Frequent Urination: Another Opinion

Our son has needed to urinate extraordinarily frequently lately. Our pediatrician turned up nothing on a urine culture, and suggested that the problem was all in our son’s head.

When the problem persisted, we decided to get a second opinion. We made an appointment to see a urologist.

We had our first visit a couple of weeks ago. I was happy when the doctor did not immediately dismiss this as a psychological problem.

Instead, she told us of several possible causes for frequent urination including diet (especially if a person is eating a lot of packaged foods that are high in sodium), medication (which may cause frequent urination as a side effect), and constipation (even minor constipation may cause pressure against the bladder which leads to discomfort and feeling the need to pee).

Of these possible alternatives, none really closely matched Kai’s case. Unlike many families, we do not eat much packaged foods. My wife prepares many meals from scratch, even making homemade vegetable juice rather than getting it store bought. And while Kai may have potato chips on occasion, it is not something he consumes on a frequent basis. So, it is unlikely that a high sodium diet is the cause of this.

Medication is a possibility. We have Kai on a number of medicines and supplements. He is currently on a small dose of risperidone, and its side effects could lead to this problem. But his latest blood test indicates that his glucose level is fine, indicating that it is not the cause. And since the problem started, we experimented with temporarily eliminating the newest drugs that Kai had been on to see if it made a difference with his urination. It did not, which suggests that these medications are the issue either.

Constipation also seemed unlikely, as Kai has a bowel movement every day. But the doctor said that a person could have minor constipation even if he or she has a bowel movement every day. It may be that it is just more difficult to go, rather than not going at all. Still, even with this relaxed standard, it seemed unlikely that Kai was suffering from constipation.

Despite this, the doctor did not make the conclusion that the problem was purely psychological. She directed us to keep a diary of Kai’s urination schedule for two days. We would record the time and amount he peed every time he went.

Also, on our return visit, she wanted him to come with a full bladder, and they would measure the amount of urine still in his bladder after he peed.

Yesterday was our return visit.

He peed after we arrived at the office – about 300 cc. Then they did an ultrasound on his bladder and was able to see that he still had quite a bit of urine left in there. They estimated that about a third of his urine did not get discharged when he peed.

The doctor reviewed the diary. She saw that he sometimes peed quite a bit soon after he had peed, and concluded he wasn’t releasing all of the urine from his bladder at home either.

She explained that sometimes people put pressure on the bladder, closing it instead of keeping it open. In those cases, she said that it can be taught to relax the muscles to keep the area open and allow the free flow of urine out of the bladder.

While there are drugs that can treat this as well, she recommended that we first try a special type of training that they offer in the office. For this training, several probes are connected to the patient’s bottom area, with the other end connected to a computer. The patient watches the monitor, and is taught the right way to flex and relax the appropriate muscles.

We have scheduled our first training session for Kai next week.

I am not sure that this will completely resolve the issue. But it seems to make intuitive sense that he would have anxiety about going if his bladder is not emptied out.

And so, it is good to have found a possible answer to this mystery. And I am especially pleased to have found a knowledgeable doctor who did not jump to a conclusion just because my son has autism.