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Dear Doctor, I Very Much Appreciate Your Time To Read
Question: Dear Doctor,
I very much appreciate your time to read my personal concerns and hopefully help. I am a 42 year old male and was diagnosed as having Chronic Prostatitis in 2014, so my questions below may be related to this diagnosis. My current symptoms has been urinary hesitancy, taking several minutes to begin urination and urination stopping at mid stream causing me to restart it. I can have this start and stop of urination about 15 times in one sitting before finally emptying bladder. Also, I have a feeling of several uncontrollable clenching of the urinary sphincter muscle right before I am able to urinate. These symptoms all have the feeling of the sphincter muscles uncontrollably clenching tight or sucking/squeezing to close the urination, similar to the feeling of doing a kegel exercise. I feel I have an anxiety always to begin the urination, fearing this feeling of clenching. I dont know if clenching is a common thing people do.
I am not an very knowledgable in urology and the precise capabilities of the kidneys, ureters, bladder, prostate, etc., but being I have a severely high level of anxiety and stress about my questions, I just wanted to find out if my current symptom of urinary clenching/contractions/spasms/squeezing/sucking of the sphincter muscles (not sure what to call it) causes reflux of urine into the kidneys. Basically, I am concerned that when I attempt to urinate and there are these initial uncontrollable clenching contractions/spasms with no release of urine there may be urine reflux from pressure of urine failing to exit the urethra and reversing. Then when the urination does begin, I have continuous starting and stopping of urination (intermittent urination) during mid stream and fear if this causes harm to bladder and kidneys.. I dont know if this type of urination reflux is possible from these sudden stop of urination or such clenching contractions that are unable to start the urination. I am just anxious when I thought about this. Can you tell me please if my concerns and theories of this is true?
I think my anxieties and fear of urinating, made the urinary clenching/contractions/spasms/squeezing/sucking worse. And I’m not sure if this is actually called a bladder spasm.
I cannot find any information about this online, but I read that we are not suppose to do kegels when bladder is not empty, so this may be from my reasoning. I’m fearing I would need immediately need to use a catheter or have surgery on prostate if my reasoning is true. not sure if this is common.
You don’t have to answer this question below but it may be related to the above concern. Is it safe to push/squeeze out last remaining residual urine in bladder at the end of a urine stream? I’ve been doing this for 5 years now to get residual urine out. I usually just push/squeeze about 2 or 3 times at the end of the stream to finish my stream.
I’m sorry for writing so much, but just very anxious about this causing harm. Thank you for your time to help me!
XXXXXXX
I very much appreciate your time to read my personal concerns and hopefully help. I am a 42 year old male and was diagnosed as having Chronic Prostatitis in 2014, so my questions below may be related to this diagnosis. My current symptoms has been urinary hesitancy, taking several minutes to begin urination and urination stopping at mid stream causing me to restart it. I can have this start and stop of urination about 15 times in one sitting before finally emptying bladder. Also, I have a feeling of several uncontrollable clenching of the urinary sphincter muscle right before I am able to urinate. These symptoms all have the feeling of the sphincter muscles uncontrollably clenching tight or sucking/squeezing to close the urination, similar to the feeling of doing a kegel exercise. I feel I have an anxiety always to begin the urination, fearing this feeling of clenching. I dont know if clenching is a common thing people do.
I am not an very knowledgable in urology and the precise capabilities of the kidneys, ureters, bladder, prostate, etc., but being I have a severely high level of anxiety and stress about my questions, I just wanted to find out if my current symptom of urinary clenching/contractions/spasms/squeezing/sucking of the sphincter muscles (not sure what to call it) causes reflux of urine into the kidneys. Basically, I am concerned that when I attempt to urinate and there are these initial uncontrollable clenching contractions/spasms with no release of urine there may be urine reflux from pressure of urine failing to exit the urethra and reversing. Then when the urination does begin, I have continuous starting and stopping of urination (intermittent urination) during mid stream and fear if this causes harm to bladder and kidneys.. I dont know if this type of urination reflux is possible from these sudden stop of urination or such clenching contractions that are unable to start the urination. I am just anxious when I thought about this. Can you tell me please if my concerns and theories of this is true?
I think my anxieties and fear of urinating, made the urinary clenching/contractions/spasms/squeezing/sucking worse. And I’m not sure if this is actually called a bladder spasm.
