Near constant urge to pee, but no pain, what could this be?

[oakland1970]

I've read this forum with great interest and have had a range of confounding symptoms over the past several years. I'm on my process of elimination but still very confused. Maybe others can help me think through some of this. I'm 52 have a PSA of 2.2 as of Jan but have had some enlargement in the past, prostrate measured at 47cc a few years ago.

I'll start with where I am now:

- Having lots of frequency – every 30 min during the day and before going to sleep with feeling at the tip of wanting to go, particularly on the left side of the tip if I really think about it
- Can be difficult to get to sleep easily (feel I'm starting to fixate a bit) but I only woke up once last night and that is still quite possible. Previously, I didn't have the feeling to go constantly but I would reset every 10 to 20 min when going to sleep and wake up 2 or 3 times at night.
- Hesitation – when I go to the restroom, I don't seem to really need to go, I can wait 90 seconds for what feels like my bladder neck or sphincter muscle to relax
- Low volume OR start and stop – I then either get very little out, dribbling out with urine I usually express out of the urethra or I'll feel right away I need to go again OR if I get a big more, it's still a relatively weak stream but I double void or triple void, i.e. I wait after I stop and then a little more comes out, but each amount less in volume
- I'm drinking about 1 to 1.5 liters of water a day, but it seems like I'm not getting that much out at all, I do feel retention at times
- Now it's night time and I feel a bit of a burn in the urethra (maybe from going so much?) but it feels dry and not that wet feeling. The bladder neck still feels funny
- I've been eating healthy today, drinking mostly water

Some recent things:
- I have had times where I flare to the point of UTI feeling, more of a burn on the tip when I pee, all cultures negative but a clinic did say they saw WBC's in spun urine ; this was on a Tues and on Sat I had had my prostrate “massaged” by a holistic practitioner in CA that is from Russia that claims doing this cures prostatitis and that's what I have.
- The burn is rare before (except for a few recent flares in the last 6 weeks) and generally I don't have pain on ejaculation, peeing, or perianal area
- Sometimes it does feel like after an ejaculation my urethra will feel irritated and the frequency/voiding issues exacerbate
- If I feel around I can palpate a slightly sensitive spot on the left inguinal area where my left sit bone is. It's mild now and never been too bad but I have felt it to the point where when I'm sitting I've felt it.
- Was put on 2 weeks of doxy and felt better on day 1 through 3 but symptoms returned. Also took 1 G of Azithromycin on day 13 and didn't seem to make an immediate difference but I will say on day 15 and 16 I had a completely normal day and felt like my old self, near normal frequency, better volume
- This day of near complete normality didn't last and I seem to be going through things again
- I've had a couple of times of intense pain at the bladder neck after I've held the urine for too long, esp after what felt like a spasm in the muscle. Subsequent to that I'll have urethral irritation and some burning at the tip on peeing


More generally
- I've had weak stream issues for the last 3 years and the “urethritis” type symptoms have happened a couple of times over the years, always with negative tests, married and not even that sexually active.
- Since things are getting worse in the past couple of months with flares, I'm starting to pay more attention to diet and other things but if I think back there have generally been times when I'm going to the bathroom often. Not as often as constant or every 30 min, but def once an hour at times
- I have a varicocele, also on the left side and it makes my left testicle much more sensitive - like pulling it or squeezing around there causes a pain


Prior urologists had diagnosed BPH and if I'm honest that may be the closest to what I'm feeling now after the antibiotics. My recent urologist visit indicated on the sheet urethritis or chronic bacterial prostatitis but that was because I told him I felt better with the first few days of doxy and he agreed to treat empirically.

Now that I've found this forum I see I may be going down the wrong rat holes with the bacterial angle or the prostrate massage angle for “congestion”.

Does it make sense to even do an EPS or semen culture or prostatic fluid culture to fully discard a bacterial diagnosis? How long would I want to wait and distance from this recent round of antibiotics.

If that is negative, then does this sound more like IC? Not a classic case of CPPS from what I read others experiences here.

I am the classic personality type Dr. Wise describes and I do have a PT appointment set in 10 days to check pelvic floor tightness.

What else should I get checked out? Feels like a uro dynamic testing is in order right?

Cysto? Seems like the fact that I've had days where the stream improves (may be weak) would suggest I don't have a urethral stricture. can a cysto exam cause a stricture?

I've had L5S1 issues (also on the left side) and I sometimes feel these are nerve issues. My left SI joint feels pain sometimes.

Thanks in advance for any thoughts?

[webslave]

One of the very first symptoms of BPH is frequency. What's your current prostate volume? How many years ago was it 47cc?

[oakland1970]

This was from 3 years ago when I was 49:

FINDINGS:
Bladder: No intrinsic masses, stones, or abnormal dilatation noted.
Prevoid volume is 146 cc.
Postvoid volume is 20 cc.
The visualized prostate gland measures 47 cc in volume. The prostate gland
minimally impinges upon the urinary bladder base.
IMPRESSION:
1. Mild prostatomegaly

Latest urologist said prostate size didn't matter since small prostates can cause issues as much as big ones. Seems like a lot of urologists don't want to do PSA or digital rectal exams anymore. Didn't think it was worth measuring the gland. It was done here because it was part of a void test from back then.

