Q: My 17-year-old son has the feeling he needs to urinate all the time. This started about three years ago. He is able to sleep through most of the night without having to get up. During the school day he stops at the bathroom between every class and will usually have to ask to be excused at least once each class period.
About a year and a half ago we started with his pediatrician who did a urine diabetes test and a full physical. He referred us to an urologist who has done a bladder ultrasound, checked to make sure he empties his bladder (which he is), CT scan, and who prescribed Vesicare. The CT showed a cyst on his kidney but the doctor didn’t seem concerned about it. The Vesicare has had no effect on my son. His doctor then referred us to a neurologist who ordered MRIs on his brain and bladder area. He also had more extensive blood work to check for diabetes. Everything came back clear and the MRIs showed no signs of MS but the cyst on his kidney was mentioned. We’re now referred back to the urologist and are waiting to hear from him.
Do you think we should look more into the kidney cyst? Any thoughts would be greatly appreciated.
A: It certainly appears your son has had appropriate, in-depth testing for his symptoms so it may be difficult to come up with new possibilities. Most individuals typically urinate between four and eight times a day. Beyond that, more frequent urination may be caused by an increase in the volume of urine he or she produces, or because of dysfunction in the storage or voiding process. Some of the more common reasons for frequency include a urinary tract infection (UTI), diabetes, an enlarged prostate, change in kidney function, bladder stones, cystocele, anxiety, interstitial cystitis, overactive bladder syndrome, a pelvic mass, and other factors such as the use of a diuretic.
Kidney cysts are fluid-filled pouches that form on the surface of the kidney. They are common, generally non-cancerous and don’t cause complications. Simple cysts are often detected during imaging tests performed to rule out other conditions. Because they don’t cause problems, they don’t require treatment which is why your son’s doctor didn’t get aggressive in that regard. When a cyst enlarges, symptoms might include pain in the upper abdomen and a dull pain in the back or side. A fever may be present. However, when multiple cysts form, both kidneys can be affected. Because you have been so diligent in attempting to secure answers, I feel periodic follow-up testing is vital and may be the key.
Stress and anxiety may also come in to play here. While frequent urination can be a sign of a serious yet undiscovered health issue, frequency may simply be caused by anxiety. If your son is striving to get good grades, to make the basketball team, to play the lead role in a school play, or simply hoping to stay in class without having to be excused to use the restroom, the degree of tension may be overloading his nervous system. When a person suffers from stress, he or she may have an increased heart rate, headaches, physical exhaustion and increased urination, so while waiting to see his urologist regarding follow-up testing on his cyst, he might incorporate meditation, yoga, jogging around the block, listening to soothing music, reading, or doing whatever else reduces his stress level.
He’s young to have an enlarged prostate but that would have been part of a routine urological evaluation. It certainly is worth confirming. However, the enlarged prostate appears to be one area that hasn’t been addressed to date. Be sure to mention this to the urologist during his next visit.
Additionally, he may have a condition called overactive bladder. This is the second most common bladder dysfunction disorder following nocturnal enuresis. It can be detected through urodynamic evaluation, a procedure whereby the urologist tests the contractions of the bladder. This test should definitely be performed.
The consumption of high energy drinks, those that contain high levels of sugars and fructose, caffeine, and cocoa are very popular with young adults. If he tends to indulge in any of them frequently, he might reduce or eliminate the offender(s) on a trial basis. Further, high acidic foods such as tomatoes and citrus drinks such as orange, grapefruit and lemon can irritate the bladder, as can artificial sweeteners, carbonated beverages and alcohol.
Lastly, a visit to a super specialist in a nearby teaching hospital may be appropriate. Sometimes a new take on a long-standing problem will point an individual in a different direction. Good luck.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Bladder and Urinary Tract Infections” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
