You Are Not My Urologist, but if you me unblock! (slightly squicky details inside)
June 27, 2012 8:20 AM   Subscribe

Hello! I'm a 33 year old male (NYC-based until 8/1 when I will be in Atlanta) with a very frustrating issue that I'm hoping those of you in the field might be able to help me diagnose. I've been to several urologists who have not helped me very much (the list of things that have been done is included below). If nothing else, I would love a recommendation for a urologist in either city that wont just dismiss me out of hand and not take this seriously. Throwaway email for additional details:

- Not sure when it started (at least a year ago)
- Possibly after riding bike after a long time


- frequent clenching of pelvic muscules (kegels). have to consciously relax them, frequently
- tip of urethra is often tender
- also feels like the urethral sphincter is not letting fluid out completely, (not opening all the way to let everything out?)
- occasional "burning" sensation after bladder is emptied (as i'm "finishing up"

- frequent urination (more than before... 4-5 times a day?), small amounts of fluid (other than standard urination), sometimes clear, but always watery consistency
- Frequent need for urination, sometimes unconsciously "holding it in"... doesn't seem to be as much of a 'urgency requirement' as before

- Ejaculatory difficulty - muscles out of sync, not everything comes out (have to "milk" it out afterward), generally uncomfortable and painful, feels like i have a cock ring on or something.

- Feels like the muscles are out of sync / not doing their correct thing during the orgasm/ejaculation cycle, or being blocked by the urethral sphincter somehow.

Diagnostic Procedures i've had done
- Cystoscopy: clean bladder, clean urethra
- Prostate check (2x): normal
- UTI test (2x): clean
- Voiding test: bladder gets emptied (apparently). Also no kidney stones

Things that seem to help:
- Heat/Hot water (muscles relax more in the shower), but not 100%

Things i've been told it is
- Non-Bacterial Prostatitis
- Chronic Prostatitis
- Pelvic Floor Syndrome

Treatments that have been suggested:
- Anti-inflammatories
- Alpha blockers (with the caveat that it would cause retrograde ejaculation...not an ideal solution)

Lifestyle: geek. mostly sedentary .a lot of sititng.

So...what might it be and what might my options be? It's super frustrating for me and for my girlfriend, and I'd really like to not be stuck feeling like this for the rest of my days.
posted by anonymous to Health & Fitness (12 answers total) 1 user marked this as a favorite
That sounds a lot like the male version of pelvic floor issues to me! (I am not a medical professional in anyway.)

I had this. Physical therapy for myofascial pain of the pelvic floor helped a ton. I'm surprised that hasn't been suggested for you (and it alleviated a ton of the symptoms you're describing in a short period of time).

I think the next time you go into a doctor's office, you just need to be really clear about how this is affecting your life negatively and it needs to be resolved. Tell them that it is impacting your ability to enjoy your life and you need help now.
posted by zizzle at 8:27 AM on June 27, 2012

(Though I am female! Meant to add that.)
posted by zizzle at 8:27 AM on June 27, 2012

Could it be caused by other medication you're on? Certain meds, like SSRIs and finasteride, can cause similar problems.
posted by qxntpqbbbqxl at 8:33 AM on June 27, 2012

IANAD, but it sounds like an inflamed prostate. If the inflammation is from a bacterial infection, antibiotics may help - but talk to your doctor first.
posted by wolfdreams01 at 8:39 AM on June 27, 2012

Whoops, never mind - if you've been checked twice already for prostate issues, then I guess it isn't that, and I withdraw the advice.
posted by wolfdreams01 at 8:40 AM on June 27, 2012

IANAD but even after your UTI tests, with these continuing issues I think you should have a simple 10 day course of antibiotic before those others.
posted by caclwmr4 at 8:53 AM on June 27, 2012

you may need to go beyond Urology and get a full examination to rule out a neurological component. Since most of the routine stuff has been tested/discarded time, to consider the spinal cord. While I always ascribe to the mantra "where you hear hooves, think horses not zebras" at least one of those urologists might have thought to rule out MS and send you to a neurologist.
posted by Wilder at 9:03 AM on June 27, 2012 [1 favorite]

Check out this thread:
. I suggested the person posting read a fairly new book "Teach Us To Sit Still" by Tim Parks.

