Why do I feel like I have to pee all the time?

March 21, 2010 4:34 PM

EmbarassingUrologyFilter: I've got to pee all of the time, except when I don't. What's going on here? (Gross, NSFW stuff inside)

To begin with, I know you're not my doctor, you're probably not a doctor, and yes, I'm going to go see a doctor whenever I have the opportunity. I just need to get a better grip on what I'm dealing with, and see if anyone has any possible anecdata for me.

Background: I'm a 25 year old straight, married male in relatively good health, with no previous medical issues.

In August, I had an issue with a bloody discharge from my penis. It seemed to be blood in my semen, but it came out not only when I was ejaculating, but other times as well. I had been experimenting with anal toys, and my doctor figured that I'd done something wrong with my Aneros and dinged my prostate or something along those lines. They sent me to a Urologist anyways.

Before I went to the urologist, my discharge had stopped, but I was starting to have trouble with urine leaking from my penis after I'd urinated. Not just the few drops most guys get, but enough to leave some visible wet streaks on my boxers. Urologist said that the bloody discharge was probably nothing and would resolve itself, and the leakage was nothing to worry about. He also noticed a lump on my testicle and sent me to get an ultrasound, but that turned out to just be a cyst.

Things were fine until about December, when I started having this feeling of persistent urination. After I would urinate, I'd still feel like I had some stuck inside my urethra, and I was beginning to have issues with leakage after urinating again.

I went to my GP the first time for another issue and mentioned this. They did a urine sample, which came back clean (every urine sample I've given, since the first, came back clean of anything). She first thought pre-diabetes, but my levels weren't high enough. I went back to my GP a week later, and saw a different doctor due to mine being out. He gave me a ton of antibiotics, said that it might be an STI (even though I'm a married and monogamous), and said to come back if nothing got fixed. That was over Christmas break, and while it seemed to get better for a bit, it came back.

I went to my GP a third time after Christmas, and she sent me back to my urologist. My urologist said that it was probably my Strattera (which I was taking for ADHD), and gave me Oxybutynin. I got off the Strattera (which wasn't seeming to work after a few months anyways) and tried the Oxybutynin, but that didn't seem to work either. Now, it's March, and I'm not sure what to do.

The symptoms of having to urinate most of the time are still there. I can sometimes make the symptom go away if I sit and squeeze my "pee" muscle to try to force all of the drops out of my urethra, but sometimes that doesn't work. This feeling doesn't wake me up in the middle of the night, but it causes me discomfort during the day (and kills my sex drive, because nothing's sexier than feeling like I have to pee all the time, right?). I don't generally pee any more often than normal (5-7 times a day), but there always feels like there's a little left in my penis.

All of my doctors seem to not have a clue what this could possibly be. Where should I go from here? I've never dealt with a medical condition such as this. My GP seems to be a dead end, but my urologist doesn't seem to know what it is either.

Do I find another urologist? Has anyone dealt with anything like this, so that I could at least give my doctor a guess to go with? No one seems to understand how much this is messing with my life, and how this uncomfortable feeling is really derailing other parts of my well being.

Throwaway e-mail: [e-mail]

posted by anonymous to health & fitness (18 answers total)

The symptoms of having to urinate most of the time are still there. I can sometimes make the symptom go away if I sit and squeeze my "pee" muscle to try to force all of the drops out of my urethra, but sometimes that doesn't work. This feeling doesn't wake me up in the middle of the night, but it causes me discomfort during the day (and kills my sex drive, because nothing's sexier than feeling like I have to pee all the time, right?). I don't generally pee any more often than normal (5-7 times a day), but there always feels like there's a little left in my penis.

