2005 and 2006: What is wrong with me?

Here's the story of my mystery symptoms through July 06:

Approximately holiday season 2004 I remember going to the bathroom to #2, I would finish, wipe, get up and flush, and within a couple of minutes have to come back to urinate. Kind of seemed like when I sat to move the bowels it was blocking the front side, and then when I got up it would release. First and second time I thought nothing of it, then when it started happening more regularly, I distinctly remember thinking about asking a doctor friend to see if that was strange.

In Spring of 2005 I was starting to have a lot of urgency in urinating. I figured coffee and other caffeine were causing it since it's a diuretic, so I cut way back on that. I first noticed some signs of ED at this time too. Was able to become aroused, but had trouble keeping it.

June 2005 I got a vasectomy. On one of the follow up visits (roughly July or August when I had to sample check the procedure), I discussed with the urologist that I was having a lot of urinary bathroom emergencies and some ED symptoms. He prescribed Uroxotrol and Viagra. I filled the Viagra prescription and not the uroxatrol because I was afraid of it when I read the label.

I didn't use the Uroxatrol at all (not even the samples), and used the Viagra - also Cialis and Levitra. Initially these worked well, but as the summer turned into fall, they became less effective and I also noticed what felt like a big sinus block under my eyes which would last several days. In October or so, the ED medications only made the sinuses act up and had almost no effect where it was supposed to.

January 2006 I came to realize I might be sugar sensitive and realized I was having wild mood swings in the day along with blood sugar highs and lows. Falling asleep at my computer at 3:00, things like that. I modified my diet, substituting higher protein and complex carbs with great success in eliminating almost all moodiness. My sugar sensitivity - possible addiction - seemed to be causing my mood issues and this remains good with the right foods. The by product is I've also lost about 15 pounds.

I have lost control of my bowels about 4 or 5 times in the past year also. Most recently was August 14 and prior was June. Both in the morning. Stool normal color and texture.

I also now drink VERY little coffee, a cup a week or less, I consume 10% of the sugar I used to (which was substantial). I drink water, but still not as much as I should because of the urinary problems. I carry a cup in my car and often have to use it at stop lights. If I drink alcohol with friends in the evening, I have to use the bathroom at least 2 times per drink.

After having an MRI in August 2006 showing an enlarged piriformis muscle, I did about 2-3 weeks in chiropractic and deep tissue massage, along with stretching. This actually made the symptoms a little worse, as I awoke 3-5 time a night to urinate, each time less than an eggshell in volume. I am used to sleeping through the night and this episode of night awakenings made my sleep awful and I was exhausted during the day. I usually now have to urinate at least once every night, which is still difficult to manage.

Current symptoms:
1) Urinary problems. I have to go numerous times a day – between 10 and 25 visits, many times with tremendous urgency and often leaking. I also get little flow after these emergencies, usually an eggshell or two’s worth. As a pilot, I have had to carry a relief bottle even for short flights, and have had as many as 3 or 4 urinary emergencies in a less than 2 hour flight. Leakage is common. Despite the heat in Las Vegas, I sometimes resist drinking anything for fear of another emergency. I also have to urinate sometimes at night which I never used to do, and in order to reduce that, I press on my stomach while urinating just before bed to try and empty it out. In the past few months, most times when I pee in the morning it smells quite bad and is also darker.

2) ED. I feel like I did before puberty in that I am interested and love women and I'm just as bad as ever at spinning my head to look when I see a great looking woman. My wife is great and I feel no less attracted to her than ever. I am able to get an erection once every week or two, but cannot maintain it longer than 10 seconds, so sex is not really possible without the pills. I do get the pre-ejaculation fluid, and still get that from thinking about it. I seems there just isn't any blood going there. I haven't used any medications for this since January at least.

3) Occasional loss of control of the rectum. In June 2006 on a Sunday morning, I woke up and used the bathroom, ate breakfast, and then went #2. I got up and got ready to go outside and skin the palm tree in the front yard. Put on some shorts, knee pads, and grabbed a knife. I bent down on my knees, realized I had to poop more, couldn't hold it, and then had to go take a shower because I made quite a mess of myself. This happens once in awhile, maybe 3 or 4 times in the past year. It isn't diarrhea. Possibly softer than normal but not runny. Normal color.

