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What causes frequent urination and weak urine stream in an elderly person?

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Posted on Mon, 16 May 2016
Question: Hello. I am 70 year old male with an excellent PSA test score over the last three years of 1.03 and perfect urine test-no blood, everything okay. Yet over the last few years I have lost 14 pounds and my urine flow is weak and urgent. I go urinate so many, many times. I have all the symptoms of BPH except my prostate is fine. My urologist felt it today and said it was normal. He sent me to get a kidney ultrasound and wants to do a cytoscopy in a few weeks.
My question is what could be causing my weak urine stream and urgency to go urinate so often. Also would generic flomax help me even though my prostate is normal?
doctor
Answered by Dr. P. T. Patil (42 minutes later)
Brief Answer:
Need some more information .

Detailed Answer:
Hello
Thanks for your query,based on the facts that you have posted it appears that you have obstructive voiding symptoms like poor urinary stream ,increased frequency for urination and bladder irritative symptom like Urgency for urination suggestive of bladder outlet obstruction due to Enlarged Prostate .

I shall be happy if you can post me few more details to help me in making comments on your problem.
1) What is the size of the prostate reported on Ultrasound Scanning of abdomen ?
2) What is the volume of Post Void Urine residue reported on scanning ?
3) Have you done Uroflowmetry ?if yes what is maximum flow rate of urine ?

The poor urine flow can be due to Bladder Neck Obstruction which can be confirmed only on endoscopic examination of bladder (Cystoscopy).

Taking Flomax (Tomsulosin ) along with anti muscuranic drug like Darifenacin Once daily will help to improve the urine flow and reduce urgency for urination .

Further treatment will depend upon result of Cystoscopy and final diagnosis.

Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you.
Thanks and Regards.
Dr.Patil.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil (10 minutes later)
Hello Dr. XXXXXXX

My blood test is normal-no blood in urine. Also no pain on urination. Just a weak flow and urgency to urinate often. My PSA score has been stable at 1.03 for the last three years. My urologist palpitated my prostate today and found it good. He is sending me for kidney ultrasound and wants to do a cytoscopy on me at the end of this month.
So even though my prostate PSA is only 1.03, the generic Flomax can help?
Even if the generic Flomax helps, it's a good idea to have the kidney ultrasound and Cytoscopy?

Thank you!
XXXXXXX XXXX
doctor
Answered by Dr. P. T. Patil (17 minutes later)
Brief Answer:
Read detail answer below .

Detailed Answer:
Hello
Thanks for follow up .

You are confusing with Normal PSA values with symptoms due mechanical obstruction in voiding which is mainly due to BEP .

Raised PSA is important tool to rule out cancer of the prostate and can be normal with enlarged prostate and has no relation to obstructive voiding symptoms like poor flow ,frequency etc .

The digital rectal examination is not 100% confirmative of normal prostate One requires to get it confirmed by Ultrasound Scanning of the abdomen and pelvis and by estimation of Post Void Residual Urine volume to confirm the Enlarged Prostate .

The urgency that you have could be due to Over Active Bladder .which can be treated with Derifenacin .

Flomax has no relation with normal PSA value .It is a smooth muscle relaxant which relaxes bladder neck and smooth muscles in prostate and helps to improve urine flow .

Please note that Normlal PSA does not rule out Enlarged Prostate and Bladder neck Obstruction .You need to get Ultrasound and Cystoscopic examination to establish the cause for your symptoms .

Thanks and Regards.
Dr.Patil.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil (35 minutes later)
Thank you Dr. Patil!

Yes! I was confused. I assumed a 1.03 PSA meant no prostate enlargement. So it is possible I have BPH after all and I will go ahead and have the kidney Ultrasound and Cytoscopy to help determine the exact cause of the weakened flow and constant urge to evacuate. Meanwhile I will commence the Tomsulosin since the tests are a few weeks away.

I don't have the measurements you asked for, since no tests were performed on me yet.

You have been most helpful, Dr. Patil!

By the way, I do have another querie:

As a 70 year old male, my eyes are pre-glaucoma and cateracts are beginning to develop. I read Tomulosin may interfere with future cateract surgery-years away, according to my opthamologist. Should I just simply take the Tomulosin and don't worry about something that is not a near term event?

