"Bladder issues": my (long) story :S

[KayVee]

Ello all,

I'm a 24 year old guy from Brighton, who's sort of at his wits end. Really hope I can get some support and advice here.

In February 2010, after an HIV scare (tests in January were negative), a prolonged period of extreme job stress (a job I HATED, felt constantly stress-paralysed in, and no longer have; currently trying to set up my own business ... no pressure there, eh?) and a sudden bout of illness (laryn/conjunctiv/bronch/sinusitis, all at the same time), I developed a serious problem with my bladder.

Since I was about 18, I'd occasionally felt the urge to go to the loo when I didn't need to, even if I'd just been. It occurred mainly when I was in a sexual situation, and bizarrely EVERY time I got on a treadmill at the gym ... I attributed it to "performance anxiety", it was always temporary, and it never ever bothered me before this year.

One night in February, the day before I was due to go back to work after my illness, I felt this sensation before going to sleep. It was still there in the morning, and what followed was a major breakdown, including suicidal thoughts, lots of crying, a short course of diazepam (which did nothing except make me feel like a zombie), the loss of my job, panic attacks, serious weight gain, and 8 months of the near-CONSTANT feeling that I needed to take a leak, ranging from a niggling feeling in my bladder to agonising, toe-tapping urgency.

I was sent for the usual crazy rigmarole of tests, and I know for certain that I don't have IC, IBS, CPPS, OAB or any of the other possible physical disorders that might cause similar issues. My problem is entirely centered around my anxiety: the symptoms are extremely uncomfortable, more than any other anxiety symptom I have ever experienced. I feel anxious about the symptoms ... which creates them, which makes me feel anxious, which creates them, and so on and so forth in a perfect vicious circle.

I went to my doctor. I've been depressed for years, it turns out, and 2 months ago I was prescribed (at my request; sexual dysfunction and weight gain were ALREADY problems, so SSRIs I was really not keen to try) a medicine called bupropion (Zyban in the UK), which worked pretty much instantly to clear the depression AND the bladder symptoms. I was ecstatic, and aside from the occasional twinge of residual anxiety-based discomfort, I went back to living my normal life. I cannot stress enough how sudden and complete my symptom remission was.

Being the stupid berk that I am, I then decided to take on a significant amount of extra stress. Several of my good friends were having personal crises, some of them abroad, and I seemed to be the only point of contact for them, so I spent large parts of a fortnight consoling them and offering advice, often into the wee hours due to international time differences. I knew this was a bad idea, and that I was heading for trouble, but I couldn't abandon my friends in their time of need.

Adding to my stress was a portfolio client for my business who had been taking SERIOUS liberties, and whose work I could no longer look at without feeling angry and frustrated, which I was compelled to work on to get it out of my hair as fast as possible.

Obviously, I cracked.

A week ago, having also made a number of new friends in London and now anxious about whether I'd make a good impression, I had a panic attack at 3:30 in the morning. All of the symptoms came back, strongly, and I felt like this couldn't be happening to me, like I was in some kind of crazy nightmare.

Since that panic attack, my symptoms have been back in some form or another, and are fluctuating wildly each day. The feeling isn't remotely as strong as it once was, and it's not even really the sensation of needing the toilet any more, more an indescribably vague feeling of pressure or "unease" ... honestly, anything I feel is likely just a normal sensation blown totally out of proportion. Some days I'll be uncomfy for a grand total of an hour in the entire day, while today has been the first day since the attack that I've felt constantly uncomfortable in some way or another (largely because I've done nothing but sit at home and think about it all day).

The problem is that I feel traumatised, first by 8 months of constant discomfort, then from the panic attack hurling me violently back into that world. While the depression is under control (I feel great about myself now), I can't stop thinking about my symptoms. After I empty my bladder, I constantly, CONSTANTLY scan inside me with my mind, looking for the sensation, worried that it'll suddenly appear and make me feel uncomfortable ... which makes me feel uncomfortable, the same way that if you think about your throat for too long it closes up ... which confirms my fears, and makes me anxious, which makes the problem start up, which ... you get the picture.

