One possibility is that you don't empty your bladder efficiently.
Around - ahem - middle age, men's bladder sphincters (the muscle that
keeps the bladder from emptying) get tighter, some men more than others.
This is thought of as a prostate problem, but even though the sphincter
muscle is in the prostatic part of the urethra (which empties urine) it
is not the prostate per se. The sphincter closes as the bladder
pressure drops and before it has completely emptied, leaving residual
urine inside and making it that much sooner till the urge comes again.
The prostate can be completely normal and one can still have the
problem.
As common as it is, if someone presents to me with your symptoms and has
a normal exam, I would try a course of treatment to see if it improves.
We usually use a medication called an alpha blocker. The alpha
adrenergic receptors in the sphincter are influenced by adrenaline;
blocking them allows better relaxation of the sphincter and complete
emptying of the bladder.
Two early versions, Hytrin and Cardura, are also blood pressure
medications. A newer one, Flomax, does not affect blood pressure. You
could ask your doctor about that.
To be certain of the diagnosis would take a cystoscopy (look into the
bladder) by a urologist and perhaps urinary cystometrics where the
bladder pressures are measured. But a trial of treatment is reasonable.
Decongestants can make the problem worse so avoid them.
You could also have bladder spasms. Certain foods, such as, beer,
pepper, nuts, citrus, tomato can make the bladder try to contract. A
trial of avoiding these may improve symptoms. If not helpful, your
doctor might want to try Ditropan or Detrol. These have the side effect
of dry mouth, so before doing it, I would suggest a urology evaluation
since committing to these has implications on your singing.
John
John Messmer, M.D.
Assistant Professor, Family and Community Medicine
Penn State Hershey Medical Center
-----Original Message-----
...since I started again in May, I find that I have to be up as much as
four or five times in the night to urinate. I am "suddenly
middle-aged" at 48 and have just had blood tests for diabetes as well as
the um, "basic" examination for prostate problems, all testing negative,
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