Wednesday, May 24, 2006

Nighttime Urination?

Nighttime Urination?
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Q: What can a man do about frequent urination at night? Is this a sign of a serious health problem? -- Bobby H.

A: As men approach their forties, it isn't unusual to get up once or twice to urinate. After the age of 50, most men develop some degree of benign prostatic hypertrophy (BPH), or enlargement of the prostate, which obstructs outflow of urine from the bladder and can cause increased nighttime urination. Other symptoms of BPH include difficulty initiating urination, weaker flow, increased frequency and dribbling at the end of urination. BPH stems from the long-term effects of testosterone on the prostate, a walnut-sized gland that secretes lubricants to condition the lining of the urethra and optimize the environment for sperm.

BPH requires treatment only if symptoms are bothersome. Drugs called alpha blockers may be prescribed to relax the smooth muscle tissue in the prostate. Another drug, finasteride (Proscar), can shrink the enlarged prostate by blocking an enzyme needed to change testosterone to another hormone that prompts prostate growth. However, finasteride works for only about 30 percent of patients; worse, it can cause impotence, less desire for sex, and even breast enlargement or tenderness in men.

Sometimes, surgery is recommended to relieve BPH symptoms by removing part of the prostate. I think this is a terrible idea. It's unnecessary, crude surgery that almost always damages sexual function.

Fortunately, there are some excellent alternatives:
  • Avoid prostatic irritants such as alcohol, caffeine, tobacco and spicy foods.
  • Eat plenty of soy foods, which may block some of the effect of testosterone on the prostate.
  • Take saw palmetto (Serenoa repens), which can protect the prostate from excess testosterone and shrink the gland. Take 160 mg of a standardized extract twice a day; this should reduce the size of the gland in about four to six weeks. Some formulas combine saw palmetto with Pygeum africanum, another prostate protectant, made from the powdered bark of a tall evergreen tree. I also recommend taking 30 mg of zinc picolinate every day.
  • In younger men, drinking alcohol or consuming too much caffeine (especially coffee) can cause nighttime urination. Frequent urination among men in their twenties and thirties can also be due to a prostate infection (prostatitis). Antibiotics can help but are less effective if the infection becomes chronic.

I advise patients to drink lots of water, and take 60 mg of zinc picolinate once a day until the symptoms improve, then halve the dose and continue on it. Other measures include keeping clear of the prostate irritants listed above as well as avoiding dehydration and prolonged sitting or bouncing (as on a horse, bicycle or motorcycle).
Andrew Weil, MD

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