Douglas L. Gaker M.D., Inc.
Specializing in Urology
"Ask the Doctor"
Question: What causes frequent urination or trouble with the urinary stream? Could overactive bladder or BPH be the problem?
Dr. Gaker Answers: Simple questions can sometimes lead to complicated answers.
When a patient complains of frequency, the evaluating physician considers this range of possibilities and first determines that no serious underlying problem exists. Your doctor will ask about a history of cigarette smoking and your family history of medical conditions, such as diabetes or bladder conditions. The physical examination can also point to signs of illness or the possibility of neurologic diseases that can cause voiding problems.
A simple screening tool is a voiding diary. I often ask patients to measure the amount of urine voided and the time of voiding over a 24-hour period. This can yield information about the output per void as well as the total output in a day. It may be the only test needed other than a microscopic and dipstick evaluation of urine in the office. The diary can differentiate between an abnormal bladder capacity and an abnormally high volume of urine.
Other office procedures such as bladder ultrasound, a fiber optic visualization of the bladder (cystoscopy) or specific neuologic testing (urodynamics) can be performed if more specific information is needed.
As you can see, the causes of urinary frequency are quite varied. They can include medical conditions that are seemingly unrelated, physical problems that can put pressure on the bladder, inflammatory conditions of the bladder lining such as infection, and even obstruction of the drainage for the bladder that can result from stones or tumors or, in men, from an enlarging prostate (BPH). It can be dangerous to simply try a medicine that might reduce the frequency without a clear picture of the likely cause.
Overactive bladder is the term for bladder muscle overactivity not caused by an underlying metabolic or pathologic condition. Symptoms can be either a sudden urge to void or frequency. The prevalence of overactive bladder is staggering, affecting 43 to 65 percent of all women and smaller proportion of men. About one in four women with this problem seek professional help. Great strides have been made in recent years toward successful medical management.
Urgency incontinence (loss of bladder control) associated with overactive bladder is what prompts most people to seek help. Estimated treatment costs in the U.S. exceed those of breast, ovarian, cervical and uterine cancer combined. Overactive bladder has received more attention recently as many newer and better medications have been approved. They have fewer side effects than older medications.
So, if you're noticing a change in your urinary frequency, at least consider making a voiding diary. If the volume per void on average does not fall between 150 and 350 ml, you should see your doctor. If you are voiding ten or more times per day or three or more times at night, there probably is an underlying problem that may be simple or serious. These are good benchmarks to use when considering a doctor visit.
Trouble with the urinary stream is usually a problem that affects men as they age. Most commonly it's caused by the changes that accompany an enlarging prostate (BPH), but as with frequent urination, there may be other causes. And just as for overactive bladder, many newly approved medications and less invasive surgical options are available. Men who have urgency incontinence or bladder infection, or who void frequently, should see a doctor for urologic evaluation. With earlier evaluation and treatment, surgery can often be avoided.
Most people with urination problems are embarrassed and feel the need to be very private. That feeling is normal. But, as you can see, you're part of a very large group of people with a real problem that can often be treated successfully.