I KNOW my symptoms are anxiety related: curing the depression cured it, until it came back in a panic attack, which is pretty damn definitive. I've never ever had to get out of bed in the night to go to the toilet (a primary symptom of practically everything organic). I don't meet any criteria for similar physical illness. Caffeine/alcohol/citrus fruits/chocolate/tomatoes/etc. make absolutely no difference to the sensation at all. I've had similar psychosomatic sensations before this whole thing started since I was about 18. If I distract myself adequately, the feeling vanishes totally (as in ACTUALLY vanishes, even under my own "checking" and "testing", as opposed to it being something I'm simply distracted from temporarily), until I get anxious again, or next genuinely need the toilet, then the lottery starts again. Even writing up this post dramatically reduced the symptoms I was experiencing for a while.

At the same time, the anxiety is making me think totally irrational thoughts. Mr Negative (who I'm sure a lot of you guys are acquainted with) keeps shouting things like "what if this is permanent?", "what if the feeling permanently damages your nerves?", "what if it IS interstitial cystitis/prostatitis/IBS?", and most recently "what if it's the medication you're taking, suddenly hurting you?", all of which are COMPLETELY ridiculous. I try to deflect these thoughts, but I have a well-developed tendency (from years of crap) to assume any negative thought is probably true.

I know, in my head, that being anxious of the anxiety is a silly idea, and that I need to let the anxiety breathe in me and acknowledge it. I've talked/distracted/slept myself down from the uncomfortable sensations time after time after time this week, to a relative feeling of calm, but every time I got to the bathroom and urinate, the whole process starts up all over again, no matter how much I try to ignore it. My brain immediately goes to my bladder and stays there, and no amount of certainty about the psychological transientness of the symptoms can stop Mr Negative from putting the seed of doubt in my mind, scaring me.

I was doing so well on the meds that I put a CBT appointment on the backburner, but now I realise I need some kind of therapy. I just don't know what else I could be doing myself to get back to the paradise that the 2 symptom-free months have been ... my coping strategies seem to be ineffective, and the cycle is persistent and hard to break. I have an SAD-esque component to my depression/anxiety as well, which is making stuff a lot harder ... I don't think it's a coincidence that I worsened in December, nor that the whole saga started in February.

There's a number of legitimately anxiety-provoking things in my life right now, that I'm trying to get rid of, but some (like my weight, my new stretch marks, and the condition itself) are in for the long haul. I'd be grateful for any and all support you guys could offer me, in particular advice about what I could do to break the cycle. I'm toying with the idea of speaking to my doctor about going on some kind of beta-blocker, but I know in my heart of hearts that the second I came off them I'd have a massive panic attack and be back to square one, so I'd prefer to deal with the anxiety through more natural means.

Wow that was long ... sorry guys.

Going to bed now, but thanks a lot for your time. Really hope I can use your help to help myself out. I really need to nip this in the bud before it gets any worse, or any more entrenched.

[harasgenster]

Hi there
I actually suffer from OAB but I think it has a lot to do with my anxiety as well. I don't know if this will help you but it helps me.

If you feel like you need to go to the toilet but you know your bladder isn't full, imagine that the muscles around your bladder are really tight and consciously try to relax them. If you focus on it you will feel better (or at least I do!) In my case, I guess my bladder muscle is actually contracted but it sounds like you might have tight muscles in that area too which may be causing the problem? Remember, if you're anxious, pretty much every muscle in your body can get tense!

Also, you mention short-term and long-term worries. Even if it is true that some of your worries may last longer, it might not be a good idea to think of it this way. The reason I say this is because at the moment it sounds like you're going - I'll have this worry sorted and out of the way really quickly but then I've got ALL THESE OTHER THINGS to worry about and I'm going to have them FOR AGES!

You're really making yourself feel like you're trapped by your worries this way, I think. First of all, concentrate on one worry at a time. I know that's not easy but maybe just write everything down like a checklist and then only look at one worry or task at a time. You don't need to think about any of the others until you've done the first one. After you've sorted out one thing, make sure you congratulate yourself. Also, the way you're thinking sounds almost like you don't think you'll get that sense of relief when the first worry is out of the way. But surely the resolution of any worry is relieving? You could maybe try focusing on the rewarding sense of relief you're going to get after that first step and try to look forward to it! Then do that for all the other steps too.

