When urination is normal, it occupies a small portion of our active attention. However, when it becomes abnormal, it comes to occupy a larger portion and the more abnormal it is, the more we pay attention and become increasingly upset.
People generally get to realize that they are spending more and more time in the toilet with shorter time intervals between. The increased time in the toilet may be related to delay in starting the stream or the increased time for a slow stream to finally trickle to a conclusion only to be followed by the need to let more out just a few seconds to a minute or so later and often with great urgency.
The urgency is often associated with some degree of incontinence especially if you zippered up too soon. Many, will notice on bending down to pick up something from the floor, a strong urge to urinate, which requires putting all else aside to proceed immediately to the toilet. When asked about such symptoms, many patients explain that it happens more on drinking water or being exposed to cold weather.
Others notice that their urinary frequency occurs at night and repeatedly wakens them from sleep. Some more astute observers may notice that their ankles, which had been puffy and swollen in the evening were back to normal size in the morning. All these things can occur in the absence of any pain or burning on urination, which might indicate that an infection could be present.
Eventually, the patient will come to or be referred to the urologist, who will carefully and systematically investigate to establish a working diagnosis of what exactly is causing the symptoms. There are many ways to arrive at the correct diagnosis. The most important is to gather an accurate history including collecting a day’s voiding history using a simple time and amount sheet on which he or she records the time and the volume of each urination during a period of 24 hours or less. This is a simple but invaluable gathering of very important information.
Physical examination including neurological evaluation is also essential. Further diagnostic tests may include uroflowmetry, urodynamic studies, sonography and others. In evaluating the severity of the symptoms, it is important for the doctor to determine how often each of the seven symptoms occurs. The seven symptoms referred to include slowing of the stream, pushing to void, incomplete emptying, intermittent flow, frequency, urgency and sleep interruption.
Depending on the diagnosis, medical treatment should first be tried. If medical treatment fails either initially or after working for a period of time, other modalities of treatment will be suggested. Minimally invasive procedures such as microwave thermotherapy should then be considered. Surgery involving hospitalization and anesthesia and all its attendant risks and hazards should be reserved as the court of last resort.
Question? Call Dr. Okun at 718-241-6767
