Dear Dr. Eneas, This is a question for my friend. He comes by my house and is constantly using the bathroom. He complains of frequent urination and went to the doctor and they found nothing wrong with him. Sometimes he complains of pain. What should I tell him?

Answer: There are many reasons to have frequent urination. It is also important to find out if there are any associated symptoms like burning, urgency, decreased urinary stream, hesitancy (that is difficulty initiating urination), or dribbling. Then we need to worry about whether your friend is passing a little bit of urine or a lot of urine when he goes to the bathroom. This compilation of symptoms can point to a variety of causes. Some of these causes may be attributed to problems with the prostate, bladder, kidney, or eating habits and could also depend on the age of your friend. Let's look at each of these areas.

The prostate sits right at the neck of the bladder. As the patient gets older, the prostate becomes larger under the influence of testosterone (the male hormone). As the prostate becomes larger it presses on the neck of the bladder and stimulates the bladder to go to the bathroom. That pressure not only stimulates the bladder but causes some obstruction to urine flow causing it to be more difficult to pass the urine. This will produce the symptoms of going to the bathroom frequently (usually at night), difficulty initiating urine flow and decreased force of flow. In addition, if the prostate is inflamed or infected, it can cause burning in the urine. The best way to examine the prostate is through a rectal examination to feel the prostate to determine its size and tenderness. The urine also needs to be examined for infection, blood, or pus.

The bladder itself may be the cause of frequent urination and may just be very sensitive and overactive. This can be determined by a Urologist, if the prostate turns out to be normal or if the patient is too young to have a prostate problem (usually under the age of 40).

Failing kidneys can also cause frequent urination. Normal kidneys have the ability to concentrate the urine and reclaim a lot of the water that's filtered through them. As the kidneys fail they are unable to reclaim water and you have increased frequency of urination.

Finally, increased urination can be caused by an increased load to the kidneys, even if they are normal. This increased load may be due to an increased intake of fluids, especially late in the evening. Alternatively, diuretics (water pills) may be causing the kidneys to put out more urine thus causing increased frequency of urination, or a high blood sugar (diabetes mellitus) may cause the kidneys to put out more urine. This usually happens if the sugar level goes over 180 mgs. Per 100 mls. The kidney can usually reabsorb sugar up to 180 mgs. When the sugar level exceeds the capacity of the kidneys to reabsorb it, then sugar spills over in the urine and this pulls water with it, hence an increase urine flow.

This is not a complete list and there are other conditions that can cause an increased urine flow. You should tell your friend to seek a second opinion and consult a specialist in kidney or bladder diseases. This would include a Nephrologist or a Urologist.