I am feeling constant tension while urinating and also feel like something is stuck. Why?

Question

Hi doctor,

I am a 35-year-old male. I have been having issues emptying my bladder due to a very poor urine flow for five to six years. I have to go to the toilet very frequently after drinking. I cannot empty my bladder at any single time. It has to be little drops at a time, every 15 minutes. My stream is very poor or no stream at all at times. It does not feel relaxed or normal in the lower stomach or bladder area. I am feeling constant tension. While urinating, it feels like something is stuck or compressed somewhere between the bladder opening and the urethra, not letting the urine out. I try to push but no effect. I can only have a good stream when I have not been to the toilet and held the urine under pressure for a while. I have been checked for this by doctors twice in five to six years. They performed cystoscopy and a few other tests to map how my bladder functions. They did not see any blockage inside. Their opinion is that it could do with my nervous system not squeezing the bladder and opening the exit.

I am not satisfied with the above findings due to some reasons, which are, when they performed cystoscopy, it made my flow normal for a day or two (both times). Does that mean the mussel got pushed open with the insertion of the telescope and went back to a compressed state after two days? When they inserted the telescope halfway through, I felt resistant before entering the bladder. Is this normal or suggests some squeeze or block? I have also tried tablets by two doctors, one was ayurvedic, and the other was allopathic. Both times it helped me open up to a normal stream but just for the first two to three days only and back to the problem again. I had a burning sensation while urinating when I used the ayurvedic tablets, if I remember correctly. I cannot find the name of the medicines as it has been a long time.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

You mentioned cystoscopy. According to the history you gave, it seems you have a neurogenic bladder. The normal power of the bladder to evacuate itself went away, and either you have to strain during micturation, or you have to apply suprapubic compression to empty your bladder. You felt better for a couple of days. It is the only thing that goes against this diagnosis. For sure shot diagnostic modality to know all these things, I would suggest a urodynamic study for proper diagnosis. My suggestion to you is to start tablet Urotone 25 mg (Bethanechol 25 mg) thrice a day for one month, and tablet Alfuzosin 10 mg at bedtime for one month and see results in a better urine stream and decreased frequency. I suggest you take an ultrasound of the abdomen with PVRU (post-void residual urine test), but the suggestive treatment may vary.

I hope this helps.