This sounds like my symptoms when I had a UTI. I'd say yes, get thee to a urologist.
posted by PMdixon at 4:39 PM on March 21, 2010

It could be interstitial cystitis, especially if your UTI tests are clear. Your urologist really should be familiar with this, though.
posted by emilyd22222 at 4:43 PM on March 21, 2010 [1 favorite]

I would think a urologist would have checked this out, but I had similar sensations just before discovering I had developed a massive kidney stone. My urologist speculated I might have been passing tiny crystals that were irritating the urethra without causing enough pain for me to realize what was going on.
posted by pupdog at 5:04 PM on March 21, 2010 [2 favorites]

Sounds like interstitial cystitis or its male counterpart, chronic pelvic pain syndrome. Doesn't sound like overactive bladder (which is what the anticholinergics like oxybutynin are for) or a UTI, which would already have been detected. Two good forums that discuss these issues are IC Network and ChronicProstatitis.com. There's a lot of terms used to describe the same set of symptoms, so reading about this can be confusing. You'll hear about:

- Interstitial cystitis
- Painful bladder syndrome
- Bladder pain syndrome
- Chronic prostatitis
- Chronic pelvic pain syndrome
- Prostatodynia

These are all pretty much the same thing. Also, "prostate" and "cystitis" don't mean that the problem is with your prostate or bladder; those are old terms from when scientists thought the disease was caused by the prostate/bladder, which they may not be.

Therapy might involve stress reduction, dietary modification, pelvic floor physical therapy, and pain medications like Lyrica. Strattera could be problematic, since it stimulates your sympathetic nervous system. A urologist can probably look inside the urethra to see if there are any strictures/tears/etc.
posted by wireless at 5:10 PM on March 21, 2010 [1 favorite]

The doc who gave you a bunch of antibiotics because you "might" have an STD is an idiot. Also, peeing a lot because you may have diabetes happens because people who have diabetes are thirsty all the time (drink a lot, pee a lot). Your symptoms sound like a UTI (although UTIs often go from annoying to painful rather quickly). Wireless has a nice list of possibilities to have checked...
posted by MsKim at 5:28 PM on March 21, 2010

The one time I had a UTI my symptom was feeling like I had to pee all the goddamn time but nothing was there to come out...but surely your GP would have checked this.
posted by leahwrenn at 5:37 PM on March 21, 2010

In situations like this, I have made a second, follow-up appointment with the original specialist essentially to say hey, this isn't resolved, it's really affecting my life, you need to do something.

At the same time I make an appointment later in the week for another specialist.

Some docs are much more likely to want to intervene than others. I have a similar issue and one doc is very "meh, nothing is horribly wrong, whatever" and the other one has been very proactive about getting me tests. (I have different anatomy than you do so I can't say that I can guess about what's going on).
posted by internet fraud detective squad, station number 9 at 5:40 PM on March 21, 2010 [2 favorites]

You want a good urologist. I had some different, but equally embarrassing, symptoms, and a few visits to a good urologist brought things to a happy resolution. If the first one isn't taking this seriously, go to a second, and then a third and beyond as necessary. I won't speculate as to what your diagnosis might be, but you are looking for a doctor that will run through both the obvious (eg UTI, STI) and less-obvious possibilities.

Be forewarned -- the questions and exams can be uncomfortable and embarrassing, but a diagnosis/resolution makes that totally worthwhile.
posted by Forktine at 6:02 PM on March 21, 2010

I'm also seconding (thirding?) the people who suggested interstitial cystitis. It tends to be overlooked in men because it's usually seen as a "female disease." Unfortunately a lot of urologists are stumped by IC and often put people through many different medications just to see what might help. If you drink alcohol, caffeine, eat anything with citrus or peppers, you might want to try to see if it alleviates any of your symptoms. Good luck, feel to MeMail me if you have specific questions about IC (I don't have it, but my partner does).

But yeah, find many more urologists and ask for the whole nine yards.
posted by Wuggie Norple at 6:08 PM on March 21, 2010

Ack, I meant to say try to eliminate some of the above foods and see if that alleviates any of your symptoms, obviously.
posted by Wuggie Norple at 6:09 PM on March 21, 2010

Not a man here, but when I had similar symptoms that weren't resolving, it turned out to be yeast, of all things. Different plumbing, I realize, but one more possibility. Nthing specialist.
posted by chesty_a_arthur at 6:11 PM on March 21, 2010

