urinating small amounts

User

Posted 13 May 2020 at 17:14

Hi, I've had a problem for years with being unable to fully empty the bladder. And when I go to bed, it takes hours to go to sleep having to get up to urinate a single drop every 2 minutes. Literally I can have to go to the toilet 70 or 80 times before getting to sleep, so I now have a urine bottle, as I can't physically go to the bathroom that number of times.

The doctor sent me for a PSA blood test three years ago, and said it was negative and told me just to drink less (= the sort of homespun advice I wouldn't go to the GP for, because this happens even when the bladder is effectively empty). I've had tests showing no kidney disease, no kidney stones or bladder stones. I have been diagnosed with borderline diabetes, but I'm tacking that by never eating carbohydrates ever. And yet this problem remains.

I spoke to the doctor today and he agreed to start me on Tamsulosin (Pamsvax XL) for a month. I'm not getting any ultrasound scan to prove an enlarged prostate, he's just trying me on this medication. I hope it works, as I believe this is what the problem is. It is a huge reduction in quality of life to constantly be urinating small amounts.

User

Posted 13 May 2020 at 17:19

I think I need this moved to the BPH forum. Can a moderator help? Thanks.

User

Posted 13 May 2020 at 17:44

Have you ever had your bladder capacity measured ? If the situation has gone on for years your bladder elasticity may not be as good as it should be. What is the best amount you can urinate at any one time. Is it just a bedtime problem ?

Thanks Chris

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User

Posted 13 May 2020 at 17:19

I think I need this moved to the BPH forum. Can a moderator help? Thanks.

User

Posted 13 May 2020 at 17:35

I wouldn't worry about which folder your post is in - most active members just log in and check all posts made since they last logged in.

Tamsulosin seems like a sensible next step although I am really hoping that you have had annual PSA tests since the one three years ago? If not, perhaps tell the GP that you would like a PSA test now before you start the tamsulosin, to get a baseline. Also, it is never a good idea to accept 'the PSA was normal' from a doctor - ask exactly what the reading was, even now three years on that is important info for you and the doctor's receptionist should be able to tell you over the phone.

I have to say though that your symptoms aren't classic for BPH - it may be that having had a new PSA test and tried Tamsulosin for a month, you should ask for a referral to urology for a flow dynamics test and possible bladder retraining;in other words, your brain is misinterpreting messages from your bladder.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 13 May 2020 at 17:44

Thanks Chris

User

Posted 13 May 2020 at 17:46

Thank you LynEyre. I'll get those test results and see what the doctor has to say in a month's time.

User

Posted 13 May 2020 at 17:49

No, colwickchris, I've never had my bladder capacity measured. I'm with a particularly difficult surgery - they have a huge number of patients on the books and prefer consultations to be online via askmygp. It's difficult to get a meeting with the doctor. It is much worse when I lie down ,which makes me think there is some kind of obstruction that becomes worse in certain positions. But in fact I can't fully empty the bladder ever. It always feels like there is a bit more. If I've drunk a lot, there is more urine flow but even then it is not a continuous stream. I don't think doctors like dealing with this issue, as it is a bit unsavoury.

User

Posted 13 May 2020 at 18:19

You do not mention frequency during the day. Is it similar during the day to what you experience during the night? If it is not maybe there is something you drink or in excess that irritates affects your bladder as it passes through? Have you tried having your last wee earlier before you go to bed?

There could be a physical or emotional problem. I was once in a very emotional situation and I wouldn't have believed how I had to keep passing water every few minutes but I wouldn't have thought that you would have experienced this for so long. Prior to this I was needing to pass water more frequently than I should and had a camera fed to my bladder and some other tests. It transpired I had a narrowed sphincter and also some pouches that retained urine so these were not not emptied in one go. I was started on Tamsulosin Hydrochloride and have been taking it for over 20 years, (well before I was diagnosed with PCa). I also had to attend a urinary clinic where I was told to avoid many things that can irritate the bladder such as drinks containing caffeine but to drink cranberry juice which can ease the situation. I also had to measure over at least a couple of weeks (probably longer) just how much liquid I was drinking and passing and at what intervals This formed part of what the clinic called 'bladder retraining' and I was encouraged 'not to give in' and to hold on for a long as possible before passing water.

It is possible that in your case that due to an enlarged Prostate pressure is being exerted which is the cause of this and the Prostate size can be determined by scans.

If Tamsulosin doesn't help much I would suggest you ask to be referred back to urology to try to establish whether it is BPH or another problem.

