REPLY to Question: Troublesome nocturia (needing to urinate frequently at night)
This is an ongoing series of replies to questions offered at the “ask me anything” post
This is an ongoing series of replies to questions offered at the “ask me anything” post; let’s use that post as the central hub for questions and I will get to them as soon as I can. As usual, this conversation is not to be misconstrued as personalized medical advice, which it is not.
Topic: Frequent urination at night, possibly due to prostate enlargement
As some of us would have expected, prostate volume was reduced after 12 months of treatment with the aromatase- inhibiting drug. I have discussed my enthusiasm for this particular drug in Inflammation Mastery 4th Edition, Chapter 4, Section on Orthoendocrinology.
Original Question:
Do you have a recommendation for nocturia? … peeing every 2 hours at night.. probably caused by anxiety. flomax is no help. Thats the best the doctors can do. Sonata helps me get to sleep but …still up peeing all night/ this cant be good for a 66 year old.
Reply:
Thank you for your question. This is a somewhat complex issue that can become much more complex in the hands of a specialist (urologist or nephrologist). Here, I`ll provide some perspectives from general medicine or integrative medicine. I worked for a while in a urology specialist-surgical office when I was in my last 2 years of naturopathic medical school, but I’m certainly not a specialist in this area (nor do I aspire to be, as I’m conceptually allergic to other people’s plumbing and fluids).
The most common causal considerations are:
Bladder outlet obstruction (BOO) in men and women
Edema—generalized
Edema—specific to the lower extremity due to venous insufficiency
Cardiac disease, congestive heart failure
BOO revisited in men, due to prostate enlargement
In men and women, the problem of nocturia could be caused by bladder outlet obstruction (BOO) which is localized to the area below the bladder, or the problem could be some type of generalized fluid distribution disorder such as generalized edema or congestive heart failure. In the later two situations, the original cause would have to be addressed such as with anti-inflammatory medications/interventions or specific treatments to improve cardiovascular function. A good summary of common considerations is provided here:
Nocturnal polyuria as a cause of nocturia is more prevalent in older patients, while in younger patients, a decreased nocturnal bladder capacity is the more common etiology. Caffeine and excessive oral fluid intake in the evenings, as well as alcoholism, can contribute significantly to this disorder. It is also associated with congestive heart failure, obstructive sleep apnea, evening use of diuretics, periphperal edema, high dietary salt intake and chronic venous insufficiency of the lower extremities. https://www.ncbi.nlm.nih.gov/books/NBK518987/
In the case of lower extremity edema with nocturnal fluid redistribution in the recumbent position, treatment of the venous insufficiency might help, and natural treatments such as bioflavonoids and botanicals have proven efficacy here.
In the chiropractic/naturopathic/nutritional worlds, we have been treating venous insufficiency with diet (reduced sodium, allergy avoidance) and “vein supporting nutrients” such as copper, vitamin C, and bioflavinoids for at least 30 years.
In fact, my enthusiasm for botanical medicine was set ablaze in 1993 when I learned about using botanicals—such as horse chestnut for the treatment of venous insufficiency—for a wide range of common and “medically untreatable” problems.
The quote below is from a medical office offering surgical treatment of venous insufficiency; this quote basically restates what I said above: