question-icon

What causes frequent urination in an elderly?

default
Posted on Thu, 5 Mar 2015
Question: Hi Doctor,
Could you please reply as early as possible doctor. This problem has caused so much trouble and depression.
For the past 10 days my mother is frequently urinating. The complaint she states is her bladder is always full and she says that there is always some pressure on the bladder. She is urinating very few drops each time. But during nights, she does not urinate that often.
We have done abdominal scan in which everything was normal - No stones,uterus was normal in size. She has only gallstones. She does not have abdominal pain. Urine culture showed no growth. One more thing I wanted to tell you is she had Norflox 400,urispas and pantop 40 before giving the urine culture. Is there a possibility that the bacterial growth did not show up because of the tablets she had.She also took "Terol 4 mg" , urimax given by a urologist. But it has not reduced the problem. Another doctor prescribed Alcit liquid and zenflox-UTI. She took one dosage of it.
After taking Terol 4 mg for 3 days she had lot of side effects such as dry mouth,dizziness. Hence we consulted an urologist again and he asked us to take a CT scan of KUB and there were no findings of stones and hence he concluded that it is UTI and hence he prescribed "Nitrofurantoin -100mg", urispas,citralka for 5 days. Out of which she took 3 days of tables and she has got slight fever for 4 days and today she got fever but it went off without taking medication.
Today doctor suddenly called up and said that the radiologist found some nodules and he doubts that it may be TB nodules and hence he asked us to take a CT of abdomen. he also said that the TB would have spread to Urinary bladder. But just before 6 months my mother has undergone a appendicitis surgery, where everything was normal during scan. Is there a possibility of such a kind of problem?
Or is it because of any other problem such as Interstitial cystitis?Or any other problem? She does not have even slightest pain in abdomen or Urinary bladder. She just has the discomfort of urinary bladder being full and some pressure on the bladder. While lying down she does not urinate. she also does not urinate at nights.
Please help us.
Regards,
XXXX
doctor
Answered by Dr. V. Sasanka (1 hour later)
Brief Answer:
possibility of interstitial cystitis

Detailed Answer:
Hi,
It looks like you have done your research. There is a possibility your mother could be having interstitial cystitis or a variant, but the way to diagnose this would be by performing a cystoscopy under anaesthetia after previously excluding potential other causes such as tuberculosis which is still common in XXXXXXX
Another test that has not been performed yet is a urodynamics which I am sure will be beneficial. This has to be done at a good academic centre like PGI XXXXXXX or CMC Vellore for proper diagnosis.
Once these are done, you are welcome to let me know the reports so we can advice further.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. V. Sasanka (46 hours later)
Hi Doctor,

Please read my questions fully before answering.
Brief Question:
1. Will URIMAX work if the urine flow is low.
2. Pressure in the bladder is more only in the evenings. Is this because of any Infection.
3. Will our doctor's remedy/treatment would work?

There were no abdominal nodules or TB as per the diagnosis in the CT.

Uroflowmetry test is performed and attaching the report. Doctor said the flow is restricted and hence prescribed URIMAX for 20 days. Later, if the problem is not resolved then he advised endoscopy as a treatment and diagnosis.

Causes explained by the doctor for the above problems is that:
1.Narrowing of the Urinary track.
2. Some blockage.
3. Problems with the UB.

All the above causes would not have raised within 15 days. Normally the causes would take long term in order to create problems.
We feel our doctor is missing something.

Kindly help.
doctor
Answered by Dr. V. Sasanka (15 hours later)
Brief Answer:
Urodynamics necessary

Detailed Answer:
Hi again,
It was good that you attached the report of the uroflowmetry. It certainly shows an interrupted, slow straining pattern.
Now in men, we would have certainly thought of bladder neck or outlet obstruction and one of the first medicines we would have suggested would have been Urimax. In females, however, this does not work very well, because in women, there are not so many alpha-receptors as in men against which this Urimax would act.
The pattern is not looking like there is a definite urethral obstruction, which would have been fairly simple in tackling as it would have meant that by a simple cysto-urethroscopy and urethral dilatation, things would have gotten better immediately.
I almost certainly do not think this is due to tuberculosis, though all said and done, in XXXXXXX we always would keep it in my mind when we deal with a puzzling case.
This is one of the reasons why I very, very strongly feel you should get a urodynamics done. This can be done after the simple endoscopy your doctor has suggested, thus confirming that she has no significant urethral stenosis. But for urodynamics, I feel that you should visit a place like CMC Vellore, logistically the most convenient for you with the best faculty to be able to help you. the other good option, by the way, would be St John's XXXXXXX which again, has a very good urodynamics centre. i am sure there are elements of bladder power not being the way it ought to be, and depending on the findings of these reports, we can act accordingly.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. V. Sasanka (4 hours later)
Hi Doctor,

She says that the problem is more in the evening and she is feeling better in the morning.
We did all the tests in Global Hospitals. CMC is again a distant place. There are lot of hospitals in XXXXXXX - "Apollo","Global","MIOT" etc. Can we take the test there.
You have mentioned that Urethral dilation would have solved the problem immediately. Where can it be done.
We feel something is missing out somewhere and we have plans to change the doctor.
Will the bladder power be lost within 10 days. It should have taken some time.
As you would know, Nowhere they would take these urodynamics tests without a request from the doctor.

Kindly help us. We have ended up nowhere.

Regards,
XXXX
doctor
Answered by Dr. V. Sasanka (26 minutes later)
Brief Answer:
urethroscopy option best right now

Detailed Answer:
Dear Ms XXXXXXX
Hi again,
I do not think thus trouble has happened only over the past 10 days.
As the uroflowmetry shows a definite slow flow, the question is whether it is due to obstruction or poor bladder power. That is the reason why I feel that urethroscopy with diksyayion if urethra if required at the same sitting will be useful. If there is no improvement in urine gliw despite what seems adequate urethral calibre after urethroscopy, then it would imply that there is poor bladder tone or there is dome Neuro cause which is why I feel she might benefit from urodynamics.
I worked earlier in XXXXXXX and that's why I know that a good urodynamics study is still difficult though not impossible in XXXXXXX and therefore suggested that you visit Vellore where I am sure that the treatment will be optimum.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. V. Sasanka

Urologist

Practicing since :1995

Answered : 529 Questions

premium_optimized

The User accepted the expert's answer

Share on
What causes frequent urination in an elderly?

Brief Answer: possibility of interstitial cystitis Detailed Answer: Hi, It looks like you have done your research. There is a possibility your mother could be having interstitial cystitis or a variant, but the way to diagnose this would be by performing a cystoscopy under anaesthetia after previously excluding potential other causes such as tuberculosis which is still common in XXXXXXX Another test that has not been performed yet is a urodynamics which I am sure will be beneficial. This has to be done at a good academic centre like PGI XXXXXXX or CMC Vellore for proper diagnosis. Once these are done, you are welcome to let me know the reports so we can advice further. Regards.