Daily Cialis -- Side Effects -- Muscle Pain

No. I'm pretty good. I empty completely most of the time and have the IPSS score of a 20 year old! It's just that every once in a while I can't initiate a void, so I have to self cath. That could be once a day or once every three days, or once a week. It depends on various factors such as fluid intake, sodium intake and activity level. That said, I like to experiment, so have tried different things to try and get over that occasional hump. What seems to work, but not always, are exercising just prior to voiding and now Daily Cialis, except that I probably won't be taking Cialis anytime soon! The other meds I won't take because of the side effects. Of course, fluid management makes a difference, but I'd rather cath every now and then rather than forgo that beer! And while Chips can get me through the night, not great for my blood pressure!

Jim

 

Jim, I guess what you have is not hesitatancy. The hesitancy I have happens almost all the time, unless I wait until my bladder is full. I usually get the flow started by a few seconds of penis shaking or stretching. Upping my Doxazosin will solve it also, but I face with two other potential side effects: low blood pressure and occasional leakage.

Hank

Not sure what it would be called. It starts out like any other urge to urinate, but within a second or so of standing there I will know if it's coming out or if it won't. And if it won't absolutely nothing comes out, not a dribble. It's AUR.  The "penis shaking", or other reflex aids like running water, are sometimes helpful starting the flow, but not in this case. Most of the time I could solve the problem by just walking around for five to ten minutes, but a the middle of the night, I'd rather just cath. I do think the Daily Cialis helped in that regard -- only cathed once in five days -- but no way I will continue with the muscle pain. Doxazosin or Flomax would probably help in a similar fashion, but I would prefer the occasional CIC to taking meds. Some of the yoga Bandhas also seem to help but not every time.  As mentioned, this happens less than once a day so really no big deal. The rest of the time I empty almost to zero and voids are usually 250ml with my normal hydration and 300-400ml if I hydrate the way I probably should. 

Jim

I'll also add that sex may effect those episodes in a negative way, but not all the time. What's going on here could be some prostatic inflammation. Just enough to close down the circuit, in a similar manner to a very full bladder. You also mentioned constipation. And while I'm not generally constipated, I'm sure many of us with obstructions void slightly better with an empty colon versus a full one. So there are lots of variables and a very fine line in my case between a nice full stream and a no go. No doubt it's the obstruction, but my bladder has been rehabbed to the point where once that obstruction is overcome, voiding is normal and pretty complete. That's all due to CIC.

Jim

Lastly, if I wanted to pursue this more scientifically, I could take my own advice, and have video urodynamics done. However, logistically, I would have to be able to duplicate the "no go" situation and have it compared to a "go" situation. This could involve a lot of time at the urologists office, assuming I could find one willing and patient enough to wait for an event that may not be easy to duplicate on demand. That said, other than academic, not sure what would be the point since the only solution would probably be some sort of prostate reduction. And honestly, if I was having real issues, I'd be considering it. But with an IPSS score in the "mild" range, why risk any procedure because there is always the possibility you will end up worse. We see it here all the time. You know where you check off on the bottom of the IPSS sheet whether or not you are OK with your current condition for the rest of your life? Of course, I'd prefer not to cath at all, but I can honestly at this point answer "yes" to that question.

Jim

You and I share the same dilemma: not bad enough symptoms to pursue surgery, yet. I also have mild IPSS score, even though I am cheating with meds. Hank

Nothing else is obvious, I'd considered constipation seriously. It is usually underestimated. In my case, I don't need to be completely clogged up. All I need is a slow moving colon to cause problems, under a marginal situation. Hank

Hank,

I can rule out constipation as the sole cause because I've had the issue on an empty colon as well as with a full one. This is not to say it couldn't be one of the contributing causes along with a very full bladder, inactivity, uneven sodium intake, mild prostatitis (inflammation), etc. The combination of variables is such that even Sherlock would be stumped. In most probability the reason is simply an obstructing prostate, that most of the time isn't obstructing to the degree where it causes symptons, given my rehabilitated bladder. However, when one (or probably) a combination of variables increases that obstruction, then I get my issue. Or, it could be something else Like I mentioned, video urodyamics might offer another clue, or not, but since I'm not motivated to fix what isn't really all that broke, I'm not in a rush.

Jim

This sounds like a bladder issue more than a prostate thing. Prostates stay the same size in the short run, so if something occasionally won't fire, its probably in your bladder. If you're OK with using Cialis, but the side effects aren't worth any relief, have you considered Alfusozin? When I took it I had absolutely no side effects and the research says about 80% who use it fall into that camp.

I'm not sure how much impact any of these meds have on the bladder, but its worth a try. If it doesn't help or causes unacceptable side effects, you can always stop taking them. I think you'll know within a week or two if its helping. This may be more than you're up for, but that stimulation implant the JerseyUro mentioned sounds like it might help too.

Have you ever had your prostate measured? Do you know how big it actually is?

Jim: " .. a combination of variables increases that obstruction ... "

That pretty much sums it up. Hank

Hi OB,

Not saying you're wrong. But not saying I agree. It also could be a combo. Just too many variables. I will have to check my notes regarding prostate size.

The thing is that I have the IPSS score of a 20 year old (3-5), no retention, natural voids up to 400ml, and usually only get up once at night, often not at all. So not sure the risks or bother of a surgery or procedure is worth the reward, given that not everyone comes out better than they went in, and some worse. Currently, I only have to self cath a few times a week, and I can easily live with that as the process itself is now as easy as brushing my teeth.

I could rational Cialis because of the sexual boost, but that doesn't come with Alfusozin.

Jim

 

Hi JJ,

I'm sure the larger prostate doesn't help, but it doesn't seem likely that it would occasionally keep you from peeing at all, when most of the time you're fine.

But your IPSS score says it all - if you're happy the way things are, why ask for trouble? If I was in your situation and a pill with no side effects could allow me to bring my cath supply to the basement, I would do it - as having to always have a cath available would be more of a bother than a once daily pill.

But I'm not you and I would have a higher IPSS score with the same parameters. You are more knowledgeable than many urologists, are fully aware of the potential risks and advantages of meds and procedures and are more than satisfied with your current situation. As the old saying goes, "if it ain't broke..."

Unfortunately, that pill doesn't exist, at least for me. Even with the Cialis, I did have to cath once in five days, so not a complete solution. Pretty sure I tried Alfuzosin four or five years ago and I did have retro even though my uro said I probably wouldn't. 

Going back to the bladder versus prostate (or maybe a combo), video urodyamics might provide an answer, but again the logistics would be tough as I would have to duplicate the "no go" event at the time of the ultrasound. And like when you bring your car in for that "noise", you never hear it at the mechanics! Still, one day I might do it, but not motivated enough now, because while the answer is of academic interest, not sure what I could or would want to do with it in terms of action. 

Jim