Intermittent Overactivity and Pain

[Student777]

To start, I'm 24 year old Caucasian male. Been having these issues since I was 15. I don't drink alcohol, coffee, and have never have been sexually active. I'm also a healthy weight. When I was a sophomore in high school, I started to have a bit stress incontinence after urinating. I ignored this until it got was months later when in addition to the incontinence, I was having was I would describe as this slight leaky/urge feeling that varies in intensity and duration after urination. Sometime it'll subside after a few hours or until I feel like my bladder needs to use the restroom again, sometimes it'll turn into more of an urge and I'll need to use the restroom within an hour or so. After urinating during a bowel movement, the slight leaky/urge feeling seems to be more intense and last longer, with it either subsiding after a few hours or developing into an urge to urinate fairly quickly. The problem is is that it doesn't seem to follow any sort of pattern, some days or parts of days will be better than others, with me feeling more normal or feeling like I have overactive bladder. For example, in a morning I may have to pee 3-4 in a 4 hour window, but then in the afternoon I go 1 time over a 5 hour window. Unless I drink water or fluids before bed, this never causes me to wake up in the middle of the night to pee. Went to the GP when I was 16, then the urologist, then the GI. The GP didn't find anything from surface level tests. The urologist did the cystoscopy, bladder ultrasound, and urodynamic tests. They didn't find anything significant, but noticed my bladder wasn't emptying all the way. Nothing alarming, but my bladder was holding more residual urine after micturition than expected for a regular 16 year old. The GI doctor did a x-ray of my GI tract and a colonoscopy. The colonoscopy didn't reveal anything, but the x-ray showed I had chronic constipation. They also found I had an anal fissure from the constipation. We put me on Miralax to clear my bowels and get me regular again. This fixed the stress incontinence I was having, but not the weird emptying/overactiv e bladder episodes. I didn't leak urine anymore, the but leaky sensation/slight urge still was there. I also had an onset of pains to accompany all of this. I don't remember when they started in all of this, so I didn't mention them initially to my parents but they have been there for a while. Sometimes when I urinate it stings a bit for a portion of me urinating, sometimes it doesn't. After urination, there can be sharp quick pains in my penis, testicles, or perineum. Sometimes they can crop up randomly. Most of the time they are quick bursts, but on rare occasions they have last for several minutes, and are unbearable. They sometimes crop up after ejaculating as well. I also get dull pains in my pelvis from time to time. After the constipation was fixed, I went back to the urologist when I was 16, 17, 18, 19, to see if they could treat the leaky bladder sensation. They did a video urodynamic study and saw some crystallization in my bladder (I imagine from not being able to empty entirely), but otherwise everything turned up normal or within normal limits. We tried medicines that relaxed the bladder neck like Phenazopyridine and Imipramine, but they did nothing. I also went to physical therapy/biofeedbac k to learn kegels. But this didn't change anything. Went to new urologist and they ran the usual tests like urine culture, cystoscopy, and urodynamic studies and put me on some overactive bladder medications like Oxybutynin and Myrbetriq. I don't have any infections, and from what they can tell my prostate looks fine from the cystoscopy and there are not urinary strictures. The urodynamic study this time found that I have a bladder outlet obstruction. None of the medicines they gave me did anything, and the doctors concluded that since my prostate seemed okay, it must just be caused by "stress" . Never had/experienced stress/anxiety issues in my life (ie. Generalized Anxiety Disorder, Panic Attacks, etc). Please help.