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Difficulty Urinating and Pain

Sunday, August 27th, 2006
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Hello. I am a 21 year old male, white, about 5′10″, around 125 lbs. I am not sexually active. I have experiencing several worrisome symptoms that have been occurring since last fall. Some of these symptoms occur on and off, while other symptoms are more constant. First of all, I was experiencing testicular pain, for which I had a testicular ultrasound in late January. Since I don’t have insurance, I had to go to a urologist at a free clinic, and the urologist determined that I had an infection in my scrotum, so he prescribed Sulfatrim Oral Suspension USP for me to take twice daily for two weeks. The testicular pain went away for the most part after that until very recently. Lately, I’ve been feeling a sharp pain in the area that connects my penis and scrotum and on the right side of my scrotum. It occurs on and off at random times of the day, but when it does occur, it is fairly intense. Also, for several months, I’ve been having pain in my penis, both when I urinate and at other times of the day when I’m not urinating. However, this does not happen every time that I urinate and it doesn’t even happen every day. When it occurs while I’m urinating, it’s more of a burning pain and when it occurs while I’m not urinating, it’s more of an ache or a sharp pain. Back in February, the urologist looked at my penis and he said it looked red and irritated, so he prescribed Clotrimazole and Betamethasone Dipropionate Cream for me to rub on my penis. I also had a few urine and blood tests, but they didn’t find any signs of infection. I was also concerned about the color of my urine. Sometimes it is very dark, especially when I haven’t urinated in a long time, like when I wake up after sleeping. When that happens, my urine is often for there is just white specks on the surface. What has really been driving me crazy is that I constantly worry every single time I go to the bathroom about whether or not I urinate properly. Sometimes I urinate only a few times during the day no matter how much I drink. When that happens, I also seem to urinate slowly. The reason why this makes me a nervous wreck every time I urinate is because I worry that if I push too hard, I might hurt myself, but if I don’t push hard enough, I won’t completely empty out my bladder. I even sometimes try to hold my breath while I’m urinating so I don’t make any sudden movements, but often find myself doing involuntary pushes throughout the time that the urine stream is coming out. I also wait over the toilet for a couple of minutes to let the drops of urine come out on their own before I shake. I’ve tried sitting down when I urinate and that makes me feel a little better, but I would not like to do that every time, especially when I use a public restroom, since most of them are filthy. Now, although so far I’ve been talking about days when I urinate not often enough and too slowly, there are other days when I seem to urinate nonstop. Last week, for example, in spite of the fact that I didn’t drink very much, I couldn’t get any sleep at all because I was urinating every few minutes for several hours. I also felt very cold. When I urinate very frequently like this, my urine starts to get almost clear. The same thing has been happening to me since yesterday, although this time I don’t feel cold and I haven’t been urinating quite as much as last week. If I can change the subject, I’d like to mention the problems I’ve been having with my bowel movements. Even though I occasionally have diarrhea, most of the time I’m constipated. I have a bowel movement almost every day, but usually I only go a small amount and my stools are small. I don’t feel that I’m finished, so I stay on the toilet for a long time, but I usually can’t get anything to come out. It must really be constipation because I sometimes get abdominal cramps. Because of rectal bleeding that I was experiencing a few months ago, I had a colonoscopy performed on me by a gastroenterologist from the clinic. She found a polyp that was not cancerous but she removed it anyway. She also, said she found hemorrhoids, which she said I can have surgically removed, but I don’t know if I will do that. They are too far in me to put cream on them. I have the same problem with bowel movements as I do with urination. I worry that I push too hard because I want to get everything out. Another problem I have is that I find it hard to separate the muscles that I use to push my bowels from the muscles that I use to urinate. This means that when I push hard while I’m constipated, my penis sometimes hurts as a result. I forgot to mention that I examine my penis regularly, and I sometimes notice that my penis feels wet and sticky, as if some form of urethral discharge came out. Also, last time I masturbated, I felt an orgasm but not much semen came out. I consulted an alternative medicine expert online and he gave me some instructions to follow, which I have been trying to do. First of all, I was told to drink 8-10 glasses of warm water every day. I find it hard to drink that many glasses of water every day, and I’m also not used to drinking warm water, since I used to drink very cold beverages that I put in the freezer for a while. I have largely cut out drinking sodas, and I have been trying to drink more cranberry and other juices. I am also trying to eat more fruit. The main thing he told me to do was to take a product called Fruta Vida, which is a type of juice made from acai berry and other plant extracts from the Brazilian jungle. However, none of these things seem to have changed my situation all that much. I apologize for the huge length of this question, but wanted to give as precise and thorough explanation of my symptoms as possible so that you may give me the best advice possible. I know you said you are very busy, but I would be very grateful if you would answer my questions. I would even donate money if I could, but I am unemployed right now. I would first like you to let me know whether or not you think I could have cancer or some other deadly disease because that is my main concern. If you don’t think I have that, what do you think I should do? The people at the clinic think that it’s all in my head and I can’t afford to go anywhere else. Even if I could, I’m terrified of any tests that they might put me through, especially a colonoscopy, which I understand is extremely painful and I have a very low tolerance for pain. I also forgot to mention that I had a rectal exam, but there was no problem found with my prostate. One symptom I forgot to mention was that I sometimes feel dizzy, especially when I sit up after I awake or when I stand up after sitting for a while. I had an EKG and blood pressure taken, but everything I was told is fine. So, please get back to me as soon as you can because I am frightened that I’m dying. I also would like you to explain to me how I can properly go to the bathroom without thinking or worrying about it. I know I can’t thank you enough, but I appreciate your help tremendously.

Dr. Joshua’s Answer

I’ll start with the question that’s the easiest to answer: The dizziness you feel when sitting up after awaking or standing up after sitting is a normal phenomenon, having to do with blood pressure changes when changing position. It’s called postural hypotension and we all have it to some degree. I wouldn’t be worried about this at all.

As for your urological problems, the best information that I have is that you’ve been examined by an urologist and the doctors at the clinic do not seem to think there is any serious underlying illness behind these symptoms. I appreciate your thorough explanation of your symptoms, but I’m afraid I still cannot evaluate or diagnose your symptoms without physically examining you. I hope you are not too disappointed and understand my position.

From your description it seems that you have been quite properly examined by specialists and they have taken your symptoms seriously. I’m happy about this. I can’t say whether everything necessary has been done, and I recommend that ask your urologist a straight question: Is he absolutely satisfied that all necessary examinations have been done and the symptoms can be safely followed? Also, tell him about how you worry so much.

In this kind of situation, it is best to follow the advice of the doctors that have examined you. If they think there’s a psychological aspect to your symptoms, consider trying to pay less attention to your symptoms and just trust your doctors and see how things go. When no underlying disease is found, most symptoms subside over time.

Please join the Forum and keep us posted on how you are doing. Good luck!


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