Do You Pee Like A Horse

Men's health
1

Several years ago, when my former uroloigst tried to talk me into a TURP, he mentioned the usual benefits such as more complete bladder emptying, less urgency, fewer night time trips to the bathroom, etc. But when he tried to close the deal, he looked at me, his eyes lit up, and he said, "Jim, you will pee like a horse"!

I guess he's not the only one who singles out flow rate when selling an operation, because I have heard the phrase here often attributed to both doctors as well as people reporting on how their flow rate changed after an operation or procedure.

What I'm curious about is the correlation between "peeing like a horse" and some of the other bph symptons such as incomplete bladder emptying, urgency, night time trips to the bathroom, etc. 

So this question is for those of you here who "pee like a horse". (If you pee like a dog or cat no need to reply biggrin

Have all your other symptons resolved, and if not, what is going on. Also, what is your current IPSS score and what type of procedure did you have?

Personally, I've never had a procedure done, and do not pee anything like a horse! In fact, I don't think I've had a strong stream since the age of 25 and before that frankly I can't remember!

That said, my bladder empties completely and my plumbing functions pretty normally considering I'm pushing 70. In fact, things work better now then they did when I was in my 20's.  My IPSS score is around an "8"" (borderline mild) but it would be closer to a "3" if the "weak stream" question wasn't in there. I understand that a weak stream suggests bph but it really doesn't affect lifestyle like the other questions unless I guess extending your void time ten seconds cuts into your work or social life smile

If you don't know your IPSS score, I will post a link shortly in a follow up post.

Jim

 

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Link to IPSS Score (International Prostate Sympton Score) in first post of the following thread:

https://patient.info/forums/discuss/what-is-your-international-prostate-sympton-score--453484

3

Great thread Jim. One of the symptons of LUTS(Lower Urinary Tract Symptons) is a weak stream. While this could be associated with BPH it is now known that weak streams are also associated with weak detrusors caused by poor arterial blood flow to the bladder. Men with LUTS often have normal prostates.

I was also told I would pee like a horse after my PAE. Well it has been over 3 months and the horse still wins!

Neil

4

Sorry about the horse winning!

My stream has been weak since my early twenties after several bouts of STD's within a short period of time. The uro way back then suggested scar build up from the STD's as the cause, however the uro's I've seen more recently never mentioned anything about scarring or strictures even though I have asked, been imaged and scoped and then asked again. So, perhaps my weak stream doesn't have to do with my bph, perhaps it does now. But the main point is that at least with me that weak stream doesn't translate into incomplete emptying, it only translates into a few seconds more doing my business. Let's see if any race horses show up and hear their story!

Jim

 

5

Hi All,

I have had a PAE and certainly do not pee like a horse. However like Jim 

I am fairly sure I am voiding completely. I had a US Bladder scan 6 hours after Ihad a Foley catheter removed and there was 18ml of urine present!

I would be prepared to bet that even if I underwent a "succesful" TURP my flow rate would not increase much if at all. I can live with that. my problem is going into AUR after drinking too much Beer; something I am reluctant to give up. 

6

Still no race horses! 18ml is pretty good and I'd dare say more important than peeing like a horse. As discussed in the other thread, don't count on an operation or procedure changing anything in regards to AUR after too much beer. It might. Might not. As I mentioned over there, if that was my only issue then I would either just watch my beer, or learn how to self cath so I could continue to enjoy drinking without worrying about going to the doc's or ER for a Foley.

In fact, although our histories are different, symptomatically we're now similar in that I believe both of us have normally functioning urinary systems with the exception of occasional AUR caused by too much fluid overload of the bladder. So when I say I'd forgo any procedures and just keep some caths on hand, I'm recommending to you what I'm doing myself.

Jim

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My ipss score is 8-9. I don't pee like a horse, but my flow si greatly improved. The biggest problem is that I normally have to strain or pump under my scrotum to get the last 20% or so out and my problem now is bladder function not the prostate. The wierd thing is that I didn't seem to have bladder issues prior to the Ruzum procedure. But other than not being able to empty without a little work (extra 15 seconds or so at most) and having to pump all most all of it out when I drink a lot of alcohol I'm in pretty good shape now. My ipss used to be 19-21, so its dropped alot. I get up once a night most nights - it used to be 2-4. I never could go more than two hours between bathroom trips during the day and now its been as much as 4.

