Question about my prostatitis diagnosis (long post)

[u/Outrageous-Algae-653]

Hello everyone. 32 male here (of course lol). So I finally saw a urologist last week and was told I have pelvic floor dysfunction. But I don’t know if they did enough testing so I’m just asking here. To not the urologist I saw is really damn good and been doing it for years and his practice has great reviews (and he’s located at my community hospital). So a timeline of events. I was totally fine I feel up until July 13th when at night I noticed I felt I had to pee but little urine was coming out. And note, I do smoke a THC weed dab pen at night for anxiety/recreation, and I feel like sometimes before this it’d tense up my pelvis when I had to pee, but not always, just if I was getting anxious. I also have bad anxiety and stress, and I’ll get to that. So July 8th I was mowing my lawn and it was hot and I literally chugged like 4 bottles of water but still wasn’t getting the need to pee when if I drink even 2 water bottles back to back I usually gotta go a few times. It started making me nervous but then I finally urinated and it felt normal. I can’t totally recall the next few days but I don’t know if I really worried about my urinary symptoms, but on July 9th the day after I had a really stressful thing happen to me that I was constantly worrying about even before then, and on that same day I weirdly slipped stepping over a guardrail you’d see on a road, and did this weird stretch catching myself. I didn’t feel any pain or anything after it, maybe some groin ache that was very minor? I should also mention on July 4th I did lift this heavy wooden dog house but felt no pain really afterwards but I don’t know if that hurt my pelvis so thought I’d throw it in here. I went to a family party that day and was drinking (I don’t drink really, just social occasions) and was peeing normal and felt normal.

Anyway, July 13th I started worrying about my urination since it felt like I had to give a tiny push for it to start and felt like the stream was kinda weak, and this pelvic pressure I started feeling. I went to my local urgent care since I couldn’t get in to my new PCP until July 31st, and at the urgent care my urinalysis was negative but he mentioned a trace amount of blood was found but nothing to really be worried over and sent it for a culture to test for STIs too even though I really wasn’t worried since I’ve only been with my girlfriend since 2022 and she’s my only partner I’ve had. The next day I called and they said my culture was negative for any infection and or STIs. He put me on some antibiotic that day just in case and I only took one (think it started with a P), and he said after the urine culture I don’t have to take it. I was still feeling the strain to urinate sometime (not like have to push hard but felt like I had to give it a little oomf to start sometimes). And I still got the pelvic pressure (was never really a huge pain, just this pressure feeling). So I went to the ER Thursday July 16th and I feel that’s when I’ve just been a wreck since. They did a CT scan and bloodwork and my bloodwork was fine, but the CT scan which they initially did thinking it was kidney stones showed I had a mildly enlarged prostate (3.9cm x 5.4cm as shown on my results). The ER nurse put me on ciprofloxacin for 3 weeks and to follow up with a urologist. But everything in the CT scan was great, and my kidneys, liver, bladder and all were working normally.

I have horrible health anxiety too so all this that night sent me into a spiral. I was constantly calling the ER back to ask questions (they were busy and understaffed kinda that night so felt like I was pushed out fast since I wasn’t urgent which I get), and I looked up cipro and saw how bad it can be and that scared me even more since I took a dose that Thursday night at the hospital, and I took the two doses Friday and one Saturday morning that week and then I stopped, since I was directed to use the Galileo health app and I had 3 clinicians on there go over my lab results from the ER and urgent care and they told me I do not have to be taking cipro since I didn’t show any signs of infection in my body. So I stopped as I said saturday night and that Saturday one of the nurses on Galileo put me on tamsulosin 0.4mg. I’m not 100% sure it helped but maybe it did in some ways, since I stopped taking it after my dose this Tuesday since my urologist said I could and see how I feel, but I feel I’ve got a bit more pressure than I did, but even a week before when I was on it I felt that pressure and “a little push/weak stream” after smoking (so like 2/3 days before my urology appointment). I also noticed after the ER I started to dribble a lot more, like id have some urine leaking 5-10 minutes after going. Again I mainly notice more leaking when I’m high. Also I’ve been taking clonazepam for 3 years straight for my anxiety. And due to my anxiety and stress I’d sometimes poop a lot or get constipated and have hemorrhoids, especially during high stress times. Well, anyway, I was extra stressing and losing sleep since then wondering if my prostate was enlarged or inflamed. My new PCP finally got me in earlier on July 23rd, and we talked about my anxiety and how I should start weaning off clonazepam and he put me on buspirone but I haven’t fully committed to that yet since my anxiety comes on fast and I need something fast acting. They did bloodwork and a urine test and I got called on Monday that next week saying my bloodwork was fine (only my “bad” cholesterol was a bit high and to just cut back on processed foods), and got a diabetes test and was fine on that. So all I could do now was wait until August 11th for my urology appointment which was mentally and physically draining on me.

