Bonus Episode: Nocturia Nightmare? Dr. Mistry Answers Listener Questions About Frequent Nighttime Urination, High PSA

In this episode, Dr. Mistry and Donna Lee answer listener questions about frequent nighttime urination, or nocturia. If you get up to urinate more than once in the night, listen in to learn what may be causing your urgency/frequency. Dr. Mistry explains that nocturia may be caused by poor sleep quality, incomplete emptying of the bladder, overactive bladder, pelvic floor spasticity, and/or polyuria (making too much urine). He also answers a listener who asks how an elevated PSA could affect how often he urinates at night. No matter the cause, the amazing providers at NAU Urology Specialists use a holistic approach and state-of-the-art testing to diagnose and treat nocturia. If you or someone you love struggles with frequent or urgent nighttime urination, call us at 512-238-0762 or go online to schedule your consultation today!  

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.

Phone: (512) 238-0762

Email: Armormenshealth@gmail.com

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Transcript

Speaker 1: 0:00

<silence>

Speaker 2: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 3: 0:15

Hello and welcome to the Armor Men's Health Show. I'm Dr. Mystery , your host. Join as always by my co-host and producer, and wonderful friend Donna Lee.

Speaker 4: 0:24

Hey, I'm the producer. I think that's the first time you've said that ever. But thank you.

Speaker 3: 0:27

No, I've been saying it consistently for several weeks. You should probably listen to the show once

Speaker 4: 0:31

In a while . I should. Okay. Well, I heard you be nice to me, so I got confused with all the nice words.

Speaker 3: 0:35

This is a men's health show. It's brought to you by NAU Urology specialist. That is the group that I started in 2007. I'm a board certified urologist and expert in men's health, and someone who really cares about making sure that you get your urologic care. Uh, well done from the nipples to the knees.

Speaker 4: 0:50

That's right. Hey, I have something to promote. Let's do it . I forgot to tell you , uh, my friend Ruby Nicholas , who won the search for the Funniest Mom in America show that I was on, that I'm a finalist on or was a final song 105 years ago. Yeah . We're doing a show together here in Austin, so I'm gonna tell everybody about it, but we need to sponsor Dr. Mystery

Speaker 3: 1:08

<laugh>. Oh boy.

Speaker 4: 1:09

Getting

Speaker 3: 1:09

Hit up on the radio. I'm gonna hit you

Speaker 4: 1:11

Up for that. But yeah , it'll be , um, a really fun comedy show. So more to come. Well,

Speaker 3: 1:16

There , there better be a lot of vasectomy jokes. That's the only way

Speaker 4: 1:18

That there's always vasectomy jokes and penis jokes. There's gonna be a lot of hot moms in the audience.

Speaker 3: 1:23

<laugh>. Yeah. From, from 20 years ago, from

Speaker 4: 1:26

25 years ago. <laugh> , we were hot back then.

Speaker 3: 1:29

A lot of semi decent grandmothers. Now , <laugh> , this is a men's health show. We love to talk and tackle your men's health issues, but we would love to tackle them as a part of our practice as well. Uh, so NAU Urology specialists, we're available all over town. Donna, how do people get ahold of us and where are our offices?

Speaker 4: 1:44

If you want to join us and be seen as a patient or get a second opinion, call us at (512) 238-0762 And our website, you have it memorized by now, I hope. Armor men's health.com. You can send in your questions there. There's a little submit your question here, button at the top right . And we'll answer them anonymously. If you're in central Texas, we are located in Round Rock, north Austin, south Austin, and Drip and Springs, Texas, where they had a big eclipse party not too long ago .

Speaker 3: 2:09

Lovely. Do we have any questions for today?

Speaker 4: 2:11

We do. I think this is such a good question because I forget that we've been on this radio show for so long in the podcast that there are some really basic questions that new listeners probably need to ask. So this is a really good one. It's very short, but it's really, I think, impactful for a lot of people. Dr . Mystery , I'll go to the bathroom four to five times a night. How can you treat this? I'm 65.

Speaker 3: 2:33

It's a great question. And , um, this condition is called nocturia or nighttime urination. And I think that if you are suffering from getting up at night to pee mm-Hmm. <affirmative> , and your explanation from your doctor has been overly simplistic and you haven't found a solution, right. That just means that nobody's put a lot of thought into this.

