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Urology/Frequent urination

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QUESTION: Ive been having these symptoms for months now.  Frequent urination...up to 12-15x a day along with chest pain/pressure and also intense rib pain.  The rib pain almost feels as if it were a bruise and the chest sometimes feels as if I had just lifted heavy weights (although I havent).  I already went to a urologist once and had an ultrasound and a catscan.  The primary dr says these symptoms are unrelated.  I often also have cramps and often even after I go, I don't feel full relief or it doesnt last very long.  I feel like IM going crazy.  I was going a lot during the night but weirdly in the last 2weeks, t hat has improved.  I only sleep 5-6 hours but now I often am only getting up to urinate 1x or Im not urinating in th emiddle of the night at all.  This confuses me more as the daytime has gotten worse - not better.  Ive experimented with limiting caffeine and also tried oxybutynin but that didnt help and made the cramping even worse.

ANSWER: Max:

Obviously I'm not going to be able to diagnose a problem that has eluded your regular physicians who have access to more information about you that I do.  You didn't indicate the results of the ultrasound and CT scan from the urologist.  What diagnosis did he offer and what treatment?  If he didn't offer any help, ask for a copy of your records and get another urologist.

I cannot determine if the chest pain is related, but usually it isn't.  Limiting caffeine is a good idea, but I suspect you have a prostate issue or possibly overactive bladder or both.

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QUESTION: Didn't really find anything. I have chest pain/pressure,  rib pain, pressure in mid chest and below belly button from the second I wake up.  Even after I urinate,  these pains dont go  away. I also have long history of depression so no one ever takes me seriously. Ive had this urination issue for 6 months now but the rib chest is getting worse.  What type of Dr do I see for that.. It all started at same time.  Does the fact that during the night,  I'm now going 5+ hours without urinating tell you anything.. Its strange that has improved while I feel worse in the daytime.  The bloating /urge to urinate also gets worse during times of sexual arousal.  Would this cause for a cystoscopy? I dont want to go thru unnecessary procedures but urologist sends me to gi &  vice versa.  I know what I'm feeling is not normal

ANSWER: Max:

It is unlikely that the chest pain is related to the bladder problem.  These are two very separate areas of the body and even though they appeared at the same time, they are not usually connected.

For the chest pain, start with a general practitioner or an internist.

The fact that you have more bladder problems at times of sexual arousal doesn't help identify the problem because this is normal; the internal sphincter tends to close during sexual arousal to allow for proper passage of semen and this would normally interfere with voiding.

A cystoscopy is reasonable, but we can often avoid it with flow tests, checks of post void residuals, voiding diaries, symptom scores and trials of medication.  If the problem persists, then a cystoscopy is very helpful in diagnosing the problem.

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QUESTION: Thanks.
Is there any other medications you would suggest?  Ive tried oxybutynin which worked when I had this problem when I was younger but this time it doesnt seem to help and it causes cramps.  This has been going on for months but what is confusing is sometimes I can go 2-3x in an hour and other times can hold it for 2-3 hours although I do still have the urge.  Im feeling maybe some irritation in the urethra too although not quite burning.  The frequent urination is going on for months but what is just so curious to me is that the last few weeks suddenly, Im not waking up in the middle of the night to urinate when I was doing that 2-4x prior.  The inconsistency confuses me and the urologist had said he wanted a cystoscopy when I first saw him.  I had one in my 20s and it was very traumatic...I just wanted to make sure I know what to ask because I want to try the most conservative things first and I think so far , they havent done that.  Ive read anything over 8x a day is grounds for a 'problem' and it was strange when this urologist thought every waking hour was 'normal'... It just doesnt seem anyone takes it seriously but I know something doesnt feel normal...He said my prostate was normal size and I don't have leakage and he said my prostate was emptying when he did a ultrasound.  Urinalysis on 2 separate occasions showed one occasion with a little bit of blood but he didnt seem worried.  Just was hoping to narrow it down because as you know these days you get 5 min with a doctor and since they get compensated per procedure, they seem to rush that in as a first option.  (if there are other medications that work diff than oxybutynin, please let me know)...I only drink 1-2 cups of coffee in the morning - would that affect later in the afternoon?  My attempts at no coffee have been inconsistent

Answer
Max:

Oxybutynin is a medication for bladder spasms and overactivity.  It shouldn't cause cramps unless it is causing the bladder to empty less effectively.  I still think a cystoscopy is reasonable and the newer scopes make cystoscopy far less uncomfortable than it used to be.  

Voiding every hour is certainly not normal.  We usually consider every 2 hours to be the limit.

There are at least 10 different medications that work similar to oxybutynin.  Your physicians can determine which ones are most appropriate for you.

You can still drink coffee, but try to avoid caffeine (regular) coffee. Try switching to decaf.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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