 

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Jim  If your fine just leave it alone.  Have a great day  Some doctor  will tell you anything to close the deal    Ken

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It makes sense Jim. As you say if I allowed myself to undergo an irreversible procedure such as HOLEP or Green Light and found I still went into AUR after too many beers but now had RE or worse then I'd feel pretty sick.

I think the next step for me is to  conquer this self cathing.

My only current concern is my symptoms are worse, ie frequency, and reduced flow. Do you think this might the bladder's reaction to 2 episodes of AUR within a month? Or is this now me and I have to get used to it?

Jeremy

 

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Hi again, JimJames!

Why does the phrase, "If it ain't broke, don't fix it!" come to mind?  :-D  As long as you are completely voiding at our age, it seems to me you're doing fine.  No one is standing there with a stop watch (are they?!); it's most important that you CAN empty the bag!  After 2+ years of on-and-off self-cathing, I've been thinking (as I did mention on another thread yesterday) that if urologists really had our best interests in mind (my conclusion is they typically don't...  :-(   ) , then they would teach self-cathing as a way to AVOID prescribing TURPs.  The worst symptom of of BPH is the "number of times per night I gotta get up and pee" thingy.  It's this that drives men to sleepless nights of non-rest, and then when they are punchy and least resistant to coersion, the uro-doc moves in for the kill.  "It's the 'Gold Standard,' you know!...and it'll fix ALL your problems and LET YOU SLEEP THROUGH THE NIGHT!"   "Uh, sure, doc, I gotta get some sleep!"

With self-cathing, I do so before bedtime, and ALMOST ALWAYS sleep through the night.  Last night was an exception, and as I stood there cathing at 4:00 am or whateve, I thought, "Sheesh, I'm glad this only happens once a month!"

I would certainly encourage you to look into self-cathing (SpeediCaths are the best, imho!)... Forget peeing like a race horse; can you remember what sleeping through night felt like???  :-)

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Hi Ken and Cartoonman,

I agree with both of you that flow rate is not important as long as your bladder empties completely. I thought I was making that point in my original post but I guess not. Just curious if those that do "pee like a horse" also empty their bladders competely or if the two don't necessarily go together. Still waiting for a horse to trot by smile

Jim

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Not necessarily related, the peeing and the emptying fully!  For example, if I join my friends for a couple of good beers (rare, but I do on occasion), I will pee like the proverbial.  But when I'm done, there is still anywhere for 400cc to 600cc left "in the bag."  Just the way it goes, for those of us with permanently-stretched-out bladders.  Thus, for me, the self-cathing...

13

Before I started self cathing I had to push on my bladder get the urine out. My understanding is that pushing on the scrotum is more useful to just clear out the urethra of the few last drops (Post Micturition Dribble--PMD) but apparently in your case not. 

It may or may not be relevant but one of the causes of PMD is weakening of the pelvic muscles from prostate procedures. They then suggest pelvic floor exercises if you haven't already tried them. 

Not sure if you're motivated, but instead of pushing it out, you could start cathing for a few months to give things a total rest which might accelerate any needed healing.

Jim

14

Cartoonman,

How agressively are you cathing these days? I pretty much stopped cathing lately but have no hesitation cathing if I feel the least bit of resistance because I'd rather cath than stress the system out with too much pressure. Last week I had a couple of 400ml natural voids with only 100ml retention. I was well hydrated during that period with some coffee but no beer.  My normal natural voids are 150-300ml, with 250ml as a mean if I'm decently hydrated. PVR's range from 30ml-150ml. So overall, I'm very happy with the results of my self cath bladder rehab and things seem to be getting better even off the catheter. 

As to the beer, haven't had much lately but curious if it will still put me into AUR. Plan to experiment one of these days!

Jim

15

Jezzaman,

Not sure if it was the AUR, all the stress your system has been under with the Foley, etc, or just a normal progression of BPH. Time will tell.

