Bladder Control

[anonysk]

I apologize in advance for how long this post is going to be, but I have to let it all out and get some advice and support, if possible. I was recently diagnosed with overactive bladder and it has totally turned my life upside-down. In the grand scale of things, my case is probably somewhat milder than most people's, but nevertheless I feel pschologically devastated by my condition.

To start with, I'm a male in my mid-thirties and am in excellent health otherwise. I am physically active and am in very good shape, possibly the best shape of my life. I can actually remember my first symptom which occurred about two to three years ago. It was after a dinner, and I had a 20 minute walk home. Just as I was leaving the restaurant I felt a slight urge to urinate, nothing major. However, during that walk, the urge suddenly intensified and it was all I could do to hold it in. I ended up finding a bathroom in a hotel about 15 minutes into the walk where I had the most satisfying voiding of my life, but during the walk I remember looking around for some bush or corner I could go, which was hard because it was in the middle of downtown. I had not been drinking alcohol that night, and this was a very unusual occurrence, so it stuck in my mind. In any case, it seemed to be an isolated incident though it may have planted a seed in my head.

About six months ago, I started going to the bathroom more frequently than I had in the past. I had always been drinking a lot of water, but where I would use to take perhaps take two bathroom breaks during work hours, I would take about five or six. I also had a reoccurrence of the quickly intensifying need to urinate – one day after leaving work, about to take the ten minute walk home, it became urgent enough after a few steps that I had to duck into a local sandwich place to get some food just to use the bathroom. After that experience, I made sure I urinated every day before leaving work.

About two months ago, my predicament came to a head. I had a couple of afternoons where I had to go to the bathroom six times in the span of 90 minutes. Each time I went, I urinated a reasonable amount (about 10 seconds worth), and I'm reasonably sure that I emptied each time, but somehow within about five minutes I would feel the urge building again, and in 15 minutes sure enough I would need to go. Then this happened one morning instead of in the afternoon, and I finally decided to see a doctor (I had seen a doctor maybe two times in the preceding 15 years).

Before seeing the doctor, I did some googling, and was hoping that I simply had a UTI that could be treated with antibiotics. However, the doctor diagnosed me with overactive bladder and prescribed me with Detrol LA (tolterodine). Reading the symptoms, it appears that his diagnosis is correct. I immediately started taking the medication, but it did not bring relief over the next couple of days. I ended up seeing another doctor at a walk in clinic, partly to get a second opinion. The other doctor said that the medication I was taking should work pretty quickly, certainly within a couple of days (even though the product info says it could take up to a couple of weeks). He prescribed a couple more medications for other possible conditions (Pyridium and Flomax), though he acknowledged that they may or may not work. He diagnosed me with “urethral syndrome”, though not necessarily saying I did not have overactive bladder Oh, both doctors took urine samples which seemed to be negative for infection based on the preliminary tests. The second doctor is also referring me to a specialist, though I'm still waiting for info on the appointment.

I continued taking Detrol for a few more days to see if it helped, but I did not notice any significant benefit. For the past six weeks or so, I have gone off the medication to establish what my baseline symptoms are. I have not filled the prescriptions from the second doctor yet. I have curtailed my fluid intake slightly, though I am still drinking about eight glasses of water a day and am well hydrated. Anyway, my present symptoms are as follows:

I have the very occasional good day where my urination urges and schedule is oh-so-close to normal (about 4 or 5 times), but for the most part I definitely have a frequency problem (8-12+ times over the course of the day). I do not have any pain or burning when urinating. No blood in the urine. Sometimes it takes me a little while to get started with urination. For the most part, I don't need to get up at night to urinate, partly because I empty myself pretty well before going to bed, and partly because my symptoms appear to be related to my conscious thought. My stream is average, I don't get the super strong stream from when you've been holding a lot of fluid, but I don't dribble or have difficulty urinating. When I do urinate, I usually pass a reasonable though below average amount due to my increased frequency, usually between 7 and 12 seconds. I often have a low-level urge (say a 1.5 on a scale of 1-10) that doesn't intensity that quickly, but is very annoying and may be related to my psychological condition (more below). Even when the urge is not that serious, I “feel” that I may not be able to hold it that long if the urge does intensify. Although my condition felt stable for a while, recently I feel that it is starting to worsen, which seriously worries me.