I cannot find any information about this online, but I read that we are not suppose to do kegels when bladder is not empty, so this may be from my reasoning. I’m fearing I would need immediately need to use a catheter or have surgery on prostate if my reasoning is true. not sure if this is common.
You don’t have to answer this question below but it may be related to the above concern. Is it safe to push/squeeze out last remaining residual urine in bladder at the end of a urine stream? I’ve been doing this for 5 years now to get residual urine out. I usually just push/squeeze about 2 or 3 times at the end of the stream to finish my stream.
I’m sorry for writing so much, but just very anxious about this causing harm. Thank you for your time to help me!
XXXXXXX
Brief Answer:
Straining during voiding is very bad for you and should not be done.
Detailed Answer:
Good day and thank you for being with Ask A Doctor service!
To answer your question straining during and after you void urine is highly discouraged because it will cause undue pressure in the bladder and into the kidneys causing reflux. Straining also would also cause inguinal hernias and hemorrhoids.
For your voiding problems such as hesitancy intermittency feeling of inadequate void i would suggest doing some tests such as urinalysis, ultrasound of the kidneys bladder and prostate, uroflowmetry, retrograde urethrogram and urodynamics. Possibly a cystoscopy would also be needed to look inside the urethra prostate and bladder.
After all these tests are done then we can determine if you have obstruction that may need surgery.
Straining during voiding is very bad for you and should not be done.
Detailed Answer:
Good day and thank you for being with Ask A Doctor service!
To answer your question straining during and after you void urine is highly discouraged because it will cause undue pressure in the bladder and into the kidneys causing reflux. Straining also would also cause inguinal hernias and hemorrhoids.
For your voiding problems such as hesitancy intermittency feeling of inadequate void i would suggest doing some tests such as urinalysis, ultrasound of the kidneys bladder and prostate, uroflowmetry, retrograde urethrogram and urodynamics. Possibly a cystoscopy would also be needed to look inside the urethra prostate and bladder.
After all these tests are done then we can determine if you have obstruction that may need surgery.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Dr. See,
Thank you for your response and I will follow your recommendations for the testing. I am in more anxiety now, but I just want to let you know that I usually fully empty my bladder and the Straining that you mention I would say is more of a Squeeze tightening that automatically squeezed out urine as the muscle close usually at the end of the urination to get the last drop or residual urine out.. I dont feel this is the type of Straining like for defecation or the Valsalva maneuver that may cause hernias and hemorrhoids. I know this uses alot of force.. My clenching does not use force at all. It's more like the feeling of a Kegel clench. This clenching feeling happens even when I am not urinating and its usually a regular occurrence. Like if someone frightened me I will tighten up. Like a tightening rather than straining feeling. No force or strain used to push, just a closing of the hole that automatically pushes a little stream out. Is this ok?
Thank you,
XXXXXXX
Thank you for your response and I will follow your recommendations for the testing. I am in more anxiety now, but I just want to let you know that I usually fully empty my bladder and the Straining that you mention I would say is more of a Squeeze tightening that automatically squeezed out urine as the muscle close usually at the end of the urination to get the last drop or residual urine out.. I dont feel this is the type of Straining like for defecation or the Valsalva maneuver that may cause hernias and hemorrhoids. I know this uses alot of force.. My clenching does not use force at all. It's more like the feeling of a Kegel clench. This clenching feeling happens even when I am not urinating and its usually a regular occurrence. Like if someone frightened me I will tighten up. Like a tightening rather than straining feeling. No force or strain used to push, just a closing of the hole that automatically pushes a little stream out. Is this ok?
Thank you,
XXXXXXX
Brief Answer:
Contraction on the sphincter is normal.
Detailed Answer:
Good day, and thank you for your follow up question.
Ok, I understand now thank you for your clarification.
What you feel this the sphincter whether it is the external which is voluntary and the internal sphincter which is autonomic.
We have a condition we call detrusor sphincter dysnergia this is a condition wherein the sphincter does not relax during voiding when the bladder contracts at as it normally should this is confirmed by urodynamics
Tightening of the sphincter is ok when it is part of a normal voiding pattern when it is contracting after the void and during storage of urine when the bladder is full.
Contraction on the sphincter is normal.
Detailed Answer:
Good day, and thank you for your follow up question.