Also, bit of advice. If you want to lose the weight you've put on, DON'T DIET! You'll just be putting more pressure on yourself and, since it sounds like you were slim before, you can just resume a healthy diet and some exercise and the weight will go. You need to be patient, though. Sometimes these things take a while but wanting them now or feeling like you can't be happy until you have them will make you feel worse.

Hope any of this helped.

[JaneC]

Hello KayVee . I wish you luck in overcoming the issues you have at the moment. You seem to know it won't be a quick fix, which is probably helpful, because we all have things that take time to change, both inside and outside. Have you looked at the "Reading" section near the bottom of the list on the left of the page? There's some good stuff in there, a lot of people swear by Claire Weeks in particular.

With regard to the bladder thing specifically, I'm a long-term sufferer and would be interested to know how you know you don't have OAB? I thought it was one of those IBS-type things, the thing that's left when all else has been ruled out. I've been taking meds for it for years purely on the basis of my GP telling me I had it, then, some years later having a cystoscopy and being tol there was nothing wrong so keep taking the meds.

Would it be possible to get your CBT going? Don't know much about Zyban as I am not allowed to have it but is there a possibility your dose could be increased (possibly just for the winter if that is the time when you feel ill)? You also need to learn something from this and remember in the future not to overdo it when you feel well. I know that is hard when you suddenly feel good but it is important.

Hope you can get some help from somewhere and that you feel better soon x

[KayVee]

Thanks for the replies, guys.

Hello KayVee . I wish you luck in overcoming the issues you have at the moment. You seem to know it won't be a quick fix, which is probably helpful, because we all have things that take time to change, both inside and outside. Have you looked at the "Reading" section near the bottom of the list on the left of the page? There's some good stuff in there, a lot of people swear by Claire Weeks in particular.

With regard to the bladder thing specifically, I'm a long-term sufferer and would be interested to know how you know you don't have OAB? I thought it was one of those IBS-type things, the thing that's left when all else has been ruled out. I've been taking meds for it for years purely on the basis of my GP telling me I had it, then, some years later having a cystoscopy and being tol there was nothing wrong so keep taking the meds.

Would it be possible to get your CBT going? Don't know much about Zyban as I am not allowed to have it but is there a possibility your dose could be increased (possibly just for the winter if that is the time when you feel ill)? You also need to learn something from this and remember in the future not to overdo it when you feel well. I know that is hard when you suddenly feel good but it is important.

Hope you can get some help from somewhere and that you feel better soon x

I know I don't have OAB because aside from the niggling uncomfortable feeling, I don't actually have a real increase in frequency or urgency. I go to the toilet about 4 times a day, sometimes less, and I never get a sudden, violent urge to go. Plus, if I did have OAB (or any other organic disorder), there's no reason why the antidepressants would have cured it, nor why it would return specifically after a panic attack. Simply doesn't add up. All of my flowmetrics were also completely fine.

I was put on Ditropan, and later Vesicare, for a while, but they actually seemed to make the symptoms worse, and I felt like I had to constantly strain to get my urine out, so I suppose the OAB meds having the opposite effect is another strike against it. Probably something to do with muscle tension, as harasgenster mentioned.

I take 150mg of Zyban twice a day, with an 8 hour gap in between doses, so I'm not sure how that'd be increased ... I do know that you're not supposed to take more than 200mg of it at a time, but unfortunately it's not officially licensed in the UK for depression, and the 150mg tablets are the only dosage form available, bar importing the drug.

Oddly, when I feel like I have fluid in my bladder and I know I actually do, I don't remotely feel mentally uncomfortable. It's literally just the sensation when I'm not full, that makes me feel anxious, and totally perpetuates itself.

