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Urology (Expert Forum)
Frequent Urination
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Frequent Urination
by Trevor, May 29, 2003 12:00AM
Dear Doctor,
I wrote to you on 14/5/03 re; subject: Bacteria in prostate. Corynebacteria § now Enterrococci.
Enterococci was found in my semen analysis.
An ultra sound showed my prostate to be normal in size & NO enlargement.
I have been prescribed 5 weeks of AUGMENTIN, dosage = 2 x 1000 mg per day & have been taking Augmentin for 10 days now.
The frequent urination during daytime only has NOT subsided.
My questions are:
1) If I drink 1.5 litres of water a day, how can I urinate 2 to 3 litres daily?
2) Am I going to dehydrate?, if so what are the consequencies?
3) My bladder fills up so fast, why am I still urinating so much?
4) Does this indicate the medication is NOT working?
5) My Kidneys ache slightly, rather like when one feels genreally unwell, could the cause of my symptoms be a bladder or kidney infection rather than enterococci/prostate problem?
6) As I mentioned before, my urologist "THINKS" the frequency is caused by the enterococci, however, as the symptoms have not subsided after 10 days of Augmentin, am I to assume the treatment is incorrect?
7) I have heard that it is questionable whether Augmentin/amoxillin penetrates the prostate, if this is correct, why would a urologist prescribe a drug that may not do the correct job?
8) Can this enterococci ever return after being cured? Do you have any idea of the cure rate?
9) As chronic Baterial prostatitis is UNCOMMON (so I have read), could it be a bladder infection causing my symptoms? if true, shoud my urologist check this possibilty & how?
10) I have also read that "Chronic Renal Failure" symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include frequent urination, fatigue & weakness, all of which I have. Would CRF be picked up by a urin specimen? or should I suspect CRF and have this checked? if yes, how?
11) My urologist told me "if Augmentin doesn't kill the enterococci, he would suggest another 2 treatments with different antibiotics and if this fails, then he stops with antibiotics and no further treatment is available".
Sounds like he is just guessing or trying a "trial and error" method which makes me feel very unconfortable and is worrying to say the least. What would you suggest?
12) Most days I have a whitish tongue and slight stool inconsistancies. Can this enterococci be responsible for making one feel generally rundown, even though the prostate is small?
13) Could the parasite "Blastocystis Hominus", which I have been diagnosed with, be the cause of my symptoms?
I am getting no support with this illness that has been going on for 9 months. I am worried that it could escalate into something serious & also become a psychological problem due to the LACK of support from the Swiss doctors who seem to be purposely mis-treating and mis-diagnosing me so I DO NOT get well. Do you have any recommendations?
Thanking you in advance
your sincerely
Trevor
I wrote to you on 14/5/03 re; subject: Bacteria in prostate. Corynebacteria § now Enterrococci.
Enterococci was found in my semen analysis.
An ultra sound showed my prostate to be normal in size & NO enlargement.
I have been prescribed 5 weeks of AUGMENTIN, dosage = 2 x 1000 mg per day & have been taking Augmentin for 10 days now.
The frequent urination during daytime only has NOT subsided.
My questions are:
1) If I drink 1.5 litres of water a day, how can I urinate 2 to 3 litres daily?
2) Am I going to dehydrate?, if so what are the consequencies?
3) My bladder fills up so fast, why am I still urinating so much?
4) Does this indicate the medication is NOT working?
5) My Kidneys ache slightly, rather like when one feels genreally unwell, could the cause of my symptoms be a bladder or kidney infection rather than enterococci/prostate problem?
6) As I mentioned before, my urologist "THINKS" the frequency is caused by the enterococci, however, as the symptoms have not subsided after 10 days of Augmentin, am I to assume the treatment is incorrect?
7) I have heard that it is questionable whether Augmentin/amoxillin penetrates the prostate, if this is correct, why would a urologist prescribe a drug that may not do the correct job?
8) Can this enterococci ever return after being cured? Do you have any idea of the cure rate?
9) As chronic Baterial prostatitis is UNCOMMON (so I have read), could it be a bladder infection causing my symptoms? if true, shoud my urologist check this possibilty & how?
10) I have also read that "Chronic Renal Failure" symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include frequent urination, fatigue & weakness, all of which I have. Would CRF be picked up by a urin specimen? or should I suspect CRF and have this checked? if yes, how?
11) My urologist told me "if Augmentin doesn't kill the enterococci, he would suggest another 2 treatments with different antibiotics and if this fails, then he stops with antibiotics and no further treatment is available".
Sounds like he is just guessing or trying a "trial and error" method which makes me feel very unconfortable and is worrying to say the least. What would you suggest?