Speaker 4: 2:51

Ah ,

Speaker 3: 2:52

So as you approach it, you know, I try to think of why would somebody get up at night to pee frequently? So this is how I approach patients. Yeah. So one thing is that they could be not sleeping well. So we ask them questions like, do you go right back to sleep after you go to the bathroom? Mm-Hmm. <affirmative> , do you have trouble falling asleep? Do you have a history of insomnia? Because if you are a light sleeper, quote unquote , and you're not sleeping well, then even the smallest urge will wake you up. Right ? And so we will address it through sleep melatonin. We work through this. We have a program where we help you de-stress before bedtime. And I know that sounds real, kind of sounds

Speaker 4: 3:25

Like sex.

Speaker 3: 3:26

It sounds real wishy-washy and kind of, you know, maybe, you know, non, non, non-medically to say she's asleep better. But a lot, sometimes people just don't realize that they're just not sleeping well. So if you have trouble going back to sleep after you get up to urinate mm-hmm, <affirmative> , then that could be a sleeping problem. And we would try sleeping aids and other kinds of things. The second reason is if you're not emptying your bladder enough, so if your tank, your bladder holds, let's say 10 ounces, but when you pee, you leave eight ounces in there. Mm-Hmm. <affirmative> , because you're not emptying either through an enlarged prostate or some other problem, then you would fill up the tank, you know, every time you fill up two ounces, and that's just two hours. So this , this particular listener's going to the bathroom four times a night, assuming an eight hour sleeping , uh, arrangement. That means he could be not emptying. So we discover that easily in the office. We put a little ultrasound probe right on your abdomen, and we see how much do you have left in your bladder after you pee? Oh . And if you have a lot, that means that we need to help you empty your bladder better. We do that with medications like Flomax and other similar type medications. Mm-Hmm. <affirmative> or we do surgery, which we love to do because I'm a surgeon. Mm-Hmm . <affirmative> . And , uh, and we help you empty your bladder better. So

Speaker 4: 4:31

That's two reasons . I have a question with the Flomax. How long are patients on Flomax when you prescribe it? Uh , is it months or years or forever?

Speaker 3: 4:38

It's forever. But the average time that somebody can stay on Flomax without needing, without leading to surgerys is about five years. Oh. And so at some point, the enlarged prostate problem worsens, and then you have to, you know, do something more aggressive. Mm-Hmm. <affirmative> . So if you're on Flomax right now and it's not working effectively, you may have just kind of run out of tickets Gotcha . Coins or whatever.

Speaker 4: 4:58

Are there any big side effects to those sorts of medications?

Speaker 3: 5:00

It can cause , uh, dizziness. When you stand, it can cause retrograde, which means there's less fluid that comes. Oh , excellent. Yeah. You love that one. Mm-Hmm. <affirmative> , it's the , it's the, the , the , the , the non wet spot drug.

