I raised this with my GP, she raised my Endep dose, but it's been to no avail. She seems to have no other ideas.

To date I have been unable to determine whether the cramps or the erections are the actual problem. However, while I'm no expert on physiology, I have begun to hypothersize that the erections I am experiencing are normal night time erections, that are somehow maintained or prolonged by the spasms of my sphincter. Is this plausable?

Recently I cam across something called priapism which causes erections of 4 hours or more. While I don't believe this is my problem, it alerted me to the possible damage my erections may be causing.

Please help!
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The tests that you have had - including the ultrasound and cystoscopy - constitutes a pretty comprehensive workup of the lower urinary tract.  A normal ultrasound suggests that blood flow to the penis is normal.  They would be the initial tests that I would recommend.  

You can consider a referral to a neurologist to determine if any nerve damage or compression can be leading to the spasms.  

With the urinary frequency - you can consider urodynamic studies.  These set of tests can evaluate urianry function and may explain the frequency.  Blood tests looking for diabetes should be routinely done as well.  

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.
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