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Interviewer: It never used to happen but now you have to get up and go to the bathroom once or maybe even more times every night. Dr. Gary Faerber is a urologist. What could be going on with that? Could it be one thing or is it a lot of things?
Dr. Faerber: Well, it could be a number of things. Probably the most common along these lines comes from older men who can . . . you know, who are worried that these might be the signs of prostate cancer. That's the most sinister, you know, thing that they can think about.
Interviewer: So we're talking older, how old, 50?
Dr. Faerber: Oh, yeah, men in their 50's, 60's, 70's, yeah.
Interviewer: So like up until this point, they could sleep through the night and not need to go to the bathroom and all of a sudden now . . .
Dr. Faerber: Right.
Interviewer: Does it just kind of happen all of a sudden or is it just kind of over time like . . .
Dr. Faerber: Oftentimes, it's a gradual thing, you know. Initially, they may get up once a night and then it's two times and three times and . . .
Interviewer: So if that starts happening, then there could be something going on?
Dr. Faerber: Absolutely, yeah.
Interviewer: Could it just be that they've started drinking water late at night?
Dr. Faerber: That's . . .
Interviewer: Is that the first thing you look at?
Dr. Faerber: Sure. We certainly do keep track of how much fluid they take and when they take it in just to get a sense of whether this is a normal thing just because the amount of fluids that they drink, or is this, you know, not quite so normal.
Interviewer: All right. So if it turns out to be not quite so normal, let's talk about what some of the possibilities could be.
Dr. Faerber: It's probably related to their prostate. And it's not because they have prostate cancer but in most cases, it's because they have benign or normal enlargement of the prostate gland. And when that happens, it causes some changes in how the bladder functions. And they may not be emptying all the way. The bladder may become a little bit more overactive and therefore, they can't hold the urine as much as they used to when they were younger. And all of those reasons may result in them having to get up at night.
Interviewer: So an enlarging prostate's just part of life. As you age, it's going to happen, if I understand correctly.
Dr. Faerber: Yes.
Interviewer: So nothing to be concerned about really?
Dr. Faerber: That is exactly right. If you're 80 years old, 100% of you men will have benign enlargement of the prostate. So it is a normal aging process.
Interviewer: All right. So that's kind of the most common thing. What do you for that then?
Dr. Faerber: It depends on how bad it is. For example, if it's not too bad, you can do some behavioral changes. For example, just don't have that big glass of water before you go to bed or don't have a lot to drink in the evening. And to be honest with you, most men try that initially. You know, they experiment a little bit and they said, "Yes, I've done that."
Interviewer: Yeah, by the time they get to you, right?
Dr. Faerber: Right, exactly. And then, I'll do an exam on a gentleman and see how big his prostate gland is. And then, we then also look to see how well he empties. So we'll have a gentleman void and then we can do an ultrasound of the bladder to see how much urine is left in because we want to see whether or not they're emptying all the way or whether they're just sort of emptying a little bit but most of the urine is left in the bladder. And if that's the case, then you can understand that it doesn't take very long for the bladder to refill and then they feel the urge that they have to go again and . . .
Interviewer: All right. And that is caused by the . . . not emptying all the way is caused by the enlarged prostate?
Dr. Faerber: That's exactly right.
Interviewer: So if they're not emptying all the way, is there anything you can do?
Dr. Faerber: I tell men that enlarging prostate is sort of like, you're sort of pinching off a garden hose where the prostate, as it enlarges, it narrows the channel where the urine comes out of the bladder. And there are different ways of managing that and there are different types of medications that are available nowadays.
Interviewer: Do some men choose to do nothing and just continue to get up at night?
Dr. Faerber: Yes.
Interviewer: And that's completely acceptable as well?
Dr. Faerber: Yes. You know, if we find that they're actually emptying their bladder, then that's perfectly fine. And I would assume there are a lot of men out there who are very comfortable at getting up once or twice a night, and it's really not affecting them physically or emotionally or socially.
Interviewer: So that need to get up and go to the bathroom once or more each night could be an enlarged prostate. What are some of the other things? Let's not go too in-depth but I just kind of want to do a quick of what else it could be.
Dr. Faerber: Right. We do know that as we all get older, and this has to do with not only with men, but with women too, is that the bladder becomes overactive. We all know, myself included, that when I was 18 years old, I didn't have to pay attention to my bladder when my bladder told me it was full.
Interviewer: Right. Twelve-hour road trip, 8 hours in, you could still go another 4 hours, yeah.
Dr. Faerber: Right. It was no big deal. And I was always that, you know, chuckling at my mom and dad who had to make these more frequent bathroom breaks.
Interviewer: You chuckle no more.
Dr. Faerber: Right. Exactly. I do not chuckle anymore. I understand completely. So as we get older, our functional bladder capacity goes down. And that's a normal aging process. There are some medications which can help with some of those patients where it's really a problem. But in most cases, we don't need to really do anything about it. Oftentimes, if I can just reassure patients that, "If it's not bothering you, it's not bothering me so we don't need to do anything about that." So normal aging process is one.
Two is could there be something within the bladder which makes the bladder more irritable, for example, bladder tumor or a bladder stone or something else like that, that may need to be checked. Oftentimes, if that's the case, it's associated not just with having to get up at night but there may be blood in the urine or they may have frequent urinary tract infections, or something else like that which would tell us that there may be something more going on than just an overactive bladder.
Interviewer: Yeah. And of course, if the bladder symptoms accompany any other symptoms like you said, that's when, probably . . .
Dr. Faerber: . . . you really need to get concerned. Yes, absolutely.
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updated: May 1, 2019
originally published: April 12, 2017
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