Strange problems when urinating

Some basics, I am 30, male, 22 stone in weight. Have back problems, gallbladder problems, bad piles and possible fissure, and GAD.

Over last 3 weeks I have had a strange off and on problem with urinating. About 3/4 of the times I go to pee i'm stood there for about 30 seconds before it comes out, and it feels a bit like a blockage, it finally comes out and then feels lacking in power. It's as though it should be more powerful. I never seem to pee for that long either, less then I seem to remember doing before. Stream mainly stays constant, although sometimes stops and starts at end, and I don't suffer any drips. It is just slow arriving and lacks power. This mornings pee, for example, was slow coming out and barely reached the other side of the toilet bowl, which for a morning pee is very unusual, and only lasted a few seconds. I don't feel the need to pee more after though, so it is not as though I still have the urge to pee. I still only go about 4 times a day.

However, sometimes I can go quite quickly and the power isn't too bad. Which confuses me as I would presume a prostate problem or urinary tract infection would be constant until cured. Most of the time it is slow and lacking power, but about 1/4 of the time it is virtually fine. I also have no real orgasm lately, although ejaculating and erection is fine. No blood or pain.

I have no idea if any of these things are related but I suffer from various other things, as listed at top of this message. Could anxiety cause this ? I am worried about putting every new symptom I get down to my anxiety disorder. I have had bad piles for a few months, and my stools are ultra flat and it is painful when I defecate, and throbs for hours after. I am presuming that may be piles or/and a fissure. But I am unsure if that can affect my bladder. I have had back problems for a while too, but had a spine MRI and was told other than thoracic scoliosis it is fine.

Any ideas ? Many thanks.

[Stephen Liroff, MD]

Your symptoms sound like those associated with the prostatic changes that older men experience…but you are thirty (which is not old). Some medications such as decongestants and some antihistamines (allergy medications) can give these symptoms. Also, the muscle spasms associated with rectal fissures and hemorrhoids can give these symptoms. I think that you should look into the rectal issues and see a colorectal surgeon. Certainly compression of the nerves that affect your bladder and prostate can affect your urinating, but with a negative MRI (and, I presume, neurological exam) this cause has been ruled out.
I appreciate your concerns in this matter, and think that getting the rectal issue investigated is the most likely course of action to help yourself as well as checking out any new medications that you are taking.
As to anxiety figuring into this, I doubt it, but certainly it is a consideration if nothing else can be found.
Hope that this helps.
S.A.Liroff, M.D.