Med student here, and I know you're asking for advice, and not a diagnosis, but I'll give you both. 1) Go back to your original urologist first- chances are you'll get in quicker as a continuity patient, and they can build upon the tests they've already done, as opposed to a new doctor that will want to re- work you up, which will waste time. 2) I'd be curious to know what other tests you've had done besides a urinalysis, because that's just the tip of the iceberg, especially if it was just a dipstick in the office. They could send that sample for culture or look for casts. Did you get a rectal exam to examine your prostate? Did they check your kidney function (bloodwork results for BUN and Cr)? Any sort of imaging (X-ray, ultrasound, and if you wanted to get invasive way down the line, cystoscopy)? Aaaaand, because it's fun for med students to play House, I'm just putting it out there: recurrent hematuria in a young male is textbook presentation for IgA nephropathy, which should be added to the differential as well as some of the other things listed above like kidney stones or prostatitis. And, no, don't get scared, I don't think you have bladder cancer, or even less likely, prostate cancer, but if the symptoms fit, it doesn't hurt to rule those out either. Good luck to you, I hope you get this issue resolved!
posted by alygator at 6:16 PM on March 21, 2010

alygator: "1) Go back to your original urologist first- chances are you'll get in quicker as a continuity patient, and they can build upon the tests they've already done, as opposed to a new doctor that will want to re- work you up, which will waste time. 2"

A great reason to see your original doc again before seeing another doc for a second opinion--call a few days before you go in and ask them to have a copy of your records/tests ready for you to pick up after your appointment. Or ask if they will fax/mail to the other office.

I always ask for a copy of test results immediately anyway. Docs or sometimes the radiologists themselves have offered to mail or fax me copies of the results immediately, with no charge.

That will cut down on the number of tests that need to be done or re-done by the second opinion doc.

It is also good policy even if you're happy with your doc--a few times I have caught test results that were significant or tests that never got done. In most cases I just asked the doc and they explained that it wasn't a big deal for x reason, great.

In one case I never got a vitamin D test that I needed because the lab tech forgot about it (I was deficient). More recently, a doc didn't think that two jacked-up fallopian tubes were worth mentioning when she went over my ultrasound results. If I hadn't asked for my own copy my chronic pelvic pain would still be a mystery (well, it still kinda is, but you see my point, I hope).

Trust but verify, don't be afraid to ask questions, don't be afraid to get as many opinions as you need.
posted by internet fraud detective squad, station number 9 at 6:49 PM on March 21, 2010

Meanwhile, drink lots of water. If you have kidney stones or any sort of Urinary Tract Infection, lots of water helps move anything downstream and out. Cranberry juice helps women with UTIs and can't hurt.
posted by theora55 at 7:19 PM on March 21, 2010

Cranberry juice helps women with UTIs and can't hurt.

Cranberry juice is the worst possible thing that you can drink if you have IC. Also, if you already have a UTI, it won't do anything.
posted by emilyd22222 at 7:59 PM on March 21, 2010

All of this sounds a lot like a kidney stone to me, a blocked urethra, and that will cause the infections, and can be caused by prostatitis (@25?). Yeah, get to a urologists, and lemonade is better than cranberry stuff for preventing calcium deposits (according to my urologists)
posted by Some1 at 8:05 PM on March 21, 2010

As the med student said somewhere upthread, ask your doctor that did the urine test whether they sent it out for further analysis (culture and sensitivity, specifically) or if they just relied on the little dipstick in the office. I've had this happen personally when I had a UTI: the dipstick said nothing but the urinalysis came back with a resistant strain of bacteria. I venture the guess that I had the UTI for an extended period of time and it wasn't strong enough to show up on lower level tests.

I know you say you are monogamous and such and such, but just suck it up and get an STI panel done. These infections can be long-lasting and for both you and your partner's sake you need to know if it's one of those.

Perhaps a full lab panel is worth it to see if you have any chemical deficiencies causing some kind of spasms or poor muscle contractions. I feel like it would be more likely to be the latter as you didn't have success with the oxybutynin.
posted by nursegracer at 11:27 PM on March 21, 2010

Get checked for a yeast infection (ask you wife to get checked too). They can spread partner-to partner through sexual contact, but can originate in a person due to about 50 million reasons that have nothing to do with sex (and a few that do).
posted by WeekendJen at 9:17 AM on March 22, 2010