HJAR Nov/Dec 2019

48 NOV / DEC 2019 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN UROLOGY Few specialties are more closely associ- ated with getting older than urology, and yet, urologists are continually fighting the myth that our causes for concern are merely a nor- mal part of getting older. For instance, while many older Americans awake and visit the bathroom more than once a night, such fre- quency very often is not a normal outgrowth of advanced age. Nocturia, or urination at night, is not abnormal in every case, but it becomes increasingly worthy of a urologi- cal examination as the average number of visits each night climbs to two, three, or more. We often hear the question, “Is this nor- mal?” Patients who care enough about their well-being to stop in and ask are winning half the battle. We are delighted to probe