Speaker 4: 5:12

I'm a busy lady, Dr . Mystery . I don't have time for all

Speaker 3: 5:15

That. And there's some evidence that if taken for the long term , it can cause some cognitive decline. So that's why a lot of our patients that come to us, we try to dissuade them from taking it long term and try to move them onto a surgical intervention. Just like if you had high blood pressure and I had a 30 minute surgery that could take care of your blood pressure, you'd be like, huh. A pill every day for the rest of my life that can cause all sorts of problems or Huh. A 30 minute surgery that can take care of this problem forever. Good point. And so that , that's the kind of options we try to give them. So now we get back to why people get up at night. So I describe two things, not sleeping well and not emptying your bladder. The third thing that that can happen is something called overactive bladder. That means the bladder gets the sensation that you have to urinate when it , you don't really have to. Meaning it gets the sensation with a very small amount of urine in there. Mm-Hmm. <affirmative> that, that symptom usually happens during the day. So those people generally have urgency and frequency during the day. And you'll notice that maybe the first time you get up to pee , uh, if you get up four times, you pee a lot, and then the rest of the time you pee very little. Mm . And we can frustrating, we can , we can , uh, discover that or evaluate that very easily. We give you a urinal here in the office. Mm-Hmm. <affirmative> . And you just record how much you pee every time. So if you pee 10 ounces the first time and then two ounces the next three times, then I know that you probably have overactive bladder. Mm-Hmm . <affirmative> . And in that case, we will , uh, treat you with overactive bladder medications like , um, uh, mitric or Gem. Tessa would be some, some, some titled names. Uh , oxybutynin is another name. And there's a variety of, of, of, you know , uh, things in that , uh, in that genre. Okay. So not sleeping well, not emptying your bladder and an overactive bladder. The next reason that you can get up a lot is you could have something called polyuria, where you make too much urine at night. Now, as animals, we've developed gene genetic , you know, in , in , in terms of phy physiologically. Mm-Hmm. <affirmative> . We have a hormone that gets released at night called antidiuretic hormone. And that hormone makes it so we don't make a lot of urine. And why would you do this ? Because if you're sleeping in a cave and there's saber tooth tigers outside, you don't want people to having to go outside every two hours to go pee. You'll get eaten <laugh> . So, so we've created a system in which, in which , uh, you , you can sleep during the night because your body actually physically does not make as much urine at night. Mm-Hmm . <affirmative> . And that's how it's designed. But there are things that can happen to us that cause that system not to work. And the most common one is obstructive sleep apnea. If you're kind of not sleep , if you're not oxygenating well at night, which is why we check it here in the office. Mm-Hmm. <affirmative> , if you're not oxygenating well at night, you won't release this hormone and you'll make too much urine. Mm . And that's why we fix the sleep apnea. Oh. And we have a drug that actually mimics that antidiuretic hormone called desmopressin. So how do we check that? Well, we give you the urinal and you check how much urine you make at night. And if you're making more than a liter of urine at night, then that probably means you have polyuria. Mm-Hmm . <affirmative> . And we treat you a little differently. Gotcha. Hmm . And then the secret one , uh oh , this is the secret one. Tell

Speaker 4: 8:02

Me.

Speaker 3: 8:03

So if you sleep in the couch, on the couch Mm-Hmm. <affirmative> or in a recliner, and you don't get up to pee, but when you're lying flat, you have to get up to pee. Oh. That's when we call it a pelvic floor issue. So if you have chronic hip, knee, ankle back problems, and if you sleep in a recliner and you can sleep through the night, but when you sleep flat in bed, you have to get up every couple hours. Yeah. That could be something to do with the muscles. The muscles and the nerves of the pelvis and the, and that, so we call that pelvic floor spasticity. And we see that a lot in pretty , in particularly thin people who pee a lot when they're, you know, because they , they probably don't have sleep apnea. They have other issues. And so now you don't get to that answer easy. Right. You have to, you have to rule out , you rule out the others . All the other ones Yeah. Before you start blaming the pelvic floor. And that's when, that's why we have our pelvic floor physical therapist here in the office.

Speaker 4: 8:52

So some people never get to that point though. That's why I think pelvic four , they just

Speaker 3: 8:56

Give

Speaker 4: 8:56

Up. Yeah. Like even maybe primary care doctors, they don't know to, if they're not sending to urology, they kind of give up before they get to that point.

Speaker 3: 9:03

And I would say 90% of urologists don't go through a , a good nocturia algorithm. Mm-Hmm . Because it takes some visits. Yeah. People get frustrated. You gotta try something. If it doesn't work, then you don't know if there's something else to be offered. And , and the fear that everything's gonna end up in surgery. Yeah. And there's some , sometimes there's a combination of things you don't sleep particularly well and you have a little bit of overactive bladder. So now, you know, in terms of goal setting , we usually set the goal of we'll let everybody get up one time. Mm-Hmm. <affirmative>. So if you're going to the bathroom one time at night and you're trying to get to zero, sometimes you're, you're kind of chasing, you're chasing a goal that might be a little too fleeting. Mm-Hmm . But if you're getting it more than once a night, then usually we can help you get to that point. Now, if you're taking your diuretic medication, <laugh> right before bedtime. Mm-Hmm. <affirmative> , I mean, that's, that don't, that means that means you're making too much urine. That's called the polyuria. Right. And then we can fix that by adjusting when you take your medication. So if you want a more like, you know, investigative thoughtful approach to your urinary issues, we would love to see you as a patient. Mm-Hmm. <affirmative> Donna, why don't tell people again how to get ahold of us and how to become our patient.

