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DR. TALK

An insightful discussion with Dr. Gutta Srinivas, Urologist, Star Hospital. Issued in public interest for creating awareness and enhancing the quality of life

What is regarded as ‘increased frequency’ in terms of Urination?

In terms of Urination or Voiding, if an individual is voiding more than eight times in 24 hours, it is regarded as Increased Frequency.

What is the recommended ‘normal’ water/fluid intake and how does it impact Urination?

In terms of water/fluid intake, it varies from person to person, and alsoon various environmental factors. Some people what they hear on television or in articles their to the the individual

What fluids, other than water, can lead to ‘frequent urination’ ?

Some people who are addicted to tea and coffee, and have ten or more cups in a day, are liable to urinate frequently. Tea and Coffee have a stimulant effect on the bladder and induce diuresis (frequent urination). Smoking has a similar effect on the bladder. Westerners tend to drink huge amounts of Coke and Pepsi (litres) per day, which also have a significant diuretic effect on the bladder and can increase the frequency of urination.

Can we change this pattern of ‘frequent urination?’

Yes of course!! You can get complete control on the frequency of urination byaltering our habits, cutting out excessive tea, coffee, coke and similar sugary drinks, giving up smoking, etc.,

Isthere any other factor that affectsvoiding of the bladder?

Another factor that determines how frequently or how infrequently we visit the restroom, is climate. For instance, people from coastal areas which are hot and humid, tend to lose water in sweat. When they travel to areas which are not so hot or humid, they tend to urinate more frequently. Similarly, in summer, due to the heat, the frequency of urination is reduced, while in winter, one visits the restroom more often. This is because of the cold weather, high winds and cool breeze that stimulates the bladder to void more frequently.

Does age determine voiding frequency or create voiding problems?

There are some Urinary/Urination problems that comes with Age. Enlarged Prostate is one such condition in men. When the Prostate Gland enlarges, the urinary bladder changes. Thus we see that no matter how much or how little urine is in the bladder, the pressure remains the same. Normally, only when the bladder is full, it sends a signal to the brain that it needs to be emptied. In the presence of Enlarged Prostate, the smooth and uninterrupted flow of urine through the urethra is blocked. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra, the ‘chute’ through which urine exits the body. As the urethra narrows, the bladder has to contract more forcefully to push urine through the body. Over the time, bladder muscle may gradually become stronger, thicker, and overly sensitive, and it begins to contract even when it contains small amounts of urine, causing the need to urinate more frequently. Eventually the bladder muscle cannot overcome the effect of the narrowed urethra, so urine remains in the bladder and is not completely emptied. Sometimes this problem is caused by the bladder stones.

Do Neurological problems also play a role in bladder function/voiding?

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Some neurological problems also contribute to frequency or infrequency of urination. For the urinary system to work as it should, muscles and nerves must work together to hold the urine in the bladder and then release it at the right time. Nerves carry messages from the bladder to the brain to let it know when the bladder is full. They also carry messages from the brain to the bladder, instructing the muscles to either tighten or release. A nerve problem might affect your bladder control, if the nerves that are supposed to carry messages between the brain and bladder do not work properly. This could result in the following: • Overactive bladder:When damaged nerves send signals to the bladder at the wrong time, instigating its muscles to squeeze without warning,it causesurinary frequency (eight or more times a day and two or more times at night); urinary urgency (the sudden, strong need to urinate immediately) and urge incontinence (the leakage of urine that follows a sudden, strong urge to urinate). • Poor control of Sphincter Muscles: Sphincter muscles surround the urethra and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage, or stay tight when you are trying to release urine. • Urine retention: For some people, nerve damage means that their bladder muscles do not get the message that it is time to release urine or are too weak to completely empty the bladder. If the bladder becomes too full, urine may back up, and the increasing pressure may damage the kidneys. In addition to this, urine that stays in too long may lead to infection in the kidneys or bladder. Urine retention may also lead to Overflow Incontinence.

Is it necessaryto get a check-up if one is urinating more frequently than usual?

Even though it seems to be trivial issue, you should get it checked when there is a sudden and inexplicable frequency of urination.

How much water we should drink per day?

When it comes to how much water is required for the human body, it depends on weather and climate. For a normal individual, 1 ½ - 2 litres of urine output is required per day, so a minimum input of 2 litres of water per day is required. At any age, the minimum amount of fluid required is 2 litres, plus a further 500 ml (half litre) from food.500 ml, approximately, evaporates during respiration and perspiration. However, people with heart, liver and kidney problems will be advised by their doctors to restrict their water intake to one litre per day only.

Are there anyhealth conditions that require an increased intake of water?

Yes. Some people suffer from repeated UTIs (Urinary Tract Infections). It is vitally important for them to drink more water, so that the bacteria can be flushed out.During infection, lakhs of bacteria need to be cleansed from the bladder, and water is an essential component of this process. When people are prone to kidney stones, doctors advise them to consume more water. Kidney stones occur when urine contains more crystal-forming substances such as calcium, oxalate and uric acid which the fluid in the urine cannot dilute. At the same time, the urine may lack substances that prevent these crystals from sticking together, thus creating an ideal environment for the formation of kidney stones.

How long does it take to flush out your system with water?

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Some people’s bodies tend to absorb excess calcium. In other cases, uric acid in meat is retained in the system and stones are formed. The body needs to throw this out, either through the intestines or through the urine. When people have kidney stones – or are prone to having them –they need to aim for a urine output of 3 litres, in which case they need an intake 3 ½ litres of waterin the cold weather conditions. In warm weather they need to take 5 litres of water, in order to ensure a urine output of 3 litres. Thus we see that temperature and weather/climatic conditions determine the amount of water that is required.

What do you feel is the main cause of bladder problems in India and how can we control them?

Essentially the main cause of bladder problems in India is westernisation of diet- eating fast/processed foods; drinking commercially available soft drinks and eating non-vegetarian food.There is a common misconception that avoiding tomatoes and spinach is the answer to keeping stones away, but this is not the case. Non-vegetarians need to restrict meat intake to twice a week, while soft drinks like Coke need to be eliminated from one’s diet completely as they also contribute to stone formation. Polished rice is also linked to high risk of stone formation, so it is suggestible to eat brown rice and other high fiber foods.

Any advice for people prone to Kidney Stones?

• Drink four litres of water through the day. (This is calculated as per the weather conditions of Hyderabad)

• Avoid drinking water before sleeping

• Drink half a litre of water in the morning

• Take in 150-200 ml of water per hour and have a little more after meals.

• Have a little water if you wake at night to urinate

• Space out your water intake in order to keep your body hydrated. • Continuous flow of fluid through the kidneys is essential to prevent the formation of kidney stones. • Control your intake of salt. Don’t add extra salt at the table, and avoid pickles, etc.

• Eat more high fiber foods like fruit and vegetables.

• Tomatoes have nothing to do with the formation of kidney stones. They are good for you as they contain lycopene which has cancer fighting properties. • Spinach is also good for you and does not contribute to the formation of kidney stones. • Get a regular check done to ensure you are free of kidney stones.

Book Appointment: Dr. Gutta Srinivas, Urologist, Star Hospital

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