Thank you.
XXXXXXX XXXX
doctor
Answered by Dr. P. T. Patil (27 minutes later)
Brief Answer:
Tomsulosin can be taken .

Detailed Answer:
Hello
Thanks for follow up .
Cataract and Enlarged prostate both run hand in hand are part of ageing process .

One can certainly take Tomsulosin even with having cataract as it does not alter the out come of the process of developing cataract and the treatment .

I would suggest you to get Ultrasound Scanning of abdomen done as the first basic investigation and decide about need for doing Cystoscopy only if required
Thanks and Regards.
dr.Patil.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil (28 minutes later)
Thank you Dr. Patil!

Now something new came up. I attempted to "perform" with my wife and for the first time ever, I could not get an erection. I am taking one of those herbal conncoctions with a lot of saw palmetto, pygyum and beta siasterol, among other herbs for the prostate. Could such a potion cause impotence? I started taking this potion around a week ago. I usually get an erection without any problem. I believe I should stop taking this.

Thanks for your input.
XXXXXXX XXXX
doctor
Answered by Dr. P. T. Patil (1 hour later)
Brief Answer:
Not getting Erection is unlikely to be due to herbal products

Detailed Answer:
Hello
Thanks for follow up

Not getting Erection once in a while has little significance and it is definitely not due to herbal products that are taking since only for 10 days .
.
It is mostly anxiety related .

Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil (11 hours later)
Thank you Dr. Patil!

I have one more question:

Could the palpitation of my prostate by the Urologist during the digital rectal exam yesterday morning affect my lack of erection last night? Like a "temporary impotency" due to irritation of the prostate?

You are right though-you don't even know me-and I have had chronic anxiety problems most of my life. An anxiety-driven perfectionist is my crime!

You have been most helpful, Doctor Patil!

Thank you!

Regards,
XXXXXXX XXXX
doctor
Answered by Dr. P. T. Patil (1 hour later)
Brief Answer:
Thanks for appreciation.

Detailed Answer:
Hello
Thanks for follow up .

One can face Erectile Dysfunction after digital Rectal Examination due to irritation of prostate.

If you have time please do post your review about my suggestions and advice on the forum of Health Care Magic .

Thanks and Regards and have a good health .

DR.Patil.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. P. T. Patil (1 hour later)
Thanks so much Dr. XXXXXXX I feel relieved about the Erectile Dysfunction!

I will give you a fine review!!

Regards,
XXXXXXX XXXX
doctor
Answered by Dr. P. T. Patil (4 minutes later)
Brief Answer:
O.K bye and have a fast recovery

Detailed Answer:
Hello
Thanks for follow up and have a fast recovery .
Thanks again
Dr.Patil.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. P. T. Patil (1 hour later)
Thank you Dr. Patil!

Regards and good luck!
XXXXXXX Powders XXXXXXX Florida USA
doctor
Answered by Dr. P. T. Patil (4 hours later)
Brief Answer:
Thanks again and let us close our discussion .

Detailed Answer:
Hello
Thanks and let us close our discussion here .
Do write if you need my help .
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. P. T. Patil

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Practicing since :1971

Answered : 10363 Questions

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What causes frequent urination and weak urine stream in an elderly person?

Brief Answer: Need some more information . Detailed Answer: Hello Thanks for your query,based on the facts that you have posted it appears that you have obstructive voiding symptoms like poor urinary stream ,increased frequency for urination and bladder irritative symptom like Urgency for urination suggestive of bladder outlet obstruction due to Enlarged Prostate . I shall be happy if you can post me few more details to help me in making comments on your problem. 1) What is the size of the prostate reported on Ultrasound Scanning of abdomen ? 2) What is the volume of Post Void Urine residue reported on scanning ? 3) Have you done Uroflowmetry ?if yes what is maximum flow rate of urine ? The poor urine flow can be due to Bladder Neck Obstruction which can be confirmed only on endoscopic examination of bladder (Cystoscopy). Taking Flomax (Tomsulosin ) along with anti muscuranic drug like Darifenacin Once daily will help to improve the urine flow and reduce urgency for urination . Further treatment will depend upon result of Cystoscopy and final diagnosis. Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you. Thanks and Regards. Dr.Patil.