Clearly I've had stream and frequency issues for awhile, but seems like they've hit a new level this year and am getting flare ups just off of work. Flare-up is just extreme going to the rest room type symptoms, longer hesitation, feeling un-emptied after void and eventually something like a mild urethritis irritation with some stinging and burn (that is probably due to more acidic pee since I notice its more amber when that happens). it does feel like if I drink more water (8oz every hour), I get a higher volume of pee but regardless of how long I hold it and create urgency, it takes a long time to open up and stream is weak (with start stop enabling a double or triple void) and a disconnected feeling on the pee coming out. It also feels like the bladder doesn't push the urine out.

Thx

[webslave]

Has anyone suggested treating the BPH surgically?

[oakland1970]

Not yet, things are clearing up a bit and here's where I stand. Since I live in the Bay Area, I've talked to Dr. Wise and Tim Sawyer and they seem to think based on what I have described about myself and my symptoms that it may be something that will benefit from their protocol. At least I'll be evaluated. I suppose my "pain" would be the burning type feeling at the tip of the penis.

I've been working on this "flare" and things are becoming clearer for me. I took 5mg of Cialis and it did allow me to start peeing more freely again (greater volume). It's funny how when you are in the thick of a flare up / retention (unable to sleep) your mind will jump to conclusions like IC, neurogenic bladder, etc. A few weeks ago it was potentially some phantom STI but with the antibiotic course and my sexual history, that's really a near impossibility.

Now my issue is urgency/frequency which may be helped by the SP/Wise-Anderson Protocol if there are trigger points there. If not, then I'll have to decide if I want to manage the situation with consistent Cialis for longer, get on an alpha-blocker to try to reduce the size and prolong further growth of the prostrate give myself more runway before a surgical intervention in the future. The combination of feeling I understand that this is likely still BPH or a very mild CPPS, being on a practical fast the last 2 days and eliminating variables, and doing some pelvic floor stretches is helping right now. No doubt they psychological component is there for me and I suspect that is a factor in BPH has well.

I don't like the idea of surgery as I was pushed L5S1 disc surgery once and passed and things cleared up largely on their own. Like the back, I'd likely want to push off surgery as long as possible, as long as you don't wait too long where recovery is hampered by age. Urologists are surgeons just like back surgeons, and they are happy to jump into it. I hope to exhaust all other methods first. \

Thanks much for having this forum and your replying to so many people. It is very instructive for me. Funny enough, I went to Tucson in the late 90's when I found the PF website and was diagnosed with chronic abacterial prostatitis back then by a urologist that saw WBC's in my prostatic fluid under a microscope. Gave me Cipro and other antibiotics and swear that's when my manageable but annoying tinnitus started. Never had pain or classic symptoms, just a trauma like irritation at the tip of my penis. Back then the urology was mostly fine. Things resolved on their own and I've gone 17 years with no issues, until the flow and weak stream started a few years ago. Take care and since you have BPH, happy to hear any suggestions you have.

[oakland1970]

BTW, correct me if I'm wrong but the symptoms I have that would still point to CPPS over BPH (and why I'm interested in exploring the trigger point therapy) are these:

1. As my urine levels drop in my bladder, the burn increases at my penile tip as my pee becomes more amber and acidic (this is a more recent development)
2. After ejaculation, it can feel a bit stingy/burny at times in my urethra - as if a mild irritation ; subsequent urination begins to be flare-like (more frequency, at times more burny) (this is a more recent development for me)

I've had a series of prostatic massages before (in the past year) and I believe my prostrate to be more tender and boggy, and repeated massages make things less tender and perhaps less boggy -- I do buy that this is from the muscle below the prostrate however ; moderately firm pressing during those massages did elicit the burning tip sensation (mostly unilaterally); another reason I'm looking forward to exploring the trigger point therapy

[webslave]

There no harm in exploring conservative treatments like the Wise Anderson Protocol first. BPH, if you have it, is not an urgent condition (unless you get urinary retention, which in your case is most unlikely). There are symptom overlaps between UCPPS and BPH, so some degree of confusion is understandable.

If symptoms persist unchanged after using the Wise-Anderson Protocol, move to alpha blocker and then BPH surgery, which is, unlike spinal surgery, completely routine.

[oakland1970]

Just wanted to give an update a year later. The flare up I had starting June of 2022 was certainly either another grade of BPH or a true flare-up of some sort. Either way it led to anxiety and insomnia that made recovery longer and worse. Eventually, after 7 months, things were calming down. In all of the workup, my urethra was deemed to be obstructed due to BPH and obstructive as well. So fixing that via surgery was first priority, and then dealing with OAB or seeing if there was continued PFD. So I had greenlight enucleation (like HOLEP) to clear out the obstructing prostate tissue. Things have gotten much better since the procedure and while I do believe I also had some CPPS, it is getting easier to deal with now. I believe intense stretching around the hip are helping with the urgency or frequency issue, or it may just be part of healing from the BPH surgery. Either way, recommend for people to pursue multiple angles and create a plan to discard other diagnosis.

Admin comment: I'm glad you treated the BPH surgically. Give it another few months before making a final assessment of the effect of the treatment, and please report back here with your status.