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Feeling stressed, depressed and getting frequent urination. What treatment should be done?

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Practicing since : 1995
Answered : 517 Questions
Dear Doc,
Please pardon me for the long post, but I feel the need to share whats going on. I'm about 42 yrs old. I've been alone and away from my family for almost 15 months now, and get very stressed and depressed often. For the last ten months or so, i have been recurring symptoms of frequent urination, which is making me quite uncomfortable and a decrease in the quality of life.

The first time i saw my Ditropan. In parallel, he had me take urine culture tests, blood tests, and a did a physical exam of my prostate. They all came out normal. I took the medication for about a week, and was fine for few days, but then the symptoms again showed up. I was then referred to a urologist who then told it may be a case of non bacterial prostatitis, although I did not have any pain. I was just asked to take Vesicare for a month & ibuprofen for a week, coupled with warm water baths. This did not help me, but i started to experience a non-voiding symptom.

When i followed up with my urologist, he performed three tests - an ultrasound, a cystoscopy, and a cytometry (flow tests). The ultrasound and cystocopy results were normal, but on the flow tests, it was seen that i had a residual volume left of ~117 cc. He put me on a dose of Rapaflo (Silodosin). I took it for about a month and a half (in combination with the vesicare), but i didn't see any changes.

In parallel, I also took a saccral lumbar MRI test which seemed to show normal results. This was recommended by my physical therapist, whom i see occasionally for neck pain issues.

I was extremely stressed out mainly due to what was happening, and the fact i was away from my family for an extended period alone. After these tests were done, a month later, I took a two week break and went to be with my family. I was a little de-stressed at that point, and not sure if it is co-incidental, all my symptoms seemed to have receded. At the most, only 1 or 2 days, i might have felt a little, but overall it seemed to be normal. I also consulted a doctor during my vacation, and he had me repeat the ultrasound and flow tests, and a physical prostate exam. Both came out normal, and the residual flow was about 5 cc. He then advised me to continue taking the Rapaflow along with Roliten (tolterodine).

I came back after my vacation, and immediately the next day onwards, the same old symptoms were back. I stopped taking both the vesicare and rapaflo, and this helped to remove the not-voiding symptoms, but i continue to have the "frequency". I repeated the cytometry and the residual volume was 5 cc. Also, fortunately, I can sleep through the night without having to wake up.
Just for my personal satisfaction, I have been taking some extra Vitamin D & B12 supplements without being told by my doc.
I was also asked to do Kegel exercises by both the docs, but have been unable to do them to my satisfaction.

Please help or advise me what to do further, and how to rectify this.

Appreciate your response.

Sincere Thanks XXXXXXX
Posted Thu, 25 Oct 2012 in Men's Health
Answered by Dr. V. Sasanka 3 hours later
I can assure you that you are not alone in your complaints. Almost certainly, the lower urinary tract symptoms that you have mentioned are due to stress and possibly depression, and no amount of antibiotics will help.
You should learn to do some relaxation exercises like Yoga or Taichi. They often help a good deal.
Some kind of antidepressants work for both elevating the mood, and to reduce the urinary frequency, especially at night. Commonest among these is Amitryptilline. It can cause a few side-effects, like heart rhythm changes especially in known cardiac patients or excessive sedation, but can work wonderfully well in your case. You can consult the urologist you have met earlier if he thinks it is a good idea, because it needs to be prescribed for you to be able to get it from a chemist.
The symptoms you have enumerated also can be a part of non-bacterial prostatitis, and I guess your urologist did a pretty good job so far. You can probably continue to take Silodosin if there is an issue of excess post-void urinary residue.
Your Vit D and B12 can be taken as usual. No need of Kiegel's exercises, but you can continue the warm baths - 'Sitz baths'. They still might be of help.
The best treatment would be obviously to get back to your family as soon as possible:-)
Regards and best wishes.
Above answer was peer-reviewed by
Follow-up: Feeling stressed, depressed and getting frequent urination. What treatment should be done? 22 hours later
Hello Dr. Sasanka,

Thanks much for your responses. I will try to do the Yoga and others you mentioned. Although it is re-assuring to know your feedback, i am however anxious / worried about some issues, based on what i read on other forums and by trying to map my symptoms. I'd appreciate if you could follow up on these:

a) I am very scared to ask, but do you think any of my symptoms are related to nervous system related, such as M.S or others? I ask this is because i read on some forums about folks who had similar symptoms and were asked to get tested for those. Also, I have been living in an area with very less sunshine annually for quite some time, and hence lack of Vitamin D, which i heard contributes to immune system strength for nerve related issues?

b) Do you feel i need any other tests at this point (like urodynamics, neuropathic etc). I keep reading all these, and get psyched.

c) How long should i take the antidepressants to show effect? Is this on a need basis?

b) Can any food allergies cause this like coffee, spices etc?

