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I am urinating frequently after ejaculation. Why?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At October 19, 2019
Reviewed AtJuly 20, 2023

Patient's Query

Hello doctor,

I am a 35-year-old male, single, with Familial Mediterranean fever, and I am currently under the supervision of a liver doctor. My symptoms have been occurring after ejaculation, and they include frequent urination, discomfort, and pain between the abdomen and thighs. At times, I experience pain in the thighs and notice redness in the inner side of my thighs and lower abdomen. Additionally, red vertical lines appear on my abdomen when I feel the need to urinate. Furthermore, I have been experiencing cold sensations with occasional trembling and episodes of diarrhea. Recently, I have also noticed a partial lack of sensation in my penis, and it sometimes feels like it is shrinking and becomes heavy. Additionally, I have been dealing with bloating in my stomach, and by the end of the day, I sometimes feel the urge to vomit even when my stomach is empty.

These symptoms have been present for the past 15 years, and when I noticed an increase in the frequency of urination, I consulted a doctor. The doctor prescribed antibiotics, which helped in controlling my urgent need to urinate, but they did not address all of my other problems. For the past year, I have been taking Permixon medication as part of my treatment plan. Despite this, I am still experiencing these symptoms after ejaculation, although I have noticed that the symptoms are less severe when ejaculation occurs without any rubbing of the penis.

Hello,

Welcome to icliniq.com.

What you describe is a combination of symptoms that may or may not be related to each other. The pain, urination, and ejaculation problems, as well as the sensations you feel at the penis area, points to what we call non-bacterial prostatitis or Prostatodynia syndrome. There is no known explanation as to why it happens, but it involves the urinary system, genital system, and the pelvic floor muscles, which may also explain your bowel problems. If there is no bacterial growth in the prostatic secretions and urine, empirical antibiotics usually have only limited effect. I would suggest you have a testosterone analysis, PSA (prostate-specific antigen) testing, urodynamic evaluation of the bladder and urine, and semen culture. But your bowel problems should further be evaluated by a gastroenterologist.

The Probable causes

Pelvic floor dysfunction, Prostatitis.

Investigations to be done

1. PSA, free PSA. 2. Urine and Semen culture Urodynamics.

Treatment plan

If it is a chronic pelvic pain and prostatitis syndrome most treatments are aimed at the symptomatic causes. However, new treatment modalitites such as magnetic innervation of the pelvic floor muscles, low intensity shockwave therapy along with Pregabalin oral treatment. For bladder functions treatment should be focussed on the result of the urodynamic evaluation.

Patient's Query

Thank you doctor,

I will request from my doctor the testosterone and the PSA test. The urine and semen culture was done, and it was normal. Also, I did the urodynamic, attached a clear scan, and have translated the report here: Genital examination: Good. Rectal examination: Muscle tone inlay. Maximum flow 0.44 fluid ounces per second, volume 11.03 fluid ounces. The flow curve not normal, fragmented. Left over urine 15.26 cubic inches. Not showing DSD, the bracket is synergy. Maximum urine flow: 0.3852 fluid ounces per second (fl oz/sec), volume: 38.64 cubic inches, there is straining. PFS according to is not blocked. BCI = 79 weak. The doctor thinks maybe there is a bladder construction. I hope the translation is clear, and you can find the report result in the attached file. And, I will start to search for the treatment that you suggest.

Hello,

Welcome back to icliniq.com.

Your urodynamics test shows that your muscles around the bladder are not contracting enough to empty the bladder. Since you have a considerable amount left in the bladder, you feel the discomfort in the lower abdomen. Combining these findings with the loss of sensation in the penis, you would also need to have an EMG (electromyography) study to see if there is a problem with the nerves that innervate the genital area and the bladder (pudendal SEP).

Patient's Query

Hi doctor, it took long time between waiting for doctor and for tests. The psa test result: 0.69 ng/ml TESTOSTERONE total : 23.2 nmol/l the neurologist said that he don’t know places which can make the EMG test, so still searching, I found one place which have shock wave treatment they are using it with people that have problem with eriction, so i will contact them soon to ask about the treatment. I did mri test, the technical guy said that i have disc in l5-s1 but not pressing on the nerve, the orthopedic doctor said that it’s affecting the nerve, for that he gave me lyrica, Anti-inflammatory، Muscle relaxer، and pain killers. That was basically for the back pain. Maybe I forgot to mention the ( Internal shiver ) and general light cramps beside the symptoms Which i mentioned previously.
Hello and happy new year. Lyrica may be helpful in pain management. I would suggest pelvic floor magnetic stimulation. You might need to find a center that would do the treatment. As I mentioned before your urine flow rate is slow therefore adding tamsulosin could help you as well.

Patient's Query

Thank you doctor, after searching for centers i found those things: High Intensity Focused Electro- Magnetic Technology (HIFEM), this center helping women with Incontinence as they said .is it the same technology? This is the link of the used technology: http://www.emsella.co.il/html5/web/3492/35610ImageFile3.pdf And there is the ESWT technology. Is it the same like the , low intensity shockwave therapy that you mentioned? And finally there is this device for home use: https://www.kegel8.co.uk/kegel8-v-for-men-kegel-exerciser-and-erection-enhancer-82217.html Sorry for all those questions, but I want to make sure that we are talking about the same treatment. Thank you
Yes the highintensity electro-magnetic therapy is the choice. The home devices are not really very effective. Please try the magnetic pelvic floor stimulation and I believe you will benefit from it.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Haluk Kulaksizoglu
Dr. Haluk Kulaksizoglu

Urology

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