Do You Pee Like A Horse
Posted , 13 users are following.
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 
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 
If you don't know your IPSS score, I will post a link shortly in a follow up post.
Jim
0 likes, 71 replies
harveybronx jimjames
Posted
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
jjjj57989 harveybronx
Posted
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.
jimjames harveybronx
Posted
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
harveybronx jimjames
Posted
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
jimjames harveybronx
Posted
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
jimjames harveybronx
Posted
Jim
harveybronx jimjames
Posted
Funny you mentioned self-cathing. I'm seriously considering getting one right now, just in case I really can't pee during the wee hours (that's a wee pee).
Read that article, immediately. It reviews about 272 clinical and other studies and pretty much proves the point. Exercise is not just a good thing to do, it's absolutely essential for good health. Avoiding exercise virtually guarantees some chronic ailment. The metabolic products of exercise are required for complete functioning of many/most organs. And the metabolic process of exercise consumes various proteins, etc., produced by other organs. Lack of exercise breaks the metabolic cycle, resulting in disease. I felt this was the case when I was 40y.o., but felt I had to wait until I was 80 to prove my point, at least in my own case. So, I'm telling you this 5 years ahead of schedule. The belief that one slowly disintegrates with age is a cultural myth. It's not age that causes the problems, it's lack of exercise, both physical and mental.
Try skipping to the store when you get out of your car, like kids do!
Harvey
jimjames harveybronx
Posted
Will do but you're preaching to the choir here. Exercise has always been a big part of my life but maybe the article will motivate me for more consistency.
If you do decide to self cath, do it right. The catheter I and a lot of folks here recommend is the Coloplast Speedicath FR14 with Coude Tip. It comes in a green foil packet and has a pre-lubricated hydrophillic coating. "FR14" stands for size 14. That's a good starting size and you can probably work down to a size FR12 after some practice. If you have Medicare they will cover up to 200 of these catheters a month. They are single use, then you dispose of them. If you get that far read some of the how-to self cath posts here or give a holler. Self cathing has done wonders for me but then again you don't seem to have anywhere near the symptons I had before I started cathing. Just be warned that there is no free lunch and there is a chance of UTI's, especially in the beginning. That said, self cathing lets you empty your bladder completely anytime you want to in just a minute. Not sure you need it but something to keep in mind. Certainly 1000% better than rushing to the hospital to have a Foley put in!
Jim
Jim
oldbuzzard jimjames
Posted
Another opinion here. I could have probably gone on indefinitely self cathing but chose not to. Even though I had more trouble than the norm with it initially (a little over 2 weeks to pee afterword and more like 6 til I felt better than when I went in), I'm glad I had Rezum done. My catheters are collecting dust, I get up once a night instead of 3 times and I'm happy to be free of trouble starting and worrying about whether I''ll need an accesory to pee.
If you'd rather go through some relatively minor bother and most likely be done with the issues, Rezum, PAE and Urolfit have a really good (at least 80% on each) chance of doing that for you. And if they don't work, you won't be left with any residual side effects.
Just another perspective. I'd avoid TURP like the plague and alpha 5 blockers too, but you have a good chance of forgetting about all of this if you're willing to undergo one of those three procedures.
stebrunner jimjames
Posted
Hi, Jim,
Interesting topic! When I was growing up, I worked on my family's cattle ranch so I'm very familiar with "peeing like a horse"! However, I can't remember a time when I did--unless it was while binge drinking in my college days.
Before my AUR last December, my ISPP score was very low. The only thing that applied to me was a slow stream. I never woke during the night to pee--and I am 62 years old. Since my AUR--and after I got the Foley catheters out--I now get up typically once a night, sometimes twice--rarely 3 times to pee.
Haven't had a urologist tell me I'd pee like a horse after his proposed surgery. Given my poor bladder tone, I think they know I won't fall for that one!
You've raised an important point, though, about what's important for those of us suffering from BPH--the most important thing is that we empty our bladders. I'll be reminding my uros of that when they try to push me into a TURP or HoLEP when removing my bladder and kidney stones. CIC is allowing me to empty my bladder. The added plus to CIC is that if may also help me rehab my bladder tone.
