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Nighttime urination: A frequent boomer complaint -- article by Scott Keith

Posted Jul 12 2010 12:28am

It can really be frustrating. You’re snoozing away in the middle of the night, trying to get your eight hours of quality sleep. In the middle of a good dream, you wake up and your bladder is telling you it’s time to visit the bathroom. You take care of business, get back to sleep, and hope you can avoid another visit to the porcelain throne before your alarm clock goes off.

Nighttime urination is the problem. There’s even a fancy medical name for it: Nocturia.

Dr. Jeffrey P. Weiss, Professor and ACGME Program Director and Chair in the Department of Urology at SUNY Downstate Medical School, says nocturia is “a rising at night (or other times of the day when you get your normal sleep) because of the desire to pass urine.” It’s tricky determining why one urinates during the wee hours. “Many people wake up for reasons other than the desire to pass urine, and then urinate because they figure it will allow them to sleep a little bit longer. Technically, that’s not nocturia,” says Weiss, adding that the other form of urination is a “convenience void.”

Getting up to urinate can have several causes, from drinking too much liquid during the evening to prostate issues (in men). “Particularly in the older population, the majority of the people who get up at night do so because they make much more urine than their bladder can hold, rather than it being a prostate problem,” says Weiss, in an interview with Men and Health: It’s a Guy Thing. Enlargement of the prostate can be a cause. “It used to be thought, exclusively, that nocturia was due to the prostate. That’s because we really didn’t understand the condition nearly as well as we do now. But many unnecessary prostate operations were done because people got up too much at night.”

Regarding the prostate, Weiss says nocturia is not a likely symptom of prostate cancer. “Prostate cancer today is diagnosed at an early stage. Only if someone has a high-grade blockage of the bladder (by the prostate) would you expect they might present with nocturia. That would be a pretty advanced presentation of prostate cancer, particularly today.”

Studies suggest nocturia is a frequent complaint of older baby boomers. Weiss says, “Population-based studies demonstrate that the vast majority of people urinate at least once at night, when they’re older. A very significant number, when they’re elderly, are getting up twice or more at night.” One common issue is swelling in the lower extremities, due to poor circulation. Says Weiss, “the fluid that’s locked in their legs returns to the central circulation when they lie down and go to sleep. That fluid has to return to the circulation. The body recognizes when there’s too much fluid on board and it kicks it out into the kidneys.”

Nocturia is not just a men’s condition. “Women do have nocturia. In fact, younger women have more nocturia than men. As men and women age, the incidents equal out in mid-life (fifth or sixth decade). And then in the more elderly, men take over and have a higher incidence of nocturia.”

If you develop symptoms of nocturia, see your doctor. Your primary care physician is a good starting point. Weiss says, “a primary care physician that’s interested and knows something about it most definitely can evaluate and treat nocturia.” He says most nocturia is probably not urologic in nature, although urologists tend to be experts on the subject. Weiss suggests a physical exam and a check of the urine to see if there’s infection or blood in the urine. A good next step is to complete a diary, logging a 24-hour collection of urine. Time and amount of urination can be recorded on a chart. Based on the diary, a doctor can determine how much the bladder can hold, and whether too much urine is being produced around the clock. The chart can help doctors determine the cause of too much urine, one cause being diabetes.

Weiss says there are several ways you can treat nocturia. “Usually, nocturia is multi-factorial in its cause. It’s unusual that one treatment is going to resolve nocturia. It’s usually a couple of things.” He says, for instance, he may treat swelling of the legs with compressive stockings or a diuretic (water pills).

Asked if he has a special message for baby boomers, Weiss says, “If they’re bothered by any amount of nocturia, they should know there is help. There’s an approach to it, even if it’s benign…there is effective and safe treatment.”


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