Both doctors asked if I was stressed, but when the symptoms first came on strongly I was tremendously satisfied with my job and life. However, the most distressing symptom appears to be how this condition has affected me psychologically. On days when I feel the low level urge, it is on my mind 90% of the time. It's so bad that even on my good days, it's on my mind in that I'm thinking, wow, I'm not feeling anything! When I feel the slightest urge and need to walk anywhere, I take the precaution of visiting the bathroom (which only partially helps since the urge sometimes does come back within 20 minutes). My anxiety over this situation is aggravating things, and sometimes my conscious knowledge is making things worse as well.

As an example, the other day I had a 20 minute walk back from somewhere. Within the first few minutes, I felt a slight urge, but because I had no outs I started panicking. That is, the urge was not unbearable by an means, but it was in my mind that it could increase drastically at any moment and that I could have a very embarrassing accident. In any case, I continued walking and the urge subsided somewhat, and I actually made it home no problem. Actually, once I got home I found I actually didn't need to go to the bathroom for another two hours!

As I mentioned before, I feel psychologically devastated – I don't feel that I can spend a day outdoors with friends or go on a date, and even if there are plenty of bathrooms around surely they'll notice the inordinate number trips I make. I really don't know how I can deal with this situation. Before this problem I was a positive, optimistic person – on a scale of 1 (suicidal) to 10 (absolute bliss) I was about a 9. This change in my life has reduced me to about a 5 – the thing I would dread the most is to have to live with this the rest of my life.

I should mention that I have made lifestyle changes over the last couple of months to try to make things better over the long term. For the past several years, I ate very badly, mostly preserved foods and prepared dinners from the supermarket. Over the last couple of months I have largely cut out unhealthy foods from my diet, and am eating much more fresh fruits and vegetables. I have been doing Kegels but I need to be more consistent with them. I have started doing some reading on bladder training but have not yet started a regimen.

In the end, I've been questioning why is this happening to me when I'm this young. While I'm waiting for the appointment with the urologist I'd appreciate any advice regarding treatments or questions I should be asking. I've been doing a lot of research and any additional sources of information would also be useful. I figure I'll have to go for a full urodynamic workup, some of it like the cystometry sounds pretty painful, right now I'm willing to go through whatever it takes to overcome this problem but I am genuinely worried that there may not be an easy solution.

Anyway, thanks for reading, looking forward to any help, thanks!

[Planetoid]

First of all, you are not alone in your symptoms. At my worst, I was having more than two dozen voids/day; now there is a disruption to your life. I remember having difficulty getting my GP to believe a man in his early forties was having OAB type symptoms, but I most certainly was. A DRE revealed no significant enlargement of the prostate, urinalysis and blood tests were negative, but the symptoms persisted. I was finally sent to a urologist, who first treated the OAB symptoms, but eventually performed a cystoscopy on me, and could visually observe both a stricture in the prostate and the spasming bladder sphincter. After that, I sensed a real difference in the doctor's attitude toward my complaints and a willingness to try various options to relieve the symptoms. Tried a variety of anti-spasmotics (Ditropan, Detrol, etc.), but didn't seem to work for long. Side effects from Ditropan were to intense for me, Detrol worked but not as effectively. After cysto, uro prescribed Flomax, an anti-andrenergic agent, which combined with the Detrol, seemed to work pretty well. Symptoms eventually returned, and I was given Proscar as well (to shrink the prostate), again, some temporary relief but symptoms eventually returned. I finally (after eight years) had a PVP (laser surgery) to remove the stricture, which seems to be doing pretty well, and so I have great hope of finally being free from these nagging/embarrassing symptoms. Even though you are only in your mid-30s, you may still be experiencing an enlarged prostate, or some form of stricture. Just something to ask the urologist to consider and investigate.

As for getting on with life; planning, bathroom mapping, protective pads (just in case), etc. are all ways to deal with your symptoms while you work with you physician to find relief. Good luck.

[mik123]

Hi I am 43 yr old male who has a neurogenic bladder (in other words they dont know whats wrong with me). I also have urgency to pee and have my share of accidents sometime if I am meeting with associates or contractors I will notice all of the sudden a warm wet feeling running down my leg so there I go running to the bathroom so I know the feeling. What the Dr. did for me was that ( this is going to sound nasty) he gave me a catheter to use until they figure out what was wrong with me but seeing how they dont know I am now stuck with this tube. But I must admit the catheter has been a savior becaus now I can go places do activities and not worrying about making it to a bathroom. It is weird having a yellow tube hanging out of your abdomen (just not normal) but I would not be with out one now becaus of the freedom the the catheter gives me. Finally, check with your Dr. about having one put in until they if they can figure what is wrong with you or you can do it yourself I hope it all works out for you if you have questions please feel free to contact me.