I've had uros tell me that a normal prostate is about the size of a walnut. In my case I think my prostate was always larger than average. Before I had my PAE, I used to produce more ejaculate and pre-ejaculate than normal. I now wonder if that was due to having a naturally larger prostate.
It's likely that my uros may want to do another flow test before removing my stones. If they do, I'll refuse. I already know my flow is slower than what they say is normal. The most important thing is that I'm emptying my bladder. It doesn't matter to me if it's fast or slow.
BTW, my brother does pee like a race horse, and he's 3 years older than me. He also gets up at least once during the night to pee. His doctors tell him his prostate isn't enlarged. He's never exercised. He considers beer and potato chips a complete meal. Boy, does that annoy me! LOL!
Stebrunner
jimjames stebrunner
Posted
I think we always have to keep in mind what the real benefits vs risks of any procedure are. If our bladders empty completely then our kidneys are protected and it really doesn't matter if we "pee like a horse or not". Some docs are very good in talking people into procedures that either they don't really need or where there are less invasive alternatives. That's because many of them just have one operation or procedure that they do, therefore it is the one they try and push.
I don't know all that much about stone removal, but I think someone mentioned something about not letting them cut away your prostate just to get at the stones. This sounds like very solid advice that you should clarify completely before going under anathesia. My understanding is that there are other stone removal procedures that don't go through the urethra and therefore do not require prostate cutting. It's possible your doctor doesn't perform them so it may mean going to another doctor.
Jim
cartoonman jimjames
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jimjames cartoonman
Posted
Cartoon,
I think his urologist said something about he might have to cut away at the prostate (mini turp?) to get to the stones through the urethra. Apparently you can also get the stones by bypassing the urethra/prostate by going in through the abdomen. I certainly wouldn't want a "mini turp" just to remove stones.
Jim
cartoonman jimjames
Posted
Yes, how about it?
I'm in the middle of dinner prep, so can't Google, but I thought there was a way to bust up stones in the bladder... which would allow for removal of tiny pieces... Ugh re that "necessary" min-TURPish thang... :-P
kenneth1955 jimjames
Posted
Hey Jim That was me I told one of the guys on here not to have them do that. Alot of doctor like to do a Turp to open you up to get to the bladder stones. If the stones are to big they can go through the front and go into the bladder to remove the stones. This way you know the doctor will not touch the prostate. You just have to tell your doctor what you want and if he tells you no Get another doctor. That is what I'm thinking about now. Have A-Fib and my A-Fib doctor has been putting off a heart ablation. Today he told me to stay on the meds and we will put a heart monitor on for a month and see in 2 month's I have already had one on 3 time this year. Last week I had my 4th attack. Was taken by ambulance lass wee monday heart rate was 160 Was in A-fib for 5 hours. I look like a pin cushion. The doctor in the hospital told me that I am a candidate for the ablation. ( also have a lube monitor in my chest that has been showing a-fib ) . Say my heart doctor yester and he went it taking care off. Sorry for getting off the topic But in any case we have to do what we feel is right Take care Ken
kenneth1955 cartoonman
Posted
jimjames kenneth1955
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Hi Kenneth,
Re your stone removal advice, I agree you have to be informed and ultimately in control.
Is your doc an arrhythmia specialist? Definitely read up on ablation if you haven't. I know it's one of many options. Been cardioverted a few times myself. Good luck with your decision.
Jim
kenneth1955 jimjames
Posted
Yes he is but I don't know what he's waiting for. Today he came and and said. Now we know you have A-fib. What was the other stuff. I think I'm going to see the doctor that I saw in the hospital. My kids are worry that if I have another attack I can have a stroke or a heart attack. My heart doctor thinks I should have it done but I don't know about the a-fib doctor. All his doing is putting a monitor on me. It show a-fib and the one I have in my chest show it do. My heart rate 47 to 52 all the time. Just pist off Thanks for the reply Ken
jimjames kenneth1955
Posted
A little confused. You said this was your fourth attack. Were the other three confirmed as afib? If not, you should find out what was going on then. If it turns out that this is your only confirmed afib attack, then I can understand why the doc wants to wait a bit before ablation. Ablation has a place but not a panacea so sometimes they go less invasive first. Definitely research ablation out as well as other treatments.
