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 Urine Stream 
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Joined: Mon Oct 23, 2017 4:15 pm
Posts: 6
Post Urine Stream
Voiding Symptoms:

By change it is meant that a urine stream deviation occurs from the normal 1200 to 1100/1000.

And the urine stream comes out either a split stream with one on top of the other, with the lower stream being the “original” thicker stream and the upper stream being the thinner of the two.

In addition to this, they commonly join to create a flat “blade” urine stream. This “bladed” flat stream is fine up until the half way point upon which it starts to splay and therefore spray creating a spraying stream.

Urination is seated.

Post-Micturation Symptoms:

There are the “penny” droplets after urination.

Urethral “milking” needs to be done.

Been on 2 weeks Cipro and 8 weeks Cipro after which the symptoms cleared up or at least to the best of knowledge but returned a while after finishing the course in addition to serious adverse reactions to the Cipro.

(Seriously, Cipro was bad news although probably worked due to the anti-inflammatory aspect but some effects were a pretty bad reaction.)

Urine and Semen cultures were negative, along with trans-rectal ultrasound which showed no prostate enlargement or calcification.

But the doctor doing it did say it looked like there had been infection present before and that could be seen by this doctor without any prompting or informing.

In essence Type 3 Prostatitis/CPPS (the inflammatory one) is highly likely according to them.

Urine Stream Questions:

1) Could bending of the penis in an abnormal way due to an insult/injury cause for example a change in the urine stream?

2) Also if the penis rotated/rolled/torsion (looking straight down is 1200 to about 0200); so possibly could be penile suspensory ligament damage?

3) If there is an indentation caused by the abnormal bending (bending insult occured mid shaft with penis being bent towards the body), therefore indenting the corpus cavernosum (which can be felt on obtaining an erection - flatness); could the corpus spongiosum and therefore the urethra have been indented or altered too possibly?

4) Or are the urination issues mainly to do with prostate/urethral inflammation and/or pelvic floor dysfunction (which are both present)?

5/6) Has anyone else had urine stream alterations? If so, what is the urine stream like and has it returned to your normal?

Understandably the answers to some questions are yes/no/probably/improbably but does anyone have personal experience or in depth knowledge to give in relation to the likelihoods in regards to the q's above. Any help is greatly appreciated.

Mon Oct 23, 2017 4:20 pm

Joined: Sun May 01, 2016 9:48 am
Posts: 632
Post Re: Urine Stream
Almost everybody has a bend in their shaft in one direction or another, so unless you have a very, very serious case or have suffered some injury with a lot of scar tissue then I doubt it would be an issue. Plus you usually aren't erect while urinating so I don't think this would even come into play unless something is significantly screwed up. Plus if this just started recently without some injury initiating it then I would further doubt it to be due to bending.

CP/CPPS can definitely cause weakened stream, split stream, excessive post-void dribbling, etc. At one point my post-void dribbling was so bad I was afraid to pee when I was in public places as I almost always had a spot or two on my pants afterwards no matter how thorough I was in trying to milk all of the urine out. Over the past year all those symptoms have significantly improved for me and now are generally non-issues. If you've been positively diagnosed with CP/CPPS then I would assume that's the culprit.

When your CP/CPPS symptoms disappeared while on Cipro did all your urinary issues also go away, only to come back once you finished the Cipro? If yes then I think you have your answer.

Mon Oct 23, 2017 5:08 pm

Joined: Mon Oct 23, 2017 4:15 pm
Posts: 6
Post Re: Urine Stream
There was a bending with an erection and then the split/spray symptoms occured, but that was a while back now so recollection is a bit hazy. However the CPPS symptoms were occuring just before the bending incident. Just a bit worried that the bending incident caused the split/spray due to urethral damage with the antibiotics regime (previously Cipro but now Doxy) "taking care" sort of, of the CPPS symptoms.

Although it hasn't been an "official" diagnosis but all the drugs and tests (as in negative results) lead to the most likely conclusion of it being CPPS (Type 3).

The Cipro was crazy with the side-effects; however monitoring of symptoms did lag somewhat. But the split/spray stream with "penny-drop" stayed (but not absolutely sure due to hazy recollection), but the other CPPS symptoms did dissipate.

It does seem that PFD is a muscular issue but if there are LUTS (lower urinary tract symptoms - split into storage, voiding and post-micurition) then it could be CPPS related. Thoughts?

Also have you lot been taking NSAIDs to help out or Quercetin? Or Rye Pollen? There have been studies to show some improvement as they are anti-inflammatory and anti-oxidants (not the NSAIDs which for some cause more micturation issues whilst others it helps).

The split stream from medical documents is found in prostate issues e.g. prostatitis, benign prostate enlargement, or strictures. But again no prostate enlargement so possibly obstruction.

It could be urethral inflammation which would have burning sensations along the urethra too, which is common in infection as well as inflammatory prostate issues.

Have you ever had the split/spray urine stream? Or know of other people having it with the main cause being prostatitis/CPPS etc?