[JaneC]

Only trying to help - stress can be a big factor in OAB, I'm sure its the cause of mine. Also, at times my symptoms can be pain only without an increase in frequency and urgency and it's not common for me to need to go to the loo during the night.. No experience of the meds you've tried, I've only had Detrusitol, which has worked but has possibly lost effect over time.

I really think you need to speak to your doc x

[KayVee]

Only trying to help - stress can be a big factor in OAB, I'm sure its the cause of mine. Also, at times my symptoms can be pain only without an increase in frequency and urgency and it's not common for me to need to go to the loo during the night.. No experience of the meds you've tried, I've only had Detrusitol, which has worked but has possibly lost effect over time.

I really think you need to speak to your doc x

To be honest based on everything I've read about OAB, that genuinely doesn't sound like OAB ... pain is never mentioned as a symptom of OAB, as far as I'm aware, and nocturia is one of the primary ones. Maybe it's literally just the stress causing the problems, as opposed to OAB being exacerbated by stress? It certainly doesn't sound like anything serious, but if you don't actually have regular detrusor spasms in response to bladder filling, leading to more regular trips to the loo and noticeable urgency, I'd question the diagnosis, especially if it was given to you as a "catch-all" like you mentioned ...

I'm not sure what I'd say to my doc tbh. I'm wondering if it might be possible to get a beta-blocker on an "as-needed" basis. I actually take Atarax (hydroxyzine) for my hayfever in the summer (and Autumn, and Spring ... serious allergies to grass, trees and fungus spores. Fun! ), so I might ask him whether it's OK to take them for the anxiety too, while I'm on the anti-deps.

It's irritating ... as the week goes on I'm realising it comes and goes in waves. If I wake up needing the loo vaguely, I can hold on for like 4 hours quite happily, with no mental discomfort. It all begins the second I first take a leak. Need to find some adequate distractions today, I think.

[KayVee]

Went to the loo (first time today), and as a novel exercise decided to time exactly how long it took me mentally sweeping through my bladder to develop any real recognisable uncomfortable feeling.

Turns out I spent 20 minutes sitting there thinking non-stop about how my bladder felt before I felt genuinely uncomfy. How ridiculous is that?

5 minutes after that, I'd adequately distracted myself, and felt pretty much nothing else until 2 hours after I'd been, when I genuinely needed to go cuz I'd drunk a ton since ... and even that was fine to put off for an hour or so.

I've felt basically no abnormal sensations and no real anxiety today, bar that 5 minutes ... several headaches, but headaches are vastly preferable. If anything writing this all down is showing me definitively how totally silly and irrational I'm being ...

[harasgenster]

To be honest based on everything I've read about OAB, that genuinely doesn't sound like OAB ... pain is never mentioned as a symptom of OAB, as far as I'm aware, and nocturia is one of the primary ones. Maybe it's literally just the stress causing the problems, as opposed to OAB being exacerbated by stress? It certainly doesn't sound like anything serious, but if you don't actually have regular detrusor spasms in response to bladder filling, leading to more regular trips to the loo and noticeable urgency, I'd question the diagnosis, especially if it was given to you as a "catch-all" like you mentioned ...

Hi. Just wanted to say that OAB diagnosis does include pain and neither nocturia nor urgency are required to make a diagnosis. Frequency is enough.

Sounds like JaneC has the same symptoms as me, more or less. You probably don't have it if you don't feel this way all the time, though, and you'd probably need to go to the toilet more than four times a day!

Also, with the drugs you were given - I believe difficulty in urinating can be a side effect.

ANYWAY! Well done! I think you're right. There probably is no medical condition here, it may just be anxiety. Just try to keep it in mind that you have days like this and, if the bladder gets worse sometimes, try not to let it get you down.

[JaneC]

Thanks for that harasgenster

[KayVee]

I see! You learn something new every day.

Today's been extremely interesting. Have been successfully challenging the feeling, aside from a pounding heart have felt basically normal, but it transpires that today my kidneys are apparently working overtime, and I keep GENUINELY needing to empty my bladder. :S

Early days I suppose. I was naive to think that the medicine would fix everything, definitely. Hopefully I'll be back on track before long.