Nocturia, take three – to pee or not to pee

At three in the morning, I had a sudden insight that I think may be more than a little useful to old guys like myself…and to the GPs, internists and urologists who treat them.

When dawn broke, I emailed the insight to members of the Auckland old-guys group I’ve been in for years. I also sent it to a few old-guy doctors in the US, Australia and New Zealand. Those New Zealand sends felt awkward; though we’d maintained contact over the years, the last time I’d seen them was when they were my fresh-faced young students at Otago Medical School. Now they were at the point of retiring.

Here’s what I wrote to all of them: “Gentlemen, if you dislike reading about my urination half as much as I hate writing about it, read no further. But if nocturia, aka peeing a lot at night, is a subject of more than academic interest, you might read on.

“I’m 81. For the past 10 years, I’ve been concerned with peeing a lot at night. Ordinarily, twice a night is my routine, and I’ve come to accept that as something old guys do. But every so often, the number of trips to the loo jumps: six, eight, maybe 10. Annoying and concerning.

“However, every doc I’ve consulted (and that includes urologists and internists) says the same thing: ‘Take Flomax or live with it.’ Since the side effects of Flomax include flu symp­toms, dizziness, backache, tooth prob­lems and weakness, plus the delightful-sounding retrograde ejaculation, I’m choosing to live with it. Which is what I do.

“But I’ve come up with something that actually helps. I call it ‘Nocturia, take three’. The heart of the problem lies in either a bladder that doesn’t completely empty or refills too fast, or maybe just needs a few minutes to relax. Since I’m not a medical doctor of any kind, much less a urologist, I don’t know which. To me, it doesn’t much matter; I just want to go back to bed and stay there for more than 10 short minutes.

“I’ve found a solution. Here’s how it goes. My bladder wakes me. I get up and pee. But instead of returning to bed, I futz around for about three minutes; in my case, that usually means checking emails. Then I pee again. Then, back to bed for several hours, not minutes, of blissful sleep.

“If you’ve read this far, I’d very much like your thoughts. Should I publish my solution, I will not use your name, I promise.”

Several of my old-guy friends and old-guy physician friends did send me thoughts. One urged limiting my liquid intake. One suggested Proscar and/or low-dose Cialis. Start meditation. Stop coffee. Confitex.

But not one said they knew of my “take three” solution. And no doctor I’d consulted about nocturia in Vermont, San Francisco or New Zealand had suggested I try it.

But now I have. Here’s my report on this n-of-1 clinical trial.

Every night for nearly a year now, I’ve followed my night-time urination with a few minutes at the computer, then gone back to the bathroom and peed again. Then, returned to bed and sleep. The results are as follows:

• I have not had to urinate more than twice on any night.
• Not once has my bladder urgently reawakened me a few minutes after returning to bed.
• I’ve slept appreciably better and consistently longer than before my three-in-the-morning insight.

Halfway through this trial, it occurred to me to try my “take three” solution before bedtime as well.

Since then, on several nights, I’ve got up once, not twice. In fact, after adding my pre-bed double pee, once has become the norm. I haven’t been this nocturia-free for over a decade.

Because my system requires neither pills nor potions, devices nor surgery, has no potentially harmful side effects and costs zero dollars, you might suggest it to your patients or even try it for yourself.

My n-of-1 trial may grow into something bigger. And a good night’s sleep will improve the lives of other old guys.

These are the most-raised questions I’ve received:

• Does “take three” have to be three minutes?

No. Three minutes is the minimum time. The maximum is up to you.

• What if I get an exciting email that will keep me awake?

Don’t read it until morning. If you need something excruciatingly boring, edit your contact list. I’m up to R.

• But won’t staying up for three minutes or more in the middle of the night keep me from getting back to sleep?

Not nearly as much as the frustration of getting up to pee five minutes after coming back to bed…after getting up to pee.

Jules Older, PhD, has worked in both the US and New Zealand, has previously designed a behavioural science course, taught medical students about human behaviour, and teaches aspiring writers. His website is www.julesolder.com