Nighttime urination keeps reader up

Q. I am a 74-year-old male. I am in a different city almost every week and read your column whenever I can. While in Fresno, Calif., I came across one of your columns about the prostate.

In December 2000, I had cancer for which my prostate was removed. Approximately two or three years later, I began having discomfort in my lower abdomen during the night. It persists until I get up and void. This happens about every hour and a half, and I am able to urinate less than a cup each time. I don't experience any discomfort during the day and am able to void normally in greater amounts, but it remains an effort to void at night.

In March 2007, I had a thorough examination and cystoscopy by a urologist in Tucson, Ariz. He determined there was no physical cause for my problem, nor did he have an explanation. He prescribed Vesicare, which I took. I couldn't detect any improvement and the pills gave me side effects, so I stopped taking them. I later questioned another urologist when I had a PSA test as a follow-up to my prostate cancer. He referred to the Arizona physician's examination and recommended I try the same pills again.

Neither specialist could explain why I have this problem now when I didn't before surgery, or why it only affects me at night. I hope that with your years of experience and extensive research you might have an answer for me.

A. Nocturia is a condition in which a person awakens two or more times a night to urinate. Typically, urine production slows at night, allowing most people to sleep six to eight hours straight without the need to void. Some people may find that they awaken once during the night, but this, too, is normal.

Frequent nighttime urination can have many causes, ranging from drinking too much liquid before bed, overactive bladder syndrome (OBS) and urinary-tract infections to chronic kidney failure, congestive heart failure, obstructive sleep apnea and nocturnal polyuria. Certain medications, prostate problems and diabetes are also common causes.

Because you no longer have a prostate, this can be ruled out as a cause. Your unsuccessful treatment for OBS rules it out as a likely cause. Your thorough examination probably rules out cancer, infection and obstruction. This leads me to believe that it is now time to start looking outside the bladder.

Make an appointment with your primary-care physician or an internist, and explain your symptoms. Be sure to bring the results of your urology tests and examinations so the physician doesn't repeat them unnecessarily.

Undergo a thorough physical examination (from head to toe) and lab work to include kidney and heart function, diabetes and perhaps sleep-apnea testing. If you are on any medications, they should be reviewed to determine whether one or more might be the culprit.

You should also restrict your fluid intake by not drinking any fluids two or three hours before bed. Attempt to void immediately before sleeping to ensure that your bladder is as empty as possible. Work with your doctor to get to the bottom of the problem.

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