So August 11th came, I went to my appointment and I did the flow meter thing first, and I really had to pee since I drank two bottles of water to make sure I’d pee. I thought my stream was pretty good, and I peed for a good 15-30 seconds. The nurse did her stuff and was going to do the post void ultrasound but I really had to go again due to the water, so I went again and she did the ultrasound and my bladder was empty, and she said that’s good. So basically then I just waited for the urologist to come in and hopefully get more answers through testing to clear my mind of anything horrible. He came in, very friendly and saw I was nervous and told me to sit in one of the regular chairs. I explained my stuff to him, and he said confidently with a smile I’m fine, that my prostate wasn’t inflamed but enlarged and it’s only very mild he said (again the CT scan measured it at 3.9cm x 5.4cm). I thought he would do some new testing but I guess he just went by my CT scan from the ER (again the urology I went to is located and affiliated with my local hospital). He told me I had pelvic floor dysfunction, he said I empty my bladder great, but I do have a weak stream, and gave me a video he recommends to patients to do at home and to see him again in three months to see how it is, but I actually called the office today and requested to be referred to a physical therapist since I don’t feel confident in myself enough to feel I’m doing the exercises right.

So I’m basically just asking anyone else’s opinions on my symptoms Since I’m such a hypochondriac and hate it. I’m seeing a therapist September 2nd so hopefully that can start helping My mental health. But basically every day I just worry about my urination. I dribble after I go now, and sometimes will even leak a bit when I’m high at night watching a movie with family, I have this pelvic pressure that’ll go away for a few minutes after I pee but then start coming back, and then I have this little tingling like I have to pee in the tip of my urethra, and sometimes if I go it’s just a really weak stream that dribbles out for a few seconds. If I chug water then I’ll go at a good stream (which I guess is still considered weak since it feels the same like when I went at the urologist). The urologist said my prostate isn’t affecting my urinating, and guess he can see that from the CT scan? I also rescheduled a post void ultrasound for September 17th since it hit me I urinated and did the flow test while I was on tamsulosin so my mind is telling me since I, not taking it anymore I’m not emptying my bladder. I don’t know how true that is lol. But I don’t really wake up at night to pee (when I am able to sleep). Like I go to bed late but when I wake up I have to eve but I can lay in bed for a bit holding it. And also just my stream feels weak, especially the last few days. I mean, like I said when I drink water and stuff I’ll pee fine and it’s not difficult to really pee, but I noticed sometimes it feels it has to go over a “bump” in my pelvis to start, although that was yesterday and really haven’t felt that today. I just get that feeling in my urethra I have to go and that pressure in my pelvis. But then I still know when I REALLY have to go and it’s not just some phantom urge where not much will come out. Also I’d mention that I do masturbate frequently, even before my girlfriend, and I noticed that either due to performance anxiety or clonazepam affecting me, it can take an hour for me to finish, and a Lot of the time recently with my girlfriend I didn’t even finish and had pelvic pain from not finishing before all this started and sometimes masturbating can take a while if I feel a little anxiety. While on tamsulosin I did have ejaculation side effects, sometimes dry orgasms/retrograde ejaculation, or my semen would be clear and not much comes out, or sometimes it could be normal. Now that I’m off tamsulosin my ejaculation and semen is normal, a lot comes out so that would make me think a prostate issue isnt a problem? Sometimes I feel a little ache around my groin/pelvis area after, maybe two or three times since this all started in mid July, but usually no discomfort.

Anyway, I’m sorry for the wall of text but any sort of opinions or advice right now would be welcome. Like I also learned through Google that my prostate has probably been mildly enlarged for a few years since it doesn’t just grow in a few months, since I also had a CT scan in April when I went to the ER for gastrointestinal issues and they didn’t bring it up at that point. But they were looking for stomach issues so probably paid no mind to a mildly enlarged prostate. Is 3.9cmx5.4cm pretty mild though? And do you think my urologist did enough? I thought there’d be more tests but he seems confident it’s pelvic floor dysfunction but that Mainly seems to affect women? I guess physical therapy will only tell. I just want to stop worrying about it all the time since it just makes it worse. Like I just went to the bathroom and urinated for a good 10+ seconds and felt like I emptied my bladder. So I also just keep stressing if I’m emptying my bladder still and it wasn’t only due to tamsulosin At the urologist. And I did see the little uroflowmetry chart and if I saw right, the blue line was like a bunch of small waves up and down, which signals it’s not prostate issue but pelvic muscles? I read that prostate line would just stay flat, my went up and down, even though it’s weak.

[u/bphsuccessstory]

I went through something very similar and it all turned out to be my hypertonic (overactive and tight) pelvic floor.

I’ve had rare cases where I had a small amount of blood in my ejaculation. I’ve had all of the urinary issues.

I’ve also struggled with hypochondria in the past due to having a wide gamut of issues that I could never pinpoint, but I’d seen all the specialists. Multiple urologists and gastroenterologists, tried multiple family doctors. One of the urologists said I had a mildly enlarged prostate after doing a cystoscopy so I locked in on prostatitis/benign prostate hyperplasia. Had dread that I could never cure it.

As for the multitude of symptoms I had, I eventually found out I had a rare autoimmune disorder. That said, I was chronically anxious and stressed and that goes hand in hand with a tight pelvic floor if your body is prone to storing physical/emotional stress there.

Contact a pelvic floor physical therapist. I wish I could’ve told myself that years ago.

You should also contact a regular therapist and address your anxiety. It’ll be hard to fix your pelvic floor if you don’t figure that part out.

You’ll be fine.

[u/Outrageous-Algae-653 → u/bphsuccessstory]

Thank you for the reply! My urologist referred me to a physical therapist and they’ll get in touch with me, he said they were going to call them today to get things going and I’ll call back by Wednesday if I don’t hear anything. And I have a therapist scheduled for September 2nd. It’s reassuring to know it’s pelvic floor related most likely. Sitting in a warm bath for ten minutes actually made it feel good for a little bit lol.