12) Most days I have a whitish tongue and slight stool inconsistancies. Can this enterococci be responsible for making one feel generally rundown, even though the prostate is small?
13) Could the parasite "Blastocystis Hominus", which I have been diagnosed with, be the cause of my symptoms?
I am getting no support with this illness that has been going on for 9 months. I am worried that it could escalate into something serious & also become a psychological problem due to the LACK of support from the Swiss doctors who seem to be purposely mis-treating and mis-diagnosing me so I DO NOT get well. Do you have any recommendations?
Thanking you in advance
your sincerely
Trevor
Doctor's Answer
by Kevin Pho, MD, May 31, 2003 12:00AM
, May 31, 2003 12:00AM
Hello - thanks for asking your questions.
To address your points:
1) Typically more than 2.5L per day is considered "polyuria" or increased urine output. There are many causes. They include too much fluid intake, too much salt or glucose (if diabetic),
diabetes (both diabetes insipidus and diabetes mellitus),
renal failure or sickle cell anemia. It is not directly related to the amount of water you drink, but rather to the osmolality of your serum
2) Dehydration is a clinical evaluation made by your physician. If you are dehydrated, there will be fluctuations in your electrolytes, fainting, changes in your vital signs all depending on the severity of the case.
3) If you feel you are urinating too much, you should be evaluated by a physician to evaluate your prostate, take a urinalysis, and perform further tests to rule out hormonal abnormalities (i.e. diabetes insipidus).
4) If you have been taking the medication for 5 weeks, and you continue to have symptoms, perhaps the cause is not infectious.
5) If you kidney's ache, then imaging with an ultrasound may be prudent. Any infection or cyst may cause kidney discomfort.
6) I cannot make any comment on what you have without examining you. Again, if antibiotics are not working, then you may want to discuss other causes.
7) Augmentin is normally not the first choice to treat prostatitis - Bactrim and Cipro are usually used first to treat chronic prostatitis.
8) Yes, Enterococci can return after being cured.
9) A bladder infection is normally evaluated with a urinalysis and subsequent urine culture.
10) To diagnose chronic renal failure, blood tests and a urinalysis needs to be performed. Your physician may take a measurement known as the glomerular filtration rate.
11) The easist way would be to culture out the enterococci and see what antibiotics are sensitive to it. There are times where it may seem like trial and error - patients may react differently to different antibiotics.
12) If the enterococci has entered your blood, it can certainly make you fatigued.
13) It is possible that the parasite can also play a part in your fatigue. If this has not been appropriately treated, you may want to consider this and see how it affects you.
Without examining you or your reports, I regret that I cannot be more specific.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
To address your points:
1) Typically more than 2.5L per day is considered "polyuria" or increased urine output. There are many causes. They include too much fluid intake, too much salt or glucose (if diabetic),
diabetes (both diabetes insipidus and diabetes mellitus),
renal failure or sickle cell anemia. It is not directly related to the amount of water you drink, but rather to the osmolality of your serum
2) Dehydration is a clinical evaluation made by your physician. If you are dehydrated, there will be fluctuations in your electrolytes, fainting, changes in your vital signs all depending on the severity of the case.
3) If you feel you are urinating too much, you should be evaluated by a physician to evaluate your prostate, take a urinalysis, and perform further tests to rule out hormonal abnormalities (i.e. diabetes insipidus).
4) If you have been taking the medication for 5 weeks, and you continue to have symptoms, perhaps the cause is not infectious.
5) If you kidney's ache, then imaging with an ultrasound may be prudent. Any infection or cyst may cause kidney discomfort.
6) I cannot make any comment on what you have without examining you. Again, if antibiotics are not working, then you may want to discuss other causes.
7) Augmentin is normally not the first choice to treat prostatitis - Bactrim and Cipro are usually used first to treat chronic prostatitis.
8) Yes, Enterococci can return after being cured.
9) A bladder infection is normally evaluated with a urinalysis and subsequent urine culture.
10) To diagnose chronic renal failure, blood tests and a urinalysis needs to be performed. Your physician may take a measurement known as the glomerular filtration rate.
11) The easist way would be to culture out the enterococci and see what antibiotics are sensitive to it. There are times where it may seem like trial and error - patients may react differently to different antibiotics.
12) If the enterococci has entered your blood, it can certainly make you fatigued.
13) It is possible that the parasite can also play a part in your fatigue. If this has not been appropriately treated, you may want to consider this and see how it affects you.
Without examining you or your reports, I regret that I cannot be more specific.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Member Comments
by stany, Jul 04, 2003 12:00AM
To: Urology - General
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