As I posted there, the prostate can get irritated and give you trouble. The Parks book is about his journey to find out what is going on, what can be done and what he tried and what worked. He mentions an earlier book that pointed him towards specific relaxation techniques. The blockers that are being suggested relax the muscle tissue.

Heat, especially hot baths, have been recommended for men with prostate issues, for ages, so if you are getting relief, that should tell you something.

You mentioned bicycle riding. That can cause big, big trouble for a lot of men. I saw an article saying that almost 50% of men, including Tour de France riders, suffer from blood being cut off or diminished to their male parts. If you are riding a bike, stop.

Pelvic floor issues are related and covered in the Parks book and the book that he references, so check out the thread above.
Good luck
posted by PickeringPete at 9:34 AM on June 27, 2012

I have similar symptoms. 51 year old male. Active and fit. I went through similar tests with similar results. My pain started last June and was persistent but not debilitating. I went through the antibiotic treatments, alpha blockers, anti-inflammatory, etc. My pain has been reduced, though I still have days of discomfort a few times a month. My conclusions so far based on my experience:

1. Doctors really don't have a clue on some disorders and are quick to prescribe medicine that provides little relief and can have some worrying side effects.
2. I believe stress plays a big part in my issue and that I hold stress in my pelvic area - hence, the involuntary clenching in the pelvic area.
3. I have issues particularly after long periods of sitting.

What has helped me -
- Walk at least 2 miles a day at a brisk pace.
- Stretch and use a foam roller to roll out my groin and inner thigh area. Also pay attention to lower back and hip area.
- Heating pad before bed and upon waking for 10 minutes. Hot baths never did much for me.
- Reduce alcohol intake. Though my drinking was always moderate I now only drink a couple of beers on the weekend.
- Keep hydrated and use the bathroom promptly when needed, don't hold it.
- Find ways to reduce stress - walking, meditation, weight training. I usually feel great down there after really exerting myself physically.
- During painful times I use a frozen water bottle to briefly ice the perineum area. I also use anti-inflammatories during this time.
- I have also bought and used a Aneros - prostate stimulator product - but I'm not totally sold on its effectiveness for my problem.
- I read the Tim Parks book and found it interesting, and it prompted me to attempt to meditate more often.

Hope this helps and good luck.
posted by incandissonance at 9:43 AM on June 27, 2012

I had similar, though not identical, issues for a long time until I figured out that I was allergic to something I was eating -- tomatoes, in my case. Whatever the allergen is, it clearly survives cooking and digestion and somehow irritates some tissues on the way out, leading to a mild rash, pain/burning, and a feeling of incomplete urination and the constant need to pee. It seems possible that the pain itself is causing you to clench up and causing the other pelvic symptoms. Of course, this is just speculation.

Between the lag between eating tomatoes and symptoms, as well as the ubiquity of the allergen in my diet, it was not easy to figure this out. You might keep a food journal and see if you can detect any patterns, or you might just try a bland diet for a week and see if you get any improvement.

BTW, sexual lubricants are another potential cause of irritation that you might look to, if that's relevant for you.
posted by inkfish at 2:57 PM on June 27, 2012

If the bike you're riding now is not one you've ridden comfortably before, you might want to check that the saddle is wide enough for you. If it's narrow enough that your sit bones hang over the sides, you end up with way too much pressure on bits of you that react very badly to that.
posted by flabdablet at 5:41 PM on June 27, 2012

Since you've seen several urologists and you're no better, it sounds like it's time to escalate up the doctor-ladder. Look for a urology clinic, preferably attached to a medical school or other research institution, with a reputation for excellence. The doctors there won't be the usual run-of-the-mill kind like you've been seeing — they will be excellent diagnosticians familiar with the latest research (which they may be doing themselves) into urological problems. Good luck with this, and follow up to let us know how it turns out.
posted by exphysicist345 at 5:46 PM on June 27, 2012

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