For adults experiencing the discomfort of frequency, urgency and/or incomplete emptying of the bladder, a number of tests can help determine the cause. While it’s a common condition, it can lead to more serious issues if left untreated.
Dr. Alec Schwartz, urologist at Bergen Medical Associates, explains why men (and women) might feel the need to urinate more frequently as they age and how it can be treated.
Studies show that frequent urination at night by both men and women — a condition known as nocturia — is a common function of the aging process. But it also can be indicative of any number of other treatable conditions, according to Alec Schwartz, MD, urologist at Bergen Medical Associates, which has six offices throughout Bergen County.
Alec Schwartz, MD
While both men and women can experience the need to urinate during the night, “one unique cause of this in men is related to the fact that they have a prostate, a gland which supports both urination and reproduction in males,” Dr. Schwartz said. “A hollow organ that surrounds the base of the urethra, the prostate is shaped like a doughnut and often starts growing beginning in a man’s 40s. Urine leaves the bladder through the urethra, but as the prostate grows in size and the doughnut ‘hole’ surrounding the urethra gets narrower, the bladder has to work harder to squeeze urine through the middle of the prostate,” he said. “Symptoms of this type of obstruction can include slow urine flow, increased frequency of urination, straining to get flow started, and/or the feeling of not emptying your bladder completely.
“Men can experience a sense of incomplete emptying and/or an increased need to urinate because of an enlarged prostate, or because this process can actually lead the bladder to become overactive,” Dr. Schwartz said, noting, however, that this condition isn’t a foregone conclusion for all men as they age. “Many men with enlarged prostates don’t experience any of these symptoms, while others have smaller prostates and have significant problems,” he said. “But we find that when we address the obstruction, most men will improve.
“Many women also have problems with urgency, frequency, and the need to urinate during the night,” Dr. Schwartz confirmed. “As with men, diet can be a culprit — caffeine, alcohol and spicy foods can irritate the bladder wall and lead to urinary frequency — as can intrinsic bladder overactivity and urinary tract infections (UTIs).” Dr. Schwartz said that women are more prone to UTIs than men based on their anatomy, but are often misdiagnosed as having recurring UTIs when they actually have overactive bladder, which can be effectively treated with medication.
As with men, frequent urination for women at night can be attributed to diet— caffeine, alcohol and spicy foods can irritate the bladder wall and lead to urinary frequency. Intrinsic bladder overactivity and urinary tract infections (UTIs) also can be factors for women.
Addressing the Problem
“If you’re experiencing the discomfort of frequency, urgency and/or incomplete emptying of the bladder, a number of tests can help determine the cause,” Dr. Schwartz said. “Although it’s a common condition, it can nonetheless lead to more serious issues if left untreated. For example, the bladder can start retaining more and more urine over time and the person won’t even know it because the kidneys will accommodate the problem; in severe cases, it can cause renal failure down the road.
“One of the most important tests we do in the office is a urinalysis, through which we’ll test the patient’s urine for red and white blood cells and the byproducts of a bacterial infection; if any measures are positive, we’ll do further evaluation,” he said. “And an ultrasound, which is performed on the patient both with a full bladder and then again after they urinate, will measure how much urine remained in their bladder after emptying and help us determine next steps.”
At the same time, “Men should have a rectal exam and a prostate-specific antigen (PSA) test annually to screen for prostate cancer,” Dr. Schwartz advised, though he’s quick to note that a PSA score over the “normal” level of 4 doesn’t necessarily indicate the presence of cancer.
“The prostate gland makes PSA, so an enlarged prostate will trigger a higher PSA score. The PSA may also be elevated if the patient is experiencing urinary retention, has inflammation from a UTI or irritation from a catheter, has new onset diabetes that’s not under control, or has another inflammatory condition like pneumonia,” he said. “There’s a range of acceptable PSA scores depending on the patient’s age, family history and PSA score the previous year.”
Dr. Schwartz said that a host of proven medications are available to address the frequency of urination and/or sense of urgency or incomplete emptying. Among them, “there are medications with few side effects that work to relax the bladder muscle so that the patient isn’t going as frequently, he said. “For men with urinary issues caused by an enlarged prostate, a medication called Flomax relaxes the opening of the bladder neck, making it easier for the bladder to empty. And because constipation can also be a cause of urinary frequency or other issues, stool softeners may help.”
According to Dr. Schwartz, lifestyle changes also can help relieve symptoms.
“Reducing consumption of bladder irritants like caffeine, alcohol and spicy food can make a difference,” he said. “Not only can they cause irritation to the bladder and lead to these symptoms, but they’re also diuretics that can increase the volume of urine produced, so they’re a double whammy.”
Among other positive steps, “Kegel exercises can strengthen the muscles of the pelvic floor and help relieve bladder overactivity,” Dr. Schwartz said. “If you’re waking up frequently to urinate at night, it’s often related to fluid intake, so stop consuming liquids two to three hours before bedtime and try to urinate right before bed. And because stress can also cause urinary frequency, we recommend that patients try to reduce stress through exercise or other positive outlets.
“The great thing about a practice like Bergen Medical Associates is that patients will be seen by outstanding primary care physicians who have direct access to specialists under the same roof, which streamlines the referral process,” Dr. Schwartz said. “Patients can potentially be seen by a urologist or another specialist right after their primary care visit, which offers convenience and peace of mind.”
Ultimately, if you’re running to the bathroom to urinate at night, Dr. Schwartz said that you’re not alone.
“It’s a pretty common issue,” he confirmed, “but we hope that people experiencing any of these symptoms will come see a urologist, because it’s likely that we can help you and significantly improve your quality of life.”
For More Information
With offices in Emerson, Paramus (two), Ridgewood, Northvale and Montvale, Bergen Medical Associates offers primary care and 12 areas of specialized care. Patients enjoy the “one-stop shopping” approach where so many medical services are provided under one umbrella. The multi-specialty group fosters an environment of collaboration among the physicians, which results in a seamless continuum of care for patients. For more information, visit bergenmed.com or call 201-967-8221.
— Susan Bloom