Speaker 4: 10:05

Do you know why I get up so many times? A nights to go potty

Speaker 3: 10:07

<laugh>? You have nine wieners that are pushing your

Speaker 4: 10:10

Leg all night . <laugh> four wiener dogs crawling all over me is a problem. You can call us at (512) 238-0762 to make your appointment. All

Speaker 3: 10:19

The wieners,

Speaker 4: 10:20

All the wieners are on me and love it. Or you can visit our website, arm men's health.com where you can submit your questions, we'll answer anonymously, just like this one. And remember, we're in Round Rock, north Austin, south Austin in Dripping Springs, and listen to our podcast wherever you pod. Thanks Dr. Mystery .

Speaker 3: 10:35

Hello and welcome back to the Armor Men's Health Show. I'm Dr . Mystery , your host, board certified urologist and founder of NAU Urology Specialists right here in central Texas. For those of you listening onto the podcast, you'll know our wonderful co-host, our podcast aficionado Donnel Lee . That's

Speaker 4: 10:53

Me. Welcome to the show everybody. Donna Podcast Lee .

Speaker 3: 10:56

So Donna is our , uh, business development manager. She used to service as the practice administrator and , uh, we stole her from , uh, a , a local , uh, primary care group. <laugh> , uh, who we still love very much. I sure do . And , uh, we're very fortunate to have her as part of our team. It's been how many years now?

Speaker 4: 11:12

Seven years over? Seven years.

Speaker 3: 11:14

Seven years. If you ever lose count, you can just look at your lapel because you get That's right . A a little sperm pin for every year you spend with us. That's

Speaker 4: 11:21

Right. What do we say it feels like 10 minutes

Speaker 3: 11:23

Underwater. <laugh> . So this is a men's health show. We'd love to talk about your urologic issues, but we also have a number of guests that come on to talk about other types of issues. We even have guests that come on and talk about women's issues. That's our, that's what she said. Segments. Mm-Hmm. <affirmative>. Uh , and we would , uh, invite you to listen to all of our podcast episodes and search for things. Uh , we even have somebody that's gonna put an AI chat bot to try to make sure that you could search for what you wanted. But I know that's a project we're still waiting for.

Speaker 4: 11:52

That is a big project, though. It sounds very intense. <laugh> . Um , speaking of that's what she said. Uh , I respond to all of our Google reviews and we have amazing Google reviews, but sometimes we get that really obvious one that says something like, fast, efficient, no hassle. And you know what? I have to respond with what? That's what she said. That's funny. And I put it on the Google Review response. So nobody's ever said anything, but I'm waiting for that day on Reddit when I see my responses are funny and that check out this urology office. And they're funny responses to Google reviews.

Speaker 3: 12:21

So if you wanna , uh, enhance , uh, Donna's ego, please get on Reddit. <laugh> , uh, Donna, how do people become our patient? Well,

Speaker 4: 12:27

I can't even spell Reddit, so don't do that. But you can become our patient by calling us at 5 1 2 2 3 8 0 7 6 2. Visit our website, armor men's health.com. And remember, we're in Round Rock, north Austin, south Austin and Dripping Springs. And we have another peepee question. Well,

Speaker 3: 12:41

That's excellent. Go for it.

Speaker 4: 12:42

So, kind of piggybacking what we talked about in the first one with the first question, this particular question is Dr. Mystery . For a few years now, I've been noticing an increased urgency in needing to urinate. It was becoming so much of a problem. I at times only had less than a minute to find somewhere to go. I had a digital exam and the doctor said everything was okay. I then had a PSA test that said, I have a 4.8 and I am 54 years old. An MRI confirmed that one side of the prostate, there's a shadow. The following biopsy suggested that samples were taken , taken, were not cancerous. There's a history of enlarged prostate and prostate cancer. In my proceeding two generations, I have some cysts and normal vascularity, I do have nocturia. This really long question goes on and on within , at the end, he says, additionally since um, he had a biopsy, he's lost the urgency to urinate. He can now sometimes go for the whole day, but he's wondering if this is something that you've seen before. I'll assume the answer is yes. He said he was provided Tamsin, but it did not agree with him.