Ok, I understand now thank you for your clarification.
What you feel this the sphincter whether it is the external which is voluntary and the internal sphincter which is autonomic.
We have a condition we call detrusor sphincter dysnergia this is a condition wherein the sphincter does not relax during voiding when the bladder contracts at as it normally should this is confirmed by urodynamics
Tightening of the sphincter is ok when it is part of a normal voiding pattern when it is contracting after the void and during storage of urine when the bladder is full.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you for your reply again Dr. See! It has really really helped calm my fears and I appreciate it. Especially your last sentence.
Today I went to the Physician (because it is so hard to make an appointment with a Urologist here). My Physician told me she thinks anxiety is causing me to have so much fear and tension causing Urinary Hesitancy and weak urine stream, rather than my old diagnosis of Prostatitis in 2014. I actually have a fear of urinating, which you may find hard to believe. I fear about reflux when urinating because I may have misinterpreted something I read.
I was afraid that when I was having intermittent urination, that reflux would occur each time the sphincter stopped the urination. I read that starting and stopping of urination is not good, so it created anxiety because I had this problem. Or if the bladder was not empty, any sphincter contraction would cause reflux. But it seems everyone is always contracting their sphincters on a daily basis.
About the sphincter contraction, is it okay to lightly contract it after the urination ends because it has helped me squeeze out some remaining drops or residual urine. I was doing this for 5 years but recently changed to double voiding because someone online said it is bad for the signally in the brain and bladder, and can cause urination difficulty in future. I don't know if this is true, but maybe causing my urinary problems now. I don't know if you are familiar with men or patients doing this to clear final small amount of urine out. I thought it would be pretty common or even a natural automatic closing of sphincter, but if you have any advice on whether this is okay or not, I would appreciate it.
Thank you!!
XXXXXXX
Today I went to the Physician (because it is so hard to make an appointment with a Urologist here). My Physician told me she thinks anxiety is causing me to have so much fear and tension causing Urinary Hesitancy and weak urine stream, rather than my old diagnosis of Prostatitis in 2014. I actually have a fear of urinating, which you may find hard to believe. I fear about reflux when urinating because I may have misinterpreted something I read.
I was afraid that when I was having intermittent urination, that reflux would occur each time the sphincter stopped the urination. I read that starting and stopping of urination is not good, so it created anxiety because I had this problem. Or if the bladder was not empty, any sphincter contraction would cause reflux. But it seems everyone is always contracting their sphincters on a daily basis.
About the sphincter contraction, is it okay to lightly contract it after the urination ends because it has helped me squeeze out some remaining drops or residual urine. I was doing this for 5 years but recently changed to double voiding because someone online said it is bad for the signally in the brain and bladder, and can cause urination difficulty in future. I don't know if this is true, but maybe causing my urinary problems now. I don't know if you are familiar with men or patients doing this to clear final small amount of urine out. I thought it would be pretty common or even a natural automatic closing of sphincter, but if you have any advice on whether this is okay or not, I would appreciate it.
Thank you!!
XXXXXXX
Brief Answer:
No problems with Kegels maneuver after voiding but not during.
Detailed Answer:
I think it is a habit that you have formed over the years to contract the sphincter after every urination. I don't see anything wrong with it as long as you do it at the end of voiding.
We even advise patients to do Kegels maneuvers or contraction of the sphincter to strengthen the muscle in cases where there is incontinence.
I believe a simple uroflowmetry who determine your urine pressure and intermittency on how severe it is and whether to do other medical investigation.
At the end of the day, we have to check why you have intermittency and weak stream and this does not have anything to do with your Kegels maneuvers after you are void because this intermittency and weak stream happens during the act of voiding and not at the end.
I suggest you see a urologist who specializes in neuro-urology or in urodynamics so you get an expert opinion on what you are having before counting it our part of an anxiety syndrome.
Regards
No problems with Kegels maneuver after voiding but not during.
Detailed Answer:
I think it is a habit that you have formed over the years to contract the sphincter after every urination. I don't see anything wrong with it as long as you do it at the end of voiding.
We even advise patients to do Kegels maneuvers or contraction of the sphincter to strengthen the muscle in cases where there is incontinence.
I believe a simple uroflowmetry who determine your urine pressure and intermittency on how severe it is and whether to do other medical investigation.
