Hello, I recently had a cystoscopy to see what may be

Patient

Q: Hello,

I recently had a cystoscopy to see what may be causing me to urinate frequently and have sore feeling as well as not finished feeling. The Cystoscopy shown that i had some reddening at the bladder neck which the urologists believe was causing this. He prescribed 4 weeks of Flomax and said he would see me again in 12 weeks (NHS). I have now been taking it for a week and actually feel a bit more like urinating but pain is still there a bit and i feel umcomfortable. I have also had scans etc all negative. Will the flomax work? how long will it take to work, and what does it sound like im suffering from?

Symptoms:  Sore bladder feeling (lower abdomen) frequent urination, feel like not finished urinating
Doctor

A:   Hi.

Thanks for your query and an elucidate history, noting the complaints, findings and medications; all noted.
I would like to know the first thing about Citalopram:
Since when were you taking Citalopram?
What was the indication that Citalopram was started in your case?

To recapitulate: History shows your age group is of 26-35 years, young and non-prostatism group unless there is disease of prostatitis or so - You have frequent urination - soreness feeling and feeling of not finished - Cystoscopy - redness at bladder neck - Urologist feels this to be the reason and gives Flomax for 4 weeks and asks FU after 12 weeks - taking it for a week and actually feel a bit more like urinating but pain is still there a bit and you feel uncomfortable - scans negative -

Your queries:
*Will the Flomax work? > Flomax will work if there is contraction of the muscles of prostate and the urinary bladder particularly at bladder neck.

*how long will it take to work -> It works usually within 1 to 3 days but the response of this drug is dependent on many factors. In some may take quite a longer time.

**and what does it sound like I'm suffering from?
-> The causes can be
a) Citalopram can cause frequency of urination as a common side effect.
b) Reddening at bladder neck- Maybe the reason.
c) Anxiety and stress.

Please give feedback so that we can discuss further and try to find the cause.
It is possible that we have to do trial and error like stopping the Citalopram, adding on some other medicines under the guidance of your treating Doctors. Maybe adding on the proper medications for stress and anxiety or any other condition.

I hope this answer helps you, please feel free to give the full feedback, ask freely the relevant questions if you have or if you feel that there is a gap-of-communication.

Comments / Follow Ups

Patient: i have been on citalopram a number of years and never had the issue :(; what can cause reddening of the bladder neck? how long if you where me would you give for the flomax to work before going back specialist?

previous to all this i had issue where i couldnt urinate at all, i was given cipro and doxy, this cleared the issue of not being able pee at all even though infection tests were negative. But i still have this urinating and pain feeling.
Doctor: Thanks for your feedback. Good to know that you had no issues with Citalopram, although frequency of urination is a common side effects, for your knowledge.

The reddening of the bladder neck can be due to infection, part of the cystitis and particularly this area is the one which is sensitive and hence can cause the symptoms which you have. The irritation of the part itself is many times responsible for frequency of urination, feeling of inevacuation and soreness.
This may be part of the trigonitis which can persist even after the infection has settled and excessive straining at urination can keep it persisting.

As you have a history, where you could not urinate at all could have caused this inflammation as a part of the causative factor, which still might have persisted.
Cipro and Doxy has helped you in this situation in spite of negative tests for infection.

Give full 4 weeks (three more) for Flomax to work, before going back to specialist.


Doctor: Go for urinalysis and culture and sensitivity once again, as if positive added antibiotic can help you faster recovery.
Patient: ok thanks, if it comes back negative again what would you suggest? i keep on the flomax as prescribed for 1month and wait 12 weeks to see urologist? or it sound like it not working. and any reason as to why it may not work?
Doctor: With the picture the Scopy shows, it would be better to have a course of antibiotic like Doxycyclin for say 2 to 3 weeks minimum on empirical basis.
Please continue flomax for 4 weeks and try to get an appointment with Urologist after 4 weeks.
It sounds like flomax alone is not working.

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