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Suffering from anxiety, stress and frequent urination. Ultrasound done. How to get cured?

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General & Family Physician
Practicing since : 2000
Answered : 926 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 have been alone and away from my family for an extended period of time (almost a year) now. This has caused a lot of stress and anxiety day in and out. For the last 8 months or so, i have been recurring symptoms of a combination of frequent urination & a feeling of not having voided. It all started initially with frequent urination for which my PCP put me on a dose of Vesicare (Solifenacin). I took it for about a week, and was fine for few days, but then the symptoms again showed up. In the meantime, he had me take urine culture tests, blood tests (liver, kidney, etc)., also and a physical exam of my prostate. They all seemed to be normal.

I was 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 ibuprofen for a week, and then have warm water baths. I did this, but it did not help, and the symptoms continued.

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 (input 500 and output 383 cc). The doc then told it may be a mild case of BPH and 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 dont 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 general back pain issues.

After these tests were done, a month later, I took a two week break to be with my family. I was a little de-stressed at that point, and not sure if it was 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 (Silodosin) along with Roliten (tolterodine).

I came back after my vacation, and immediately the next day onwards, the same old symptoms were back. And its been the same so far.
What normally happens now is when i have a bowel movement in the morning, I feel very relieved, and i don't experience the not-voided symptom nor the urge.. I am usually fine for about three hours or so, and then the symptoms naggingly start - first with the urge, followed by a non-voided feeling, then an urge, and so on till the night. I can feel the uncomfortness both in my bladder and my prostate area. The intensity also depends on other factors such as my sitting position, etc.

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 and a prostate supplement (available over the counter) without being told by my doc.
I have also observed that these symptoms sometimes seem to worsen with masturbation.
Please help or advise me what to do further, and how to rectify this. Also, do stress/anxiety have any relation to it?

Appreciate your response.

Sincere Thanks XXXXXXX
Posted Wed, 15 Aug 2012 in Urinary and Bladder Problems
Answered by Dr. Divya Kuttikrishnan 1 hour later

Thanks for writing in.

BPH is a common condition which occurs in most males and there is nothing to worry ,since you are already on medication and most of your test results have come back as nothing majorly wrong. You are able to sleep well at night ,which is a good sign.

I believe in the fact that a happy and healthy mind has a healthy body. I would suggest you sign up for yoga/relaxation/meditation classes. It will definitely help you relax.
Regular exercise(preferably mornings or afternoons) 30-45 minutes a day, 5 days a week is a must.Join a gym if you have to. Exercise releases endorphins which will help you feel good.
Another thing you could try is find out if there is a good acupressure clinic nearby.
Talk to your family daily either by phone or voice chat etc.

I hope I have answered your queries .I will be happy to answer any further queries you might have.

In case you don't have any further queries, please accept my answer. Any reviews are welcome.

Have a great day.

Dr.Divya Kuttikrishnan
Above answer was peer-reviewed by
Follow-up: Suffering from anxiety, stress and frequent urination. Ultrasound done. How to get cured? 29 minutes later
Thanks Dr. XXXXXXX I appreciate your responses. I keep hearing about other tests like urodynamic tests, and neurogenic / atonic bladder etc etc.. and many other health scares whose symptoms mimic with what is happening. I was wondering if i should do any other testing. Also, are there any Ayurvedic or herbal / holistic treatments to cure the urinary symptoms of frequency and retention?

Please advise. I am asking this because its going on for the last eight months with not much relief. Of course, i am very stressed and anxious. Could this be a prime factor?

Thanks again XXXXXXX
Answered by Dr. Divya Kuttikrishnan 15 minutes later
Hi there,

I feel there is no need for further tests as even if you think it is due to neurogenic bladder, the treatment is with vesicare and you are already on it. Please avoid further imaging tests and investigations, unless it is absolutely necessary.

I am not aware of ayurvedic treatment for bladder problems. I'm sure it might be there, just that I'm not aware.

I feel you should try acupressure. This might help.

Dr. Divya Kuttikrishnan
Above answer was peer-reviewed by
Follow-up: Suffering from anxiety, stress and frequent urination. Ultrasound done. How to get cured? 47 minutes later
Thanks Dr. Sorry for the inconvenience, but i have three (hopefully last one's) follow up questions.
a) Both the PCP's mentioned that my problem / issue was a *structural* one and *not a functional one*. I didn't quite understand what they meant by that.
b) Typically, how long can i take the Vesicare & Rapaflo combo?
c) Lastly, and i am scared to ask this, based on what's going on, do you feel there's a risk for MS? The reason i ask is i read that a lack of Vitamin D may cause it. I asked my physical therapist and he mentioned my symptoms were not indicative of that, and what was going on is probably due to anxiety.

Kindly advise. Thanks again.

Sincerely, XXXXXXX
Answered by Dr. Divya Kuttikrishnan 49 minutes later
No inconvenience whatsoever. I'm here to answer your queries the best way I can.
I do understand your concern.

By structural what the doctors mean is there is an organic cause to your symptoms.
Functional means thay can't find any cause to your symptoms and then it is normally attributed to somatoform or anxiety related disorders.

a) They might be saying structural as they might have done a per rectal examination and found the prostate to be hypertrophied (BPH). They have found residual volume in the bladder of 383ml. Basically they have found by examination and investigation that there is a problem, so they term it structural. However ,with their treatment you should be getting better. Also please try to follow my advise on relaxation techniques/acupressure. Your symptoms per se are not due to anxiety, but your BPH and bladder problems are your cause of anxiety.Probably your symptoms were not so bad when your family was around, because you felt happy, you were around people who love you and support you. And like I said a happy and healthy mind has a healthy body.

b) Vesicare and Rapaflo are normally given for months to years. Please do not stop and start treatment on your own. Follow your treating physician's advise for the dosage and duration of treatment.

c) If you are very anxious that you might be having a vitamin D defeciency, just get your Vitamin D levels checked. I don't think it could be Multiple Sclerosis, as you would be having many other symptoms.

If you don't have any further questions, kindly accept my answer. Any reviews are welcome.

Have a great day.

Dr. Divya Kuttikrishnan

Above answer was peer-reviewed by
Follow-up: Suffering from anxiety, stress and frequent urination. Ultrasound done. How to get cured? 14 hours later
Dr. XXXXXXX Thanks again for some re-assurance. Sorry, I have few more clarifications.

a) Any chance caffeine affects or triggers my symptoms? I have 1 cup of coffee in the morning and 1 cup in the evening - not too strong though.

b) Should i undergo any surgery in parallel with the medications?

c) A little embarrassed to ask this - What effect will any sexual activity have on my symptoms?

Best Regards XXXXXXX
Answered by Dr. Divya Kuttikrishnan 8 hours later
Hi ,

1. Coffee is a diuretic, which helps in the production of more urine , thereby increasing the frequency of urination as well as urgency in some patients . So, preferably avoid coffee.

2. No surgery is required at this stage.

3.In some patients with BPH , they might have problems with erection and ejaculation . This might lead to a reduction in sex drive.
Also symptoms of BPH might get worse temporarily after sexual activity.

Hope I have answered your queries.

Have a great day.

Dr. Divya Kuttikrishnan
Above answer was peer-reviewed by
Follow-up: Suffering from anxiety, stress and frequent urination. Ultrasound done. How to get cured? 10 hours later
Dr, Thanks for your prompt responses.

I had one concern. With regards to Vesicare, i heard it can also cause urinary retention. So i am not sure if i take that in combination with Rapaflo, which i am taking to reduce the retention.

Also, a small correction above - my initial residual volume was about 117 cc, and during my 2nd test it was 5 cc. So, i thought it was getting better. But, i still feel the symptoms now, and hence started this thread. I have re-started the Rapaflo medication, and have to see.

Sincere Regards XXXXXXX
Answered by Dr. Divya Kuttikrishnan 7 hours later
Hi ,

Vesicare may cause urinary retention in patients with significant bladder outflow obstruction and is contraindicated in patients with urinary retention.

Also your residual volume has come down from 117cc to 5cc ,which is a good sign.

Just give it some time, I'm sure you will get better.

Hope this helps.
Above answer was peer-reviewed by
Follow-up: Suffering from anxiety, stress and frequent urination. Ultrasound done. How to get cured? 2 hours later

Thanks so much so far. You have been kind enough to answer all my questions so far. I really appreciate it. I apologize, but i do have a couple of last follow-up questions and then i will surely close this discussion. Because the more i ask, the more things creep up my mind after i submit my query.

a) During the 2nd test for residual volumes (which showed 5 ml), it was after a bowel movement, whereas during the 1st test (which showed 117 ml), it was just a regular voiding without bowel movement. So, is this a good comparison then?

b) Suppose i had my second test also without the bowel movement, would it have shown different numbers? Could the bowel movements cause additional pressure and hence more voided out?

Thanks so much again.

PS: I am also from Bangalore, but currently abroad due to work needs. My family stays in Rajajinagar.

Best Regards XXXXXXX
Answered by Dr. Divya Kuttikrishnan 9 hours later
Two things are possible ;
Either the bowel movements caused additional pressure and more urine was voided out
or It is quite possible that the medications are working.

Hope this helps.
Above answer was peer-reviewed by
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