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Saturday, December 15, 2018  Spokane, Washington  Est. May 19, 1883
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Dr. Zorba Paster: Prostate may be cause of bathroom trips

Dear Doc: Every night I have to get up five or six times to pee. Needless to say, I don’t feel refreshed in the morning. My doctor wants to prescribe a pill that might help but causes mouth dryness. I already have a dry mouth all the time. My dentist said this is so bad my gums are beginning to recede. So the pill is a non-starter.

I thought about asking for Ambien so I can sleep more soundly but I’m afraid if I started on that road, I’d be hooked forever. Besides, I read that taking Ambien every day can make you dumb, give you amnesia.

Help me, please. By the way, love your show. – Dale from Schenectady, New York

Dear Dale: You are not a happy camper are you? We all want a good night’s sleep and too many trips to the toilet make for a lousy sleep session.

My daughter and son-in-law recently had a baby. They don’t get much sleep either, but there is a light at the end of the tunnel in that case. Their baby girl will grow up and sleep through the night, whereas your bladder is stuck in the infantile stage of older men – prostatism.

As we get older, the prostate – this walnut-sized gland that sits at the end of the bladder – gets bigger and bigger so you empty less and less when you pee. What does the prostate do? This little guy makes a milky white alkaline fluid that neutralizes the acidity in the vaginal tract so the tiny sperm on their way through can live longer, swim faster and go farther as they race to fertilize that egg. When you’re having sex to procreate, this is really important.

When puberty kicks in, that testosterone jolt gets this gland moving and shaking. By the way, eunuchs, historically men who had their testicles destroyed before they started producing testosterone, never had a problem with this. At the height of the last Chinese dynasty, there were 50,000 eunuchs serving the emperor.

But back to what you might do for your up-at-night problem – a far too common mature male issue.

First, stop drinking as much liquid about four hours before you go to sleep. So many Americans think they need to flush their kidneys, so at night many sit surfing Netflix, answering email or watching TV with drinks by their side. But the kidneys are not a toilet that needs emptying.

Now, I’m not suggesting you stop drinking completely but drink only as much as you need to keep hydrated – so you’re not super dry and your urine is not tea-colored and concentrated looking. This will take some time to remember if you’re a “kidney flusher” because you’ve set up a habit with expectations.

Second, when you urinate just before turning in, sit on the toilet. Relax. Turn on the faucet and see how much you might go. Quite often, those with prostatism do not empty completely. But by sitting down for a minute or two, you might squeeze out a little more urine, which will drop that get-up-and-go level down a notch. Also, sitting and not standing when you pee at night is safer by far for the older male and you empty more. Cutting down your nighttime pee rate from six to two would be a godsend.

Third, if that fails you might think about using an alpha-blocker medication such as Flomax. It will not give you a dry mouth but instead relaxes the prostate a bit so it’s not as obstructive. If you do take this med, give it a month or two to do its job.

If you want to put in some added zip, you also might ask your doctor to give you finasteride, with brand names such as Proscar. This drug has been shown on CT scans actually to shrink the prostate. But once you stop taking it, the prostate returns to its original size. For some this combination is a godsend.

Finally, there is surgery – all kinds of surgery, in fact, from lasers to stretching to more aggressive procedures such as the TURP, Transurethral Resection of the Prostate. These can all be very helpful, but I reserve invasive procedures for last.

My spin: Getting up six times a night is not healthy. Looking for ways to tame the prostate gland will give you a better night’s sleep – something we all want and need. Stay well.

Dr. Zorba Paster is a family physician, professor at University of Wisconsin School of Medicine and Public Health, and host of the public radio program “ZorbaPasteron Your Health,” which airs at noon Wednesdays on 91.1 FM, and noon Sundays on 91.9 FM. His column appears twice a month in The Spokesman-Review. He can be reached at askzorba@ doctorzorba.com.


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