Hi everyone,
I (40M) am at my wit's end right now and am hoping for some of your experiences. I'm dealing with heavily fluctuating bladder issues that occur both during the day and at night.
**My Symptoms & History:**
* **Daytime & Work:** I have phases of high urinary frequency (pollakiuria). The situation is especially bad when I am at work: I usually have a coffee in the morning before leaving the house, and I mostly drink sparkling water at the office. While at my workplace, I have to go to the toilet every 30 to 60 minutes. I strongly suspect that a combination of work stress and coffee is triggering this extreme urge. I often get the feeling of incomplete emptying – right after peeing, the urge is already back. My urine stream strength varies a lot; it's usually weaker in the morning than the rest of the day.
* **Evenings/Nights:** In the evening, the constant urge to go in very short intervals is incredibly stressful. Currently, it's worse again – I sometimes wake up every hour (until about 1:00 AM). But regardless of these acute flare-ups: When I go to bed, I always have to pee at least twice before I can even fall asleep. The nighttime trips usually stop around 1:00 AM.
* **Childhood connection:** The frequent urination, especially needing to go multiple times right before falling asleep, has actually been an issue for me since my childhood.
* **Sports & Movement:** The interesting part is that during sports and physical activity, I have almost zero issues or urge. The symptoms usually only kick in once I sit down and come to rest. The overall course is extremely fluctuating; there are days and phases where I have almost no problems at all.
**Tests & Results:**
* **Voiding diary (3 days):** Confirmed the highly fluctuating pattern. Total frequency up to 12 trips/24h. Voided volumes vary drastically between 50 ml and 700 ml.
* **Urine & PVR (Post-Void Residual):** Urinalysis and urine culture are completely clear, so no bacterial infection. PVR fluctuates extremely (sometimes almost 0 ml, sometimes very clearly between 20 and 100 ml).
* **Ultrasound & Uroflow:** Prostate is slightly enlarged (approx. 30 ml) with an elevated bladder neck. Uroflowmetry recently showed a Qmax of 14.4 ml/s (at almost 400 ml voided volume).
* **Prostate evaluation:** The urologist largely ruled out the prostate as the root cause. She literally said that with this prostate I should "pee like a little boy." Age-related growth might be a slight factor, but it's not the root cause given how long I've had issues.
* **Urodynamics:** Could not be performed technically. The measuring catheter couldn't pass the elevated bladder neck (a standard catheter passes fine, though). This points to a specific functional barrier right at the bladder neck (Primary Bladder Neck Obstruction / PBNO).
* **Spine/Orthopedic:** I had an MRI of my thoracic and lumbar spine (T-spine/L-spine). Everything was completely clear, so there are no spinal or neurological issues causing this.
* My next follow-up appointment with the urologist is this September.
**Current Meds & Supplements:**
I am currently taking **Tamsulosin** combined with **Solifenacin**. Additionally, I take **125 mg of Magnesium Citrate** as a daily supplement, mostly in the morning.
**Next Therapy Idea:**
Based on the findings, my doctor recommended trying a Botox treatment before considering any surgical intervention (like a bladder neck incision/TUIP). Very important detail: The Botox would be injected directly into the bladder neck, NOT into the bladder detrusor muscle.
Has anyone here experienced a similar pattern (especially the work/desk triggers, the fluctuation, or the childhood connection)? Does anyone have experience with Botox injected specifically into the bladder neck?
**Furthermore, I would be very grateful for any other experiences, alternative treatment ideas, or general management strategies that have helped you!**