4) Slight weakness in my legs. I can walk, but I have issues trying to run or use one leg, such as stairs, or picking up something off the ground. Balance on one leg is difficult. On occasion, one leg or the other will give out briefly. I feel clumsy when I try to run, and I haven’t been able to play baseball or basketball or do anything that requires quickness and agility. I can hit, throw batting practice to the kids, catch and throw fine, but bending down to field a ground ball, especially to one side or the other, just isn't within reach anymore. Have thought this was due to being overweight, which has prompted the weight loss of late. I went on a National Park tour in Southern Utah July 2006 and we hiked 2-7 miles every day and was able to do that.

Tests that have been done
All kinds of blood work has been done, with the exception of a PSA test. All have been negative. All urine tests are negative, though my urine does smell in the morning. Rectal exams from 5 docs now have said nothing abnormal, with the exception that one urologist and a colorectal surgeon said my sphincter clamping pressure was fairly weak.
I've also had a rectal ultrasound, which indicated my prostate was 53 grams. It also revealed the day I had it that my bladder we completely full, yet I couldn't provide a urine sample right before the test. The Doc was going to catheter me, but I then drank some coffee and managed to urinate some. That doc figured I had BPH/enlarged prostate and prescribed Flowmax and Avodart. Flowmax helped for a week or so, mostly with morning urination, but didn't stop the afternoon emergencies. Avodart did not help. A month later I went to see that same urologist and he did an exam where you catheter a tube inside the penis with an eyepiece. That exam revealed no blockages or abnormalities. Doc said to stop taking the Avodart and use the Flowmax as needed.

August 2, 2006 I had an MRI, which revealed a massively enlarged piriformis muscle having a “mass effect” on the L/S nerve. Referred to a neruosurgeon and a colorectal surgeon. Colorectal (mid Sept 2006) said this wasn’t her area of expertise, and her exam noted the weakness in the sphincter muscle. Neurosurgeon (mid sept 2006) referred me to pain management Dr. for injections into the piriformis to see if there was any change in symptoms.

A secondary reading of the MRI suggests an "avariant insertion of the piriformis". This Dr. also said that lesion alone does not explain the incontinence or impotence. To work that up he would MRI the entire cord and brain to look for any demyelinating lesions in the brain. Also Normal Pressure Hydrocephalus or some variant might present like that in a younger person.


Meds
Currently taking nothing. Have active RX for Viagra, Flowmax, Avodart. No other meds in the past few years other than an antibiotic for a short time after bronchitis or something like that. I still take no meds for little aches or groans, and I don't take any sleep meds.

Other Treatment:
Chiropractor initially seemed to reverse the intensity of some urinary symptoms . Leg weakness was reduced, but erectile symptoms have no change. I can usually make it through the night without having to urinate, but not always. Deep tissue massage did worsen all symptoms so they were discontinued.

Summary:
Urinary symptoms came first, then ED.
No low back pain but leg weakness as described above.
I have had no low back injuries and it is not in pain.
Not aware of any family Lumbosacrral or neuromuscular disorders except my mother got a shunt for normal pressure hydrocephalus (NPH) in 2005.
I haven't had any flulike symptoms in 2 years, and in fact, this past winter was the first time in years that I didn't get sick to any degree whatsoever. I'm usually first in line to get bronchitis and huge coughing, etc. but this year I was remarkably benign.
The urine isn't painful but is never complete and it starts and stops a lot. I feel like I'm running around with a 90% full bladder. I have all these emergencies but I never empty it out.

Additional history:
In 2001 was working in LA. My wife shipped our black Jeep to me in LA and I drove it around for hours a day in LA. I began noticing parasthesia on both legs, but no pain. Legs would give out like they have been now, too. I saw a neurologist, who had me in an MRI tube in 40 minutes, fearing some king of tumor or something. MRI negative. He then sent me for an EMG, also negative. He wanted to them do a surgery on the back, which I declined. I went to see a chiropractor, and this resolved the problem within a week or so.