Question: 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

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

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

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

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

Dear Dr. XXXXXXX

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