Please advise. I am asking all this because its been such a chronic thing for the last ten months or so.


Sincerely XXXXXXX
Answered by Dr. V. Sasanka 1 hour later
Let me answer one-by-one.
1) Almost certainly there is no relation to MS or any other neurological illnesses to your symptoms. Your Vit-D levels will almost certainly be not related to urinary voiding issues
2) I doubt if you require urodynamics at this stage. However, you might get it done later if you persistently fail to get relief. I am almost certain it will show no significant anomaly, but that might be one reason why you might need to get it done-to reassure yourself that you have no major problem
3) When I meant anti-depressants, I meant them to be used for their effects on bladder and urination rather than for any major depression. Your usage will typically depend on how you respond, and probably you could gradually taper once you have achieved optimum benefit
4) Almost certainly, food allergies have no relation to your present symptom complex
Try and avoid getting 'psyched'. You should realize that more you worry, more you will be troubling yourself.
Take care, let me know how you are progressing or if you have persistent troubles.
Above answer was peer-reviewed by
Follow-up: Feeling stressed, depressed and getting frequent urination. What treatment should be done? 23 hours later
Thanks Doctor.

I discontinued the Silodosin because it was causing quite discomfort - kind of pain / cramped feeling on my rear side. Possibly because it was trying to work on my prostate muscles. Are there any alternatives to Silodosin?

Also, i asked the question about Vitamin D because i keep reading about a lack of Vitamin D could be one of the causes for M.S and other neurological issues. And some urinary symptoms could be associated with the above. Hence, i mapped the two, and am quite anxious about it.

Please clarify.

Thanks and Best Regards XXXXXXX
Answered by Dr. V. Sasanka 12 hours later
I doubt if Silodosin is the cause for any discomfort, but if you want any alternative, you can try Alfuzosin. It works almost like Silodosin but without any major side effects usually.
I do not think you have any urinary dysfunction related to Vit D or MS from what you have told so far. You only will be getting tied up in knots the more you read about all these diseases.
This is something we used to experience frequently as medical students when we would imagine that we have a kind of illness the moment we read about it, and finally realize that a saner, more plausible explanation always existed:-)
Hope this answers your questions.
Best wishes..
Above answer was peer-reviewed by
Follow-up: Feeling stressed, depressed and getting frequent urination. What treatment should be done? 2 days later
Thanks Doctor; I was wondering in addition to Yoga and meditation, if you know of any Ayurvedic medicines that might help to control these symptoms and give a better quality of life? Or any specific exercises?

Answered by Dr. V. Sasanka 10 hours later
Hi, Sorry - No idea of any ayurvedic medicines.
You can try yoga. I am sure you will find it useful.
Above answer was peer-reviewed by
Follow-up: Feeling stressed, depressed and getting frequent urination. What treatment should be done? 17 days later
Dear Doc,

Thanks for your responses. I just want to find out since i had many tests in the last 1 year or so - which includes Basic Metabolic Panel, CBC, cystoscopy, physical exam of prostate, and cytometry flow testing, how often should i get tested myself given my age? Like the basic BMP and CBC needs to be done every few years or so? Also, what other general physical tests do your recommend apart from above?

Please advise.

Kind Regards XXXXXXX
Answered by Dr. V. Sasanka 3 hours later
There are no standard recommendations for all these tests. From Urology point of view, certainly you do not need to get these tests like cystometry and cystoscopy done again and again. I guess your basic haematologic, metabolic workup can take place on an annual basis. No harm in having an annual digital rectal examination of prostate with a Serum PSA.
Hope this has helped clear your doubts.
Above answer was peer-reviewed by
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