The operations and procedures are always there, but since you've already started cathing, see no harm going on a cath program now and see how things go. If you don't like it, then you can always try one of the less invasive procedures if you qualify. 

I had a lot of difficulty with self cathing the first couple of months but then I didn't have a choice since my bladder then was too flaccid for an operation or procedure anyway. But honestly, if those difficulties continued I would have dropped the self cathing and gotten whatever operation or procedure I deemed best at the time. Fortunately, like some others here, after a little tie, the self cathing turned out to be virtually painless and not much of a bother. 

Jim

16

Rather than starting a new discussion, this one seems close to my interest, which is variation of urine flow rate throughout the day and night.  I’m 75, take no medications, have not had any prostate procedures and have a 70cc prostate.  On this site I have not read of anyone having dramatic variations in the ability to begin peeing or the flow rate during the day or night.

However, for me, during the day, my peeing (flow rate) seems normal, at least similar to what I can remember going back years.  However, when I awaken from sleep, usually twice per night, or sometimes three times, with a fairly urgent need to pee, starting to pee takes a while, maybe two minutes or even more.  And recently, a couple times I was fearful that I would not be able to begin peeing at all after standing at my toilet for what seemed a very long time.  However, after I begin peeing, as my bladder pressure reduces, my flow rate gradually increases, though never as much as it is during the day, when I have no problem urinating.

I have no idea if my bladder is fully emptying or not, although sometimes, after I feel fully relieved, if I wait a minute or two, I feel the urge to pee again, and pee a significant amount of urine.  Obviously, my bladder was not fully emptied the first time, although immediately after peeing, it feels the same.  So, I have to conclude that one cannot sense if one’s bladder is fully emptied, or not.  It would be nice to know, without having an US machine at home and obtaining certification as an US technician.

Fortunately, this has not caused me any apparent lack of sleep effects, since I awaken during what seems to be the shallow period of my natural sleep cycle, which is about 2.5 to 3 hours.  On the other hand, I’ve read here, and heard from friends, that if they awaken to pee two or three times per night, it wreaks havoc with them, and they experience great loss-of-sleep effects.

I just looked at the I-PSS table, and it doesn’t seem to apply to me, since I have a very different experience when awaking from sleep and during the day.  I wouldn’t know how to score myself.  As far as rating my quality of life using the SCI score, my feeling would be mixed (3) if I didn’t consider any treatment alternatives; however, if I have to also consider treatment options, from some of the accounts I’ve read on these posts, I would consider myself rather pleased (1) or even delighted I don’t have to undergo that torture regardless of the procedure, at least not yet.

Anyone have similar experiences of big variations of urination flow rate?

Harvey in S. California

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Before my PAE I had the same experience as you are having: nightime hesistation at the beginning of urination.  I found that, on bad nights, I could start it much quicker if I were sitting on the toilet.  After a few seconds it would stop but then I could stand and finish.  

Often, on those nights, I'd return to bed and in a few minutes I'd have to pee again.  This has something to do with the kidneys releasing urine when the body is in a reclining position.

What drove me to finally seek an interventional treatment was not only the number of times my sleep was interrupted but the increasing time I was awake dealing with the starting and stopping.

18

Hi Harvey,

Everything you wrote sounds fairly typical of BPH. Many of us here have more trouble voiding in the evening. That’s primarily because the bladder tends to fill up more while we sleep. Also, we are inactive while sleeping which tends to make the bladder muscles more sluggish. So the lower flow at night and double voiding you describe, normal. Your bladder muscles just don't have the tone to empty completely on the first try.

And "yes" different people have different tolerances for the same symptons.  One example is getting up at night, which is why different people pull the trigger for an operation or procedure at different stages of BPH even with similar symptons. I've been getting up at night a few times as long as I can remember so doesn't really bother me. Some it bothers a lot. 

The IPSS score isn't perfect, but it does ask "how many times" , which includes both day and night even if different, which is often the case. You might try it again if you want, but probably the most important part is how you rate your quality of life. You picked number 3, “mixed”, and it sounds like at 75 you can live it.