At the end of the day, we have to check why you have intermittency and weak stream and this does not have anything to do with your Kegels maneuvers after you are void because this intermittency and weak stream happens during the act of voiding and not at the end.
I suggest you see a urologist who specializes in neuro-urology or in urodynamics so you get an expert opinion on what you are having before counting it our part of an anxiety syndrome.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dr. See, Thank you again for your reply and I'm gaining a better understanding about this.
In 2014 when I was diagnosed with Prostatitis, I had similar symptoms. It did get worse when I became Anxious and Depressed about it. But I naturally recovered without medication just by letting it go.
I understand this intermittency is a problem as you said. The symptom of my particular intermittency (when it does occur), is I lose power/force in the mid urine stream and it ends in a contraction feeling like a kegel maneuver. I can't control this, so it is like a Neurological feeling. But I do not feel like I purposely cut the stream at midstream, nor am I straining to urinate (as you said straining is dangerous). Please dont tell me this type of intermittency is dangerous to bladder and kidneys also. I'm getting anxious again. I asked the doctor today if this causes reflux and she said it doesnt, but now Im getting anxious again. I even asked if doing kegels in midstream causes reflux and she said it did not. So I am wondering why is it bad. I'm afraid to ask this question, but I feel I need to know since I have intermittent stream sometimes. I think a lot men with BPH may have this problem or those with neurogenic bladders. So I dont know if everyone is getting reflux when this happens.
Please dont tell me this intermittent urine stream is dangerous.. I dont know what to do because it takes so long to get an appointment with Urologist here, and one who has Neuro-Urology might be even longer.. Lately by relaxing, the intermittency has been reduced but not sure if it did any damage..
I feel you are the only person I can depend on now, and just hoping intermittency is not dangerous and that this is the same situation I had with the Prostatitis diagnosis in 2014 and not neurogenic bladder. Please help, I appreciate it so so much.
Thank you,
XXXXXXX
In 2014 when I was diagnosed with Prostatitis, I had similar symptoms. It did get worse when I became Anxious and Depressed about it. But I naturally recovered without medication just by letting it go.
I understand this intermittency is a problem as you said. The symptom of my particular intermittency (when it does occur), is I lose power/force in the mid urine stream and it ends in a contraction feeling like a kegel maneuver. I can't control this, so it is like a Neurological feeling. But I do not feel like I purposely cut the stream at midstream, nor am I straining to urinate (as you said straining is dangerous). Please dont tell me this type of intermittency is dangerous to bladder and kidneys also. I'm getting anxious again. I asked the doctor today if this causes reflux and she said it doesnt, but now Im getting anxious again. I even asked if doing kegels in midstream causes reflux and she said it did not. So I am wondering why is it bad. I'm afraid to ask this question, but I feel I need to know since I have intermittent stream sometimes. I think a lot men with BPH may have this problem or those with neurogenic bladders. So I dont know if everyone is getting reflux when this happens.
Please dont tell me this intermittent urine stream is dangerous.. I dont know what to do because it takes so long to get an appointment with Urologist here, and one who has Neuro-Urology might be even longer.. Lately by relaxing, the intermittency has been reduced but not sure if it did any damage..
I feel you are the only person I can depend on now, and just hoping intermittency is not dangerous and that this is the same situation I had with the Prostatitis diagnosis in 2014 and not neurogenic bladder. Please help, I appreciate it so so much.
Thank you,
XXXXXXX
Brief Answer:
I don't think you have renal damage.
Detailed Answer:
thank you for your follow- up question.
Intermittency may be caused by a weak bladder and a weak bladder won't cause damage to the kidneys.
an ultrasound and urinalysis would determine if damage to the kidneys are happening or not.
i suggest you continue relaxing during voiding to let the natural process take its course. i don't think you have renal damage because of intermittency and contraction of the sphincter.
I don't think you have renal damage.
Detailed Answer:
thank you for your follow- up question.
Intermittency may be caused by a weak bladder and a weak bladder won't cause damage to the kidneys.
an ultrasound and urinalysis would determine if damage to the kidneys are happening or not.
i suggest you continue relaxing during voiding to let the natural process take its course. i don't think you have renal damage because of intermittency and contraction of the sphincter.
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Above answer was peer-reviewed by :
Dr. Kampana
Answered by
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