Also just leaving this here as have seen some recent q's about gut microbiome and inflammation in health generally, so hope it helps someone: ... MC5300850/

(One of the authors is Shoskes who did the Quercetin trials and is a leader in CPPS.)

Mon Oct 23, 2017 5:48 pm

Joined: Mon Feb 13, 2012 2:52 pm
Posts: 47
Post Re: Urine Stream
My stream is fine most of the time, but there are times where it feels like I've still got urine left and I have to push on my bladder a bit to get it out in addition to a slower start. I, then have to shake quite a bit to ensure the post-void is minimal.

I've procrastinated on going to pelvic floor therapy as I need to see if it helps/if the physiotherapist can diagnose tight floor muscles.

Tue Oct 24, 2017 3:18 pm

Joined: Mon Oct 23, 2017 4:15 pm
Posts: 6
Post Re: Urine Stream
Try the urethral milking technique so you get as much out as possible to avoid the "penny drop" post-micturation.

As for the pelvic floor muscles; if you get spasms in the perineum then there is some muscle issue there too.

It does seem that there is an overlap between CPPS and Pelvic Floor Dysfunction in terms of some but not all symptoms.

Try stretching out the groin, hamstrings and quadriceps to see if there is any relief.

Tue Oct 24, 2017 4:54 pm

Joined: Tue Apr 12, 2016 11:55 am
Posts: 372
Post Re: Urine Stream
You may have a problem at the tip. I had stream splitting and spraying a long time ago when no CPPS and / or prostatitis symptoms we're presenting. Those occurrences we're infrequent, but I think they might have been caused by urethral narrowing / inflammation from weak bladder and possible damage from masturbation. If there is damage, malformation, and/or obstruction at the tip, that could do it too. Even a little dried semen or peeling skin could block the stream enough to cause it to spray or split. It also could be caused by holding at the wrong angle or squeezing while going. Milking is not a completely safe way of getting all the urine through. Urination is partly controlled by muscle contractions and bladder / other nerve pulses, so look into Flomax, relaxation techniques, and minimize milking. If you need to, get some toilet paper bunched up and finish into it. Or start the shower and pee in there until you are more back to normal urination.

Fri Oct 27, 2017 2:08 pm

Joined: Tue Aug 04, 2015 6:50 pm
Posts: 1087
Post Re: Urine Stream
My stream takes about 30 seconds to start and goes every which direction, it's really annoying sometimes. You could be standing there thinking everything is hitting the center of the toilet bowl, but then you realize you also have to change your socks and clean up a mess lol. If I take flomax though, everything is very normal, like it should be.

Fri Oct 27, 2017 2:51 pm

Joined: Tue Apr 12, 2016 11:55 am
Posts: 372
Post Re: Urine Stream
Flomax works. I think it may help to de-narrow the urethral tube and/or the prostatic tubes.

Fri Oct 27, 2017 3:32 pm

Joined: Mon Oct 23, 2017 4:15 pm
Posts: 6
Post Re: Urine Stream
These are interesting replies.

The double stream which then forms into one spraying stream is constantly present; this may be to do with the CPPS.

The CPPS could be causing urethral inflammation thereby narrowing the urethra at the end where micturation exits or it could be a urethral stricture.

The strange thing is that when the urinary sphincter (the external urinary sphincter; the one that can be controlled by a kegel movement) is "let loose" or "fully allowed open" or "relaxed" then the stream starts to spray. Any one else have any experience with this? Possible bladder outlet obstruction?

As for Flomax; it is an alpha-adrenergic blocker which are the receptor type most found in the urethra. So it helps in de-constricting the urethra as has been said before. Agreed that milking is not the best technique and there was a study on pelvic floor excercises that aid in this.

Sun Oct 29, 2017 3:08 pm

Joined: Tue Apr 12, 2016 11:55 am
Posts: 372
Post Re: Urine Stream
Does external urinary sphincter refer to where urine starts to exit or back where the bladder outlet obstruction is probably/possibly occurring? I think if I didn't have any problems, then a kegel exercise that opens it would cause spraying. It may be that urethral narrowing via prostatitis leads to increased urine velocity through the final phase of the urethra, which is too much pressure and thus spraying/splitting. You might look up peripheral pelvic massage. Since I tried 2-3 times I've had less pressure buildup in my urethra, especially during and after peeing.

Sun Oct 29, 2017 6:46 pm

Joined: Mon Oct 23, 2017 4:15 pm
Posts: 6
Post Re: Urine Stream
From the wiki the internal sphincter is the one between the bladder and prostate. With the external sphincter being between the prostate and the urethra.

So does releasing the external sphincter (through the same feeling of releasing a kegel) cause spraying for you then?

It seems that the urethra is constricted in two possible manners if Lower Urinary Tract Symptoms (LUTS) appear - one could potentially be through a permanent urethral stricture with the second potentially being urethral narrowing through inflammation.