Have they given you some Cardizem to keep at home? If not, ask. Cardizem can get your heart rate down fast during an afib episode. It's one of the drugs they use at the ER. My understanding is that it's the fast rate that is dangerous short term, not the irregular beat, so I wouldn't worry too much about a stroke or heart attack as long as you get the rate down reasonably fast. I have Cardizem at home for this reason.
Jim
Jim
stebrunner jimjames
Posted
Hey, Guys,
My local urologist told me there could be complications with the stone removal due to my large median lobe pressing into the wall of my bladder. He wants to access the stones through my urethra. He's concerned that his surgical equipment will nic the wall of my bladder where my median lobe is pressing the bladder wall, causing excessive bleeding. And at my last consultation, he said he would do an emergency "mini" TURP at that point.
Since that consultation I had a new CT-scan done, and it shows I have a kidney stone in addition to the bladder stones. I'm hoping the surgeon can take all the stones out at the same time. I will be asking them to take them out laparoscopically through my abdomen.
One of my concerns is that my bladder won't have enough strength to flush stone fragments out if they go through the urethra. I also don't want them to mess up the progress I've made with my PAE.
I'm pretty sure that my local uro and the Mayo uro will recommend doing a TURP or HoLEP--because as you say, that's the procedure they do. They will fret about my median lobe--it hasn't pulled away from my bladder yet from my PAE. And it may never pull away. At this time I'm okay with that. It isn't interfering with CIC.
I meet with my local uro in a couple of weeks to talk again about stone removal. The Mayo uro is going to call me after he reviews my latest scan results. Should be interesting to see how it goes. Thanks for all your suggestions. I'll keep you posted.
Stebrunner
jimjames stebrunner
Posted
Hi Stebrunner,
I don't like the emergency "mini" turp option at all. If that is on the table I would find another doctor who will remove it a different way. You have to be in control, and find a doctor who will work for you. It's your prostate.
Jim
kenneth1955 jimjames
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No they have not giving me that. Yes they were all comfirmed in the hospital. One time my heart rate was 198 was in a-fib for 22 hour before it went back to normal. The monitor I just had on for a month has a-fib on it and the loop monitor that is in my chest. The guy from the company or nurse that take care of it came to the hospital and put a retriver over it and printed up everthing that has been on the it from June. He told me that I have a many a-fib issue on it. Now all the doctor what to do is but another monitor on for a month to see what going to happen. I am on Brilinta 90mg 2 time a day for the stent I had put in and the a-fib doctor has me on Multag 400mg 2 times a day and he just put be back on Eliquis 5mg. The doctor in the hospital told me with all the a-fib issue I have been having I could have had a stroke at any time. I don't want that to happen. Take care hope your doing ok Ken
kenneth1955 stebrunner
Posted
Don't let them near your prostate you are doing fine. Let them use the other way. Like Jim said you have to be in control and thell them that is the only way you want them removed. Let me tell you this. If you like them in to the prostate and you told them that you did not want to have a turp mini or not. With you signing the paper for surgery. He has a right to go against what you want and just say he had a problem geting the stones and he had to do the mini turp. Be in charge and tell them to take them out the other way. If your urologist now will not do that for you find one that will. I'm sorry but I don't trust them at all. They can do what ever they want with that sign paper. Been there done that..Ken
jimjames kenneth1955
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Jim
kenneth1955 jimjames
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Tired of doing that. I think I'm going to see if i can go see the doctor that was at the hospital He seam like he was very nice. I'm just tired of the whole thing...Take it easy Ken
stebrunner kenneth1955
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Thinking of you today and hope you get your heart issues straightened out. The heart issues are a much bigger fish to fry than BPH IMHO.
Stebrunner
kenneth1955 stebrunner
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kenneth1955 stebrunner
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Hello Buddy. Went to see a new Electrophysiologist today. Will be having the ablation done in December. I have to have my linq monitor read on wednesday of next week and see him again on Thursday to see when I can have it. He does 3 a week. I will be happy to get this done. I just hope the dye don't mess up any other problem. I go see my urologist Dec 2 and I will talk to him them. Thank for thinking of me Talk later Ken
stebrunner kenneth1955
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Hi, Ken,
Thanks for your update. You sound relieved to be making progress with the situation and rightfully so. Over the weekend, I got my insurance issue straightened out, and I'm very pleased with the new plan I start in January. Now I don't feel rushed to get my bladder and kidney stones out. I can wait until after the first of the year if I want. That's a big relief for me. Take care.
