Question

Within the past several months, I have been increasingly bothered by polyuria, which forces me to get up 4 or 5 times each night. I usually go every two or three hours during the day. I do not suffer from unusual thirst. I have stopped drinking any caffeine-containing beverages. I am not incontinent, and have a fairly forceful stream and a good volume of normal looking urine each time I void. I have tested my urine and could find no sugar in the urine. I had my most recent prostate examination two years ago and this was normal . Any ideas as to the possible cause of the polyuria and possible treatment?

Answer

It is important to establish what volumes you pass, not only each time you go to the toilet, but also collectively during the day and during the night. By night we mean from the time you go to bed with the intention of going to sleep until you get up in the morning. The night-time volume should be very considerably less than the daytime volume. If it is not, then you may have a problem with concentrating your urine at night-time. If this is so, then there are a number of causes for this condition. Most of them are treatable.

When you go to the toilet, do you have urgency? This means that once you get the feeling you need to go, you have to go at once and cannot wait. If you do, then it may suggest you have detrusor instability, which again can be treated successfully with training regimes and certain tablets.

The third urological cause could be that you are not emptying your bladder, but for that you would need to have an investigation called an ultrasound, as well as an examination.

If there is no urological cause and you are otherwise in good health, you may be wakening at night for some other reason but interpreting the wakening as a call to go to the bathroom. So, you would need to be sure that nothing else is waking you at night, e.g. breathing problems, excessive snoring, pain from arthritis and so on. For sleep disorders, you would almost certainly need the report of somebody who is sleeping with you.

Each of the conditions we have described above would require very different treatment.