Speaker 3: 13:40

Well, that's great. So there's a lot to unpack in this particular question. Mm-Hmm, <affirmative> . So let's start with the, the prostate cancer risk. So the patient is young. Mm-Hmm. <affirmative> . He has a PSA level that I would consider high for his age at 54, I have a cutoff of the PSA about two to two and a half . That's not consistent amongst all urologists and even not amongst the urologists in this office. Mm-Hmm. <affirmative> . So we try to assess your risk and whether or not you're worried about it. Then if he had an MRI that showed an abnormality, the question I would ask this, this listener is did he have an MRI guided biopsy or not? Because even though it may seem reasonable in your head that you have an MR MRI and then you had a biopsy that somebody would use the technology to fuse those two. But the truth is, even in this city, a big city like we have, not all urologists have access to it. And the biggest group in town in fact charges you an extra $800 to get that MR mri . Right . So if, if you go to the big group in town and you didn't pay 800 bucks, then you did not have an MRI guided biopsy. Oh my. Now in our practice, we don't charge extra because that seems like just price gouging somebody that's looking for, you know, better diagnostic information. Mm-Hmm. <affirmative> . And as a doctor, I would like to have better information. So, Mm-Hmm. <affirmative> . Uh , so it works out best for me to do.

Speaker 4: 14:54

And we're terrible at making money

Speaker 3: 14:56

And we're terrible at making That's , that's why you're the business development.

Speaker 4: 14:58

That's why I'm in charge of that <laugh>

Speaker 3: 15:00

<laugh> . Now she drives a nice car. <laugh> <laugh> . I could use a better one. Uh , oh my . So , so , so now you have this MRI guided biopsy that needs to be performed. And so that's the one thing I would say to the listener is important. Mm-Hmm. <affirmative> . The next question is the Tamsin not agreeing with him. So he has urinary issues. He took Tamsulosin

Speaker 4: 15:21

And what do you think that means? And so

Speaker 3: 15:22

Upsets his tummy. It , it, usually, when you can't tolerate it usually means dizziness. Oh. So, so na nasal stuffiness, dizziness when you stand up at , but the retrograde in a young guy is usually what keeps them from taking it. Mm . And because some guys, it sounds great to you, it does no mess. Yeah . Retrograde. But other guys, they actually feel like their orgasm is not as intense. And that, that's bothersome.

Speaker 4: 15:46

Is that a thing or is that psychological?

Speaker 3: 15:48

I think it's a real thing. Yeah. Because , uh, there's another drug on the market called rapa flow or Ciid doin , and a lot of those guys complained about hypo orgasmic. Oh. And so that's why we don't use it as our go-to if you're sexually active in our clinic. Oh. Because it's not just not as much fluid coming out, but it's also like the orgasm's not as good. Yeah.

Speaker 4: 16:07

So that makes sense.

Speaker 3: 16:08

Yeah. Who wants to have the show if there's no finale? You know , me,

Speaker 4: 16:13

<laugh>, and so this lady right here.

Speaker 3: 16:16

So , so then you have this apparent change in the urgency with the biopsy, which is not common. Oh. So most people, if you do , if you mess with the prostate by sticking a bunch of needles in it, they tell me their urinary symptoms are worse, not better. Oh. But there is a unique scenario, and that is this, if you have a condition called pelvic floor spasticity where the muscles of your pelvis are too overly reactive to external stimuli, okay. That could cause you to have urgency and frequency. We see it all the time. Right. And in fact, the young guys, the ones in their fifties, the ones that come in and say that I've been having these urgency symptoms for 10 years, pelvic floor spasticity is very common. So I would ask this listener, do you have lower back knee, hip ankle issues? Do you have a pain in your testicles? Do you have problems pooping? Because all of these are associated Mm-Hmm . <affirmative> with pelvic floor spasticity and how you fix it, how we fix it in our office, how pelvic floor physical therapists fix it. They stick things in the rectum. Oh. Like a large probe that would be used for a biopsy, for example. And that causes the muscle to relax. It's , it's called an internal pelvic massage. That's