Stebrunner
kenneth1955 stebrunner
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harveybronx kenneth1955
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I thought the stones are broken up with an ultrasound device or other mechanism before they are removed, so I don't understand the need to increase the diameter of the urethra for their removal, unless the cystoscope, itself, requires the larger diameter urethra to fit through.
And, if that's the case, shouldn't that be determined before the procedure is performed, so the patient can decide amongst various options how the urethra would be enlarged? I don't understand how the decision to perform a TURP can be made by the performing physician while the patient is unconscious.
Harvey
kenneth1955 harveybronx
Posted
That is true. Most of them are broken up with ultrasound. To make them smaller and fluched out but there are some that are to big that they have to surgery to remove them. It also depends on how big your prostate is. If there is a problem a doctor will make the discsion to remove some of the prostate A mini Turp. The doctor has the right to do anything he feel is best for you every if you don't agree. When you sign that paper for surgery. Getting off the prostate. There was a man on here that had a stricture and had surgery. He had a end to end urethroplasty. The doctor told him that he was going to remove 1 inch of the urethra. He said fine. Well when the doctor got in the stricture was worst they he through. They took 3 inch off the urethra. The man has trouble having sex with his wife and they is nothing he can do because he sign the release for the surgery. That is way I tell a lot of the men not to let them go through the prostate not take that chance Have a good day Ken
kenneth1955 stebrunner
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stebrunner kenneth1955
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Hi, Ken,
Sounds like you've made some progress on your heart issue, and that must be a relief. No, I haven't had a TEE procedure, but it sounds somewhat like having a PAE done. For my PAE they went in through the femoral artery in my groin. I was on Twilight sedation so I was comfortable, yet awake, for the procedure.
Met with my uro on Wednesday, and he seemed surprised at the progress I've made with my PAE. We talked about my stone removal, and I asked if I should get my inguinal hernia fixed first. Now I need to see a general surgeon. My uro said he would prefer to do a TURP to reduce my prostate where it pushes into the bottom of the bladder when he does my stone removal. But he said he would just remove the stones if that's what I want. The good news is that I don't have to rush this decision, and I plan to wait a few months before I do anything.
In the meantime I will change my diet, drink more water and start taking Chanca Piedra, a herb, to see if I can dissolve my stones. My prostate has made a small volcanic cone in the base of my bladder so I don't have to worry about passing stones.
Your heart problem sounds pretty scary, but I know you're one to ask lots of questions--and you're one to take responsibility for your own health. You sound concerned about possible complications and rightfully so, but trust your gut. Before I make big decisions I find it helpful to quietly meditate. It helps me see the pros and cons more clearly. Let us know how your TEE goes.
Stebrunner
jimjames kenneth1955
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I've had three TEE's. They basically put tube down your throat with a probe that takes a picture of your heart. It's another way to do an echo cardiogram. You are asleep during the procedure so you feel nothing. I never had any side effects from it other than feeling a little drowsy from the anesthesia. It's possible you might have a sore throat from the tube but I don't remember having one. As to ablation, you should really read up a bit to better formulate questions for your doctor. I do know that they don't always work the first time and therefore might have to be repeated.
Jim
kenneth1955 jimjames
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jimjames kenneth1955
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Have you ever had an endoscopy? It's kind like that from the patient's perspective. Good luck moving forward and let us know how things go. I may need ablation one day myself, but since I only go into AFIB every six years of so, I'm happy to just treat it episodically with electro cardioversion.
Jim
kenneth1955 jimjames
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Yes had one of them about a month ago. It was not that bad. I have had 5 attacks in 11 month's. This doctor said it should have be done all ready. Will have it done a week from monday. Both will be done at the same time I quess the TEE will be done first. I will let you know. Have a great holiday with your family Ken
jimjames kenneth1955
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