Edited by member 13 May 2020 at 18:26 | Reason: Not specified

Barry

User

Posted 13 May 2020 at 18:50

Thank you for your reply, Barry.

The frequency during the day is about 20 times a day, but is not as severe as at night when it can be 50 times or more. Normally I end up after about 4 hours going to sleep out of exhaustion. But I can feel the bladder isn't empty during the day either. I can never empty it.

I have cut out caffeine entirely, and mainly don't drink alcohol either. I don't think those two substances help at all. Diet Coke for example seems to severely exacerbate the problem.

I'll take Tamsulosin for a month and then ask the doctor for a referral to a urologist if that doesn't resolve it.

I don't have haematuria (blood in the urine), as shown by urinanalysis strips, but the urine is orange at the time, and not straw-coloured, and it's orange however much I drink, so it is not dehydration. I've told the doctor there is something in the urine, as the urine strips show the specific gravity at the highest level all the time, but the doctor won't believe his and just told me I'm dehydrated.

User

Posted 13 May 2020 at 20:33

Sounds like you definitely need some investigation by a urologist. Unfortunately the timing is not great.

Might be worth doing an intake output diary before you go back to the GP. Typically you record how much and what you drink and how much you urinate over a three day period. If you want to check the flow rate measure how much you urinate and how long it takes, then divide mls by seconds. If you Google urine input output diary you will see lots of charts.

Thanks Chris

User

Posted 13 May 2020 at 21:56

Hi,

I totally agree with Chris, need metrics.

How much can you hold and pass in one visit ?

There's a lot of simple data you can gather yourself, and present.

Are you only 50 ? How long has this been going on ?

User

Posted 13 May 2020 at 23:18

OK, thank you for your advice. I'll try to work out how much I can pass. It's like DIY healthcare now the GP system appears to be failing. Yes, I'm 50, but it's been going on for at least 4 years. English people are very easy to fob off - and the GPs play on it at times. But I know you get more help out of the GP by remaining positive. I'm going to see what a month on Tamsulosin does, but basically I will have to discuss it with him then. I decided to contact him today after reading how much slack there is in the NHS now no-one not showing symptoms of corona is seeking medical help!

User

Posted 14 May 2020 at 00:11

The usual thought when urine is more orange than pale yellow is that the intake of water is insufficient. I know that if I drink less water my urine changes from pale yellow towards darker yellow to orange. The stronger it changes in colour, the more likely it is to irritate the bladder. So yes, start the urine diary now which will also help to establish how Tamsulosin helps.

I like a GP who when doubtful refers a man to a specialist. In your case you have suffered for far to long which has caused knock on problems. Sometimes you have to press for a diagnosis and answers.

It's interesting that you need to pass urine much more through the night than the day. Perhaps this could at least in part be due to your concentrating on doing things during the day whereas at night you lay awake likely thinking you will have to get up shortly.

Edited by member 14 May 2020 at 00:49 | Reason: Not specified

Barry

User

Posted 14 May 2020 at 00:14

Tamsulosin is fast acting - you should see the effects pretty instantly, although it might take your brain a while to adjust to the new normal. You'll need to ask your GP for it - it's a prescription drug.

Tamsulosin can reduce blood pressure, so first few times you take it, just be careful in case it makes you feel faint, particularly if you are taking it with PDE5 inhibitors (Viagra/Sildenafil, Cialis/Tadalafil, etc) which can do the same. Always take it with a meal. In your case where night time is the main problem, you'd probably take it with the last meal of the day.

User

Posted 14 May 2020 at 00:38

I think tamsulosin is available without prescription and is sold under the brand name Flomax. It may be worth experimenting with this to see if it relieves symptoms, rather than have the hassle of booking appointments with GP etc. Once you know whether it works you will have a little more information to help a medic diagnose the problem. Whether it works or not I think you still need a medic to confirm the cause of the problem.

I have used self catheterisation to relieve this problem in the past, but you need a prescription and a bit of training to get involved with that. And that would not address the underlying cause of the problem.

Dave

User

Posted 16 May 2020 at 01:21

Thank you all for your replies. Three days of tamsulosin appear to have slighly reduced the need to urinate during the day, but it's not a full cure, and I still have the problem during the night. The doctor said it would take 2 weeks for tamsulosin to hit full strength, so I'm carrying on with this. I also read an academic article on line that said tamsulosin would help with an overactive bladder, which could also be what it is. I'll see what happens.

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