Speaker 4: 17:25

Why we have such a long line some days for guys ,

Speaker 3: 17:27

We do have a long

Speaker 4: 17:28

Line

Speaker 3: 17:28

<laugh> . I just need three minutes. <laugh> , I don't wanna take up a lot of your time. So when I was in training, and this, this exact scenario really , uh, is, is is why we have pelvic floor physical therapy in our office. Mm-Hmm. <affirmative> , there was a patient that would drive every month to Baylor College of Medicine from Beaumont. Oh . An hour drive, Uhhuh <affirmative> sit in line, you know, have to park at the medical center just so we could do a prostate exam on him. Mm . Because he was having so much pelvic pain. Sure. Do you know , you know the kicker,

Speaker 4: 18:01

He didn't have any pelvic pain. He

Speaker 3: 18:02

Didn't have a prostate. Oh ,

Speaker 4: 18:04

<laugh> . What?

Speaker 3: 18:05

We already took out his prostate and his bladder.

Speaker 4: 18:07

Oh.

Speaker 3: 18:08

So that what, and the people around me that I trained with kind of found this whole scenario to be kind of, you know, humorous that this guy was coming for a prostate exam, didn't have a prostate. Okay. But it led me to think, well what else are we doing in there? Then why would he, why would he commit to coming all the way so that I could do something? So that means we were doing something, we were relaxing his pelvic floor by doing a prostate exam or you know, a rectal exam. And a lot of our patients in fact get a lot of relief with their urgency from a pelvic massage. So I would tell this listener, you know, if you were really to think about your urgency and frequency and the tamp slows and didn't help, then let us kind of put you in a formal program where you actually fix those things that help and you'll feel the urgency come back. It is not healthy to go all day without peeing. Mm-Hmm. <affirmative> . But maybe other things changed maybe because you were going to the bathroom so many times you stopped hydrating as much. You know, maybe , yeah . Maybe there are other things that occurred or maybe you're going to the bathroom a normal amount now, but it's because you were going so frequently before that this seems abnormal to you.

Speaker 4: 19:07

I have a question. Yeah. The guy that was coming with the no prostate and he was getting relief from the prostate exam for the prostate that wasn't there, how long does that relief last? Like was it just for the day and he kept only came once a month? Or

Speaker 3: 19:20

I guess it lasted him a month or less month . They just wouldn't see it more cut regularly. Oh . So the standard pelvic floor physical therapy kind of appointment would be anywhere between six to 12 visits weekly. Right. But then you get a long term of relief. Yeah. So just like getting that knot outta your shoulder and going to the masseuse. Mm . Okay . Three or sense or four weeks in a row. Mm-Hmm. <affirmative> . And then that shoulder pain goes away in the same way by doing a proper pelvic floor therapy program. Now let's say that the reason that your shoulder hurts and you have a , a nod in there is because your posture's bad. I see . But if , if you keep the same posture, you're gonna have the same recurrent problem. Right . So what we try to do through our therapeutic program is to fix that which is causing the pelvic floor spasticity in the first place . Mm-Hmm. <affirmative> , I'm not saying that's what this listener has, but that would be a reason why a biopsy would lead to an improvement in urgency in a young man, in my opinion. Mm-Hmm. <affirmative> . And again , to that listener, make sure that you had the appropriate MRI guided biopsy because although prostate cancer does not usually cause urgency and frequency, it would be silly to miss something just because somebody didn't do the right biopsy. And making sure that you have follow up PSAs and MRIs is really important. Right . And we would love to see that listener as a patient to make sure all the t's were crossed and the i's were dotted. Donna, how do people become our patient ? I thought

Speaker 4: 20:34

You were gonna say all the T was spilled, but you are being more proper.

Speaker 3: 20:37

All the tea bags were given. Oh, you better

Speaker 4: 20:40

Now. Is that like tossing a salad? Okay , continue. Anyway, our phone number is (512) 238-0762 . And our website, you know, is armor men's health.com. Remember you can see us in central Texas, round Rock, north Austin, south Austin, dripping Springs, Texas. And please listen to our podcast wherever you pod and send them to your friends. And thanks Dr. Miss Tree .

Speaker 2: 20:59

The Armor Men's Health Show is brought to you by NAU Urology specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.