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Having frequent urination. Could this be a sign of a really big problem?

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Practicing since : 1995
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I am a 50 year old male and have a problem with a frequent need to urinate. I am certain that this problem is linked to being cold, and am fairly certain that it only occurs after I have been sleeping in a chilly place the night before. At night I sometimes need to get up and urinate up to 3 times a night if sleeping in a damp and chilly place. I am a sailor and sometimes my bunk space is chilly. Even if I don’t drink any water at all after noon I still usually need to get up and urinate at least once in the night. In addition, during the daytime if I am chilly I need to urinate very frequently (every two hours or less is I have been drinking a normal amount of water). Often I feel warm and fine, then go out on deck, or move from the sun to the shade, and within minutes I feel an urgent need to urinate. This problem first occurred a bit over a year ago. It was a problem on and off for about 3 weeks, but I did not realize at that time that it was linked to cold. However it occurred when we were sailing in Canada and the weather was damp and cold and the crew quarters were also often cold. After I left the ship I visited a urologist about this problem. Unfortunately, I did not get an appointment until about a week after leaving my ship, I had been warm and dry all week, and by then I had long ago returned to normal. He did an exam and had some lab work done (I lost the paper that had the results, but they were normal). He gave me some Sancruta XR 60mg to try if the problem reoccurred. When I took it this summer It had no noticeable effect. This summer I sailed to Glacier Bay national park in Alaska. I did not have any problems for most of the trip, but did have problems several days. I am fairly sure that these were days immediately following anchoring for the night at the foot of glaciers, which made the air in the boat chilly all night. I went into and out of the condition at least twice during the trip with a short duration each time. I have been on my current ship for 2 months, and the crew quarters are always damp and chilly. I spend much of my days on deck working. We were in Newfoundland, XXXXXXX Scotia, and for the last month in Maine (these are cold places). This condition has been active for almost 2 straight months now, every night and about half the time during the daytime. I have been controlling it somewhat by limiting my fluid intake to mornings only; however I still almost always need to piss small amounts a couple times a day and get up at least once at night to pee. When the problem first presents itself, it is as if a switch is thrown and my kidneys go into overdrive. I need to piss every hour or two for 6 or 12 hours, even if I am not drinking anything. After a half day or a day, my body establishes a new equilibrium, (with less water in it, since I have pissed a lot and not drunk anything). What I do drink I usually feel the need to piss away as soon as I get chilled the first time – often within a half hour or so. When I am warm and dry for a day or two I will feel like I am very dehydrated and drink lots of water (without needing to piss) until I rehydrate again. This rehydration when the problem ends might be the next day, or several months after the problem starts. The problem might (I am not certain) have two criteria. I am certain that it only occurs when I am chilly; however, I am also fairly certain that the problem never occurs unless I have spent the previous night or two in a chilly bunk. I spent last winter in Seward Alaska, where I was frequently out in the cold, but I always slept in a warm dry place. I never had the problem last winter. I should also mention that 15 years ago for a few years I used to have a weird cough variant asthma that was linked to cold. Whenever I sipped ice-water, ate ice-cream, or even went out in the cold, I would cough a few times. I don’t think it is directly related to my present condition, but it is another example of my body’s sometimes weird reaction to cold. So my questions are: What is happening? Why is it doing this? Which categories (below) does this problem likely fall into? Is this nothing but an annoyance that I can safely ignore? Should I take steps to avoid triggering it (give up sailing and camping in cold weather)? Is the condition harmful to me when triggered, but if I avoid triggering it is it benign? Could it be a sign of a really big problem that I need to look into deeply?
Posted Wed, 20 Nov 2013 in Men's Health
Answered by Dr. V. Sasanka 1 hour later
Brief Answer: Overactive bladder, but rule out prostate issues Detailed Answer: Hi, What you have outlined sounds like an issue caused by an overactive bladder, brought on by the cold climates in the place you reside. This is more common among women, but males do often get affected. Sanctura should be a reasonably good choice for such patients under normal circumstances, but as you did derive benefit, I suggest you make sure your prostate is not enlarged and causing trouble. You are rather young for this, but it is not uncommon for symptoms of prostate enlargement to start early. Many people do have trouble due to getting up frequently at night, urgency, and on occasions urge incontinence. I hope your urine stream is good, but if it is not, you might have to use medicines like Flomax and see if symptoms are better. If urine flow is good, medicines like Detrusitol might help, with a mild risk of dry mouth. Also some general measures such as avoiding bladder irritants like tea and coffee, and limiting alcohol intake could help. Also try this step of 'timed voiding'. This would mean that you void urine as per clock, and gradually retrain your bladder to hold more urine. In the initial stags, you should go to the toilet on average every 2-3 hours based on your normal habits even if you do not have the urge to void, and this will reduce the chances of urinary precipitancy. Getting up at night might still persist, but we usually prefer to avoid massive interventions unless you get up more frequently than twice a night. If these measures do not work, you might have to get tests like ultrasound examination, an examination of urine, a urine culture if infection is suspected, and uroflowmetry to assess if flow is good, and a test to rule out diabetes. Hope I have been able to help you.
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Follow-up: Having frequent urination. Could this be a sign of a really big problem? 1 hour later
Thank you very much! I had a prostate exam just last year and the urologist I visited said it was normal. I would say my urine stream is good while it lasts, it just does not take me long to empty a bladder that is not really full but was telling me it was. My followup question is: Do you think it is damaging to my health to have this condition triggered? I find the condition very annoying and inconvenient, but have been managing. Assuming I can live with the inconvenience, can I just manage this as I have been (drinking no fluids after noon when the condition triggers) or would you say that to protect my health I ought to avoid any more sailing trips or other situations where I sleep in chilly places so that the condition does not manifest? Thanks.
Answered by Dr. V. Sasanka 46 minutes later
Brief Answer: Unlikely to damage health. More of a bother. Detailed Answer: Hi, Issues related to bladder and prostate are dealt by urologists all across the world with one basic parameter - how much of a bother is it causing the patient. For example, a patient who gets up five times a night but manages to sleep immediately after lying down again in the bed each time is less likely to welcome a surgical intervention for prostate than someone who keeps tossing and turning in the bed waiting to fall asleep every time he gets up at night to visit the toilet. So the degree of bother would vary considerably, and no one solution fits all. Therefore, in your case, though you get up only twice in the night (which is not so bad, believe me), if you are indeed bothered, there a definite case for you to be placed on medication till you get relief. There are several kinds of drugs, and in fact, successors to detrusitol (which I mentioned earlier) are now available in USA which have less side-effects, and almost 60-79% of patients on medications are significantly better off than earlier. Life style changes we do recommend to ensure the least amount of bother, and avoiding sleeping in chilly places would be one such measure, but changing an entire way of life (which might happen in your case if you stop sailing and fishing) is for you to decide after considerable deliberation with family and friends, because other factors such as satisfaction in life, etc. come into play. (I am a Urologist from India, and whenever I look at places like Alaska on Discovery or National Geographic Channels with its wilderness and beauty, I keep wondering if it would be ever possible for me to live and work in such magnificent environment. It might be a case of the grass being greener on the other side, though). Hope you get better. Let me know if you have urological issues for discussion.
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