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[mountainguy]

Fair warning: this medical problem may be a bit TMI to some forumites, but I could really use advice here.




For the past six months or so, I've been experiencing very frequent urination. I usually have to go at least once every two hours during the day, and I get up an average of three times during the middle of the night, which obviously interferes with my sleep pattern (I have to devote 9-10 hours to sleep each night because of the "interruptions" of waking up) . My psychiatrist sent me to my general practitioner, who did full lab work (blood and urine samples) that ruled out prostatitis, bladder infection, and hyperthyroidism. The psychiatrist thinks it's just anxiety. The GP thinks it could be medication-related (I'm on 20/mg daily of Lexapro, which is known to impair full endocrine functioning to some extent), but is reluctant to recommend any changes without the psychiatrist's approval. The psychiatrist thinks it's "unlikely" that the Lexapro is the culprit. Other factors that I've considered are that I occasionally take OTC sleep meds, which are known to cause urinary retention. But the problem is still there when I don't take sleep meds. I'm also aware that drinking soda or coffee can cause frequent urination, but I drink no more than one 8-ounce cup of coffee per day and only have soda two or three times per week, usually in very small amounts.

I guess I'm wondering if I'm being proactive enough with the psychiatrist and GP. From what I've read, this is a very rare medical problem for men in my age demographic.

[lolar2]

Diabetes? Interstitial cystitis? That's all I can think of.

[runwithscissors]

Are there any other symptoms other than excess urination?

[kedves]

I don't really think there are any gross conditions, but I don't know if I can help.  I can add that I read recently in an article about the health benefits of coffee that it is not a diuretic; it only produces urine to the same extent any other liquid does in the same quantity.  My question, which I'm sure your doctor asked you, is about liquid intake.  Are you thirsty all the time, or normal?

You are going to have to ask for a referral to a urologist.  That person will be the one who has the information to go further.

[mountainguy]

Diabetes? Interstitial cystitis? That's all I can think of.

My blood sugar levels are normal. I'm not familiar with the other condition you mention.

Are there any other symptoms other than excess urination?

None that I've noticed.

You are going to have to ask for a referral to a urologist.  That person will be the one who has the information to go further.

Yes, I was wondering if I should go that route.

[kedves]

You are going to have to ask for a referral to a urologist.  That person will be the one who has the information to go further.

Yes, I was wondering if I should go that route.

I think you should, first because you want to be certain it is not a symptom of something serious and second because even if it is a minor thing, you want to be able to manage it in a more comfortable manner.  Sleep is one of the most important foundations of mental and physical health.  (I have said so!  Actually, that is my opinion without medical evidence, but it is based on my reading about the effects of lack of sleep.)  You want to know what is going on, at least, and you will need an expert to go beyond the common things which have been ruled out.

[polly_mer]

As long as we are working on TMI, another not-at-all-worrying-but-sometimes-overlooked factor is focusing on the urinary tract instead of the bowel to see if the problem is simply not enough room in the bladder because of some changes in digestion.

[oldfullprof]

(TMI Warning) I know Lexapro is SSRI, and I recently switched to Effexor (also one), and I'm here to tell you that many drugs of this type play hob with your sphincters.  While the Effexor was coming up to a blood level, I had conditions ranging from inability to urinate to frequent dribbling.  I was thinking of Depends, but it's better now.  (Ejaculation became and is a once a month event, needing intense pressure to occur at all - which might make me more popular if I were still dating, because there has been no problem with libido or potency.  My current wife probably think it's a time waster-- just joking.)  So what the doc says is likely uninformed. As a licensed psych tech in the 70s, I can remember catheterizing Elavil (amaltryptaline) patients whose sphincters had seized up.  Elavil is not an SSRI, but I betcha many antidepressants have this effect.  (/TMI warning.)

One of the papers I wrote as an undergrad was about how physicians had little (and desired little) knowledge of the actual (and common) experiences of drugs for their patients.  Many patients say that Haldol feels like the floor and the ceiling are six inches apart, and other things of this sort.  Docs read the literature, which happy faces this stuff.

[hegemony]

Though coffee is no longer thought to be a diuretic, caffeine does irritate the bladder; so you don't actually have a full bladder, but the irritation makes you think you have to go.  So that would be one thing to assess: are you actually urinating more in terms of volume -- and thus you have to get up to relieve a full bladder -- or is it just a feeling of needing to get up and relieve the pressure, but when you do it you don't actually pee a great deal?  (TMI.)  I have noticed this myself -- if I drink a lot of caffeine, it will feel as if I'm bursting, but when it comes down to it, I wasn't.  It could also be that some other food or drink you're taking in has that irritating effect.  You could test the caffeine angle simply by giving it all up for a couple of days and seeing if you notice a difference.  That might well not be the problem, but it's an easy thing to test by yourself.

[oldfullprof]

What I forgot to say is that the irritated feeling at the sphincters (prostate and tip of the urethra) frequently feels like the need to urinate.

[msparticularity]

MG, you may need a new psychiatrist. The physicians' information on side effects for Lexapro (found on the insert that some pharmacies give out and some remove from the meds) says: "Genitourinary side effects including urinary tract infection and urinary frequency have been reported frequently." I found it on Drugs.com, but it's also on several other sites.

[biomancer]

I chime with the recommendation for a new psychiatrist or at least a very serious conversation with the current one, with the patient/prescriber information for Lexapro in hand - Occam's razor suggests that this is probably an effect of the drug.  Drug side effects can be vicious and highly variable, but anything that made it into the drug information insert is something that should be on your psychiatrist's radar.  If his radar dismisses side effects, then you need a better psychiatrist.

That being said, if this becomes persistent, and/or continues after tweaking of the Lexapro/other Rx, then you should definitely see a urologist to make sure that there's nothing seriously wrong with your plumbing.

Good luck!

[mountainguy]

Thanks for the ideas, everyone. I definitely will talk to the psychiatrist about possible options at our next appointment in a few weeks. As it turns out, I'm more inclined to believe my GP (who has many more years experience) in the first place.

Any ideas on other medications to look into???

[oldfullprof]

Many people are happy with Welbutrin (a dopaminergic drug) because it has a decided "up" effect and few G-U side effects.  I'm afraid of it because I tend to hypomania on meds.

The primarily serotonergic drugs (like Efexxor, Prozak, Zoloft, etc.) seem to do more of more of the G-U stuff.  I was on Desyrel for years but I don't get enough of an "up" effect.  So I'd drink too much coffee (a dopaminergic drug) to get it.  I like Efexxor because I can take many relaxing naps on days off.  Effexor is an SSNRI as well (generates norepinephrin at higher dosing levels.)  All of them are supposed to reduce anxiety as well as depression, and this seems to be true.  (Maybe not Welbutrin, this last.) 

[tolerantly]

If you're actually producing a good volume of urine each time, diabetes should be the first thing your doc looks at. Otherwise, my guess is infection. The docs have gotten ridiculous about withholding antibiotics but I'd go push for that and see if it does the trick. Much better than messing with your head.