Are you seeing a urologist? Usually a good idea with bph especially at your age, although after reading and experiencing a lot here, sometimes I wonder J

But if you do go to a urologist, a visit usually involves a simple bladder scan which can tell you exactly what is left in your bladder after you urinate. Sounds like you want to know that and you should. They may also do a blood test and send you out for a kidney scan to make sure the bph isn’t damaging your kidneys. It probably isn’t, but I think it’s prudent to have it checked out.

Just know that the results of any bladder scan can be way off if you drink too much fluid before the scan, something that they often tell you to do in the doc's office so they can get you in and out quick! Resist those instructions and only have a bladder scan under your normal drinking patterns. That will give you what is called your post void residual (PVR).

Alternatively you could go out and spend about six grande on a machine of your own, something which I almost did at one point but decided to save the money! No certification was necessary to get the machine, just a note from my doc saying I needed it. A great toy/device, but quite expensive!

Jim

 

19

Hi Jim,

Thanks for your response.  I have never heard before your post from anything I’ve read on these posts (or anywhere) about the differences people experience between daytime and nighttime peeing, so thanks, again.

I have been seeing a urologist since 1999 because I had a PSA of 6.2 that showed up in a blood test taken for no particular reason except an annual checkup.  And that was the very first PSA test I’d ever had.  But, I don’t think I had any urination problems, then.  I repeated it a month apart using different labs to confirm the reading, and had a 10 core biopsy that came back negative.  And five years later, after a PSA spike I had another 10-core biopsy that again came back negative.  Then, in January, 2015, I had another spike, to 14; but, by this time, multi-parametric MRI was available, and by my own research I found a place in S. California that did those in a 3-T MRI machine, and also performed in-bore biopsies, if needed.  I didn’t need the biopsy, since my mp-MRI was again, negative.  A month later, my PSA fell back down to the 8 it was 6 months earlier.

Back on the urination topic, I did have a cystoscopy done after a day of hematuria, and that examination also found nothing.  The hematuria had only lasted about 12 hours.  I did have an US examination at the same time because of the hematuria problem; but, now I don’t remember if a measurement was made of residual urine in the bladder.  I’ll have to get a copy of the report.

My absolute last resort is to take any sort medication or have any procedure performed.  The reports from actual people I’ve read on these posts are far different from what I’ve read in published literature.

I’m also a strong believer in the need to perform significant exercise, virtually every day, and my belief in exercise has been confirmed by a review article published in the J. of Applied Physiology in 2002, by Booth, entitled:  “Waging War on Physical Inactivity”  It’s a free article you can find online.   It should be life-changing for anyone who is “slowing down” with age.  In fact, I did some high-bar gymnastics with a coach beginning in 2015, for about 6 months, just to prove that I could.  I’ve been treadmilling every morning since 1995, now up to a 12% grade at 4mph.  That seems to have prevented every other disease and debility except my growing prostate, which is only twice the normal volume.

Harvey

20

Your instincts are right. Try and avoid a procedure or medication if at all possible. At the same time you should monitor your bladder and kidney functions just like you have been doing with your Prostate. Perhaps your doctor has done this but not discussed it with you in detail. It's not complicated: (1) a bladder scan in the office every once in a while to check residual volume; (2) a simple blood panel to check kidney function; (3) an ultrasound of the kidneys to make sure you don't have water in them (hydronephrosis). 

I agree about the exercise and it's admirable you're doing high bar at age 74. I'm a few years younger than you but will check my treadmill times against yours as soon as I get off my a*ss and into the gym! I have always been quite active just not lately and as consistent as yourself. 

But back to the daytime/nightime thing. It has been covered here frequently but not as a single thread or topic, it just comes up in some of the threads. As mentioned, it's mostly about extra fluid volume in the bladder at night, that combined with no bladder stimulation through activity. Also, as we get older the kidneys tend to unload a greater percentage of urine in the evening than they did when we were younger. Again this means more volume in the bladder which makes it more difficult to expel, resulting double voids in your case. Nothing to be overly concerned about, pretty normal, as long as everything else is more or less OK and as long as your kidney functions are good. Do a pull up for me tomorrow, I may even try one myself!

Jim