In other LUTS then other anatomical issues could be the cause e.g. enlarged prostate (BPH), bladder outlet obstruction, overactive bladder, interstitial cystitis, pelvic floor dysfunction(?) etc.

For the inflammatory urethral narrowing if Flomax or another type of alpha-adrenergic blocker works then that is a positive sign. But then the question arises what causes this specific receptor type dominance in the first place? E.g. low testosterone perhaps or something else being "out of whack" etc?

Peripheral pelvic massage; is that through stretches on pelvic foor muscles? Can it be done as an individual?

Mon Oct 30, 2017 6:27 am

Joined: Tue Apr 12, 2016 11:55 am
Posts: 372
Post Re: Urine Stream
Hey globe, sorry I didn't get an email that there was a new posting and have posted a ton lately.

I think it's urethral narrowing through inflammation. I thought I might have a urethral stricture, but that may be more serious than what I have. The reasoning I have for thinking it narrowing from inflammation is that the Flomax has reduced the pain and difficulty with urination and pain after urination. I suspect that my urethra is narrow, but is starting to widen back to a healthy condition.

Peripheral pelvic massage from what I've read so far is simply a massage of the ab muscles at the edges and a bit in from the pressing somewhat gently from immediately under my rib cage in a bit from my nipples and down to where my legs meet my waist. Then massaging from there (gently but firmly pressing with my finger tips) down to my groin. Pressing the muscles. Run a search for it and you'll find instructions. The effect is one of relaxing the muscles and reducing pain to at least an extent that is not as uncomfortable / painful.

Yes, a kegel exercise would probably cause spraying while I'm peeing. But it would happen when I released the exercise after pulling in. This is in the case of my narrow / obstructed urethra. I don't know how splitting would occur from that though. I would have to squeeze the glans to cause that during or immediately before starting the stream. With prostatitis and urinary difficulty I've had it is a bit slow to start, and there were times I've had to push to get it through the whole time. Not sure what that's about either. It's almost like the bladder is exerting a pull of urine back into my urethra.

You may look into getting uroflowmetry. It doesn't sound fun, but it could show the doctor and you what is really happening. Bear in mind that you're going to have symptoms that come and go, whether it's prostatitis or some other problem(s). If they go and don't come back, then you likely don't have a problem. But it's still important to get a few things checked off the list of possibilities.

Mon Nov 13, 2017 1:48 pm

Joined: Mon Oct 23, 2017 4:15 pm
Posts: 6
Post Re: Urine Stream
The urethral narrowing through inflammation seems the most likely especially if the Flomax is working.

A cytoscopy or urethrogram would need to confirm there is no permanent stricture. The uroflowmetry would confirm the LUT symptoms but not be able to ascertain if there is a stricture or inflammatory narrowing.

The Pelvic Peripheral Massage sounds good and sounds a lot like Trigger Point physiotherapy/massage/stretching, as in find a "knot" in the muscle and ease it out. Any sort of muscle relaxation is always good.

It's strange for sure in regards to the spraying. If the kegel is held then the stream seems "together" but if the kegel is released then the stream "opens up" so to speak. It's weird. As for the split stream, seems like you don't have it, but is your stream "flat" or like a "blade"?
(So for a "normal" stream the profile of the stream would be - "o" or "0". But with the "flattened" stream it's more like - "|". And this then goes back to the enlarged prostate, urethral inflammation, bladder obstruction or permanent urethral stricture etc ideas.)

As for the straining seems that is common with LUTs and just general inflammation of the urethra, prostate and bladder in most likelihood.

Interesting reference piece:

"Benign prostatic hyperplasia (BPH) affects more than 50 percent of men past the age of 50, and as many as one-third of all men develop significant BPH-related lower urinary tract symptoms (LUTS) that require treatment (137).

LUTS include increased urinary frequency, urgency, nocturia, weak urinary stream, straining to void, and a sense of incomplete emptying, and the incidence of LUTS increases with age in men (138).

Historically, LUTS in men with BPH have been attributed to physical obstruction of the bladder outflow tract by prostatic encroachment on the urethral lumen (139-142).

However, in a recent study of men with LUTS, half the study population (42/84) had no evidence of bladder outlet obstruction (143), and it has been proposed that LUTS associated with benign prostatic hyperplasia (BPH) are actually the result of 3 components: prostatic enlargement, alpha-adrenergic receptor-mediated narrowing of the urethra, and prostatic inflammation (144).

In a retrospective study of 3,942 prostatic biopsies from BPH patients, inflammation (primarily chronic inflammation) was observed in 1,700 (43.1%) (8).

Inflammation was observed in all histological specimens obtained from 80 men without symptoms of prostatic inflammation
who underwent transurethral prostatectomy for treatment of BPH, suggesting that inflammation is extremely common in patients with symptoms of BPH who have no other symptoms of prostatic inflammation (9)."

Fourth paragraph is most interesting and links back to Flomax, adrenergic receptors, testosterone(?) and other factors like insulin resistance/metabolic syndrome/central or visceral adiposity or fat.

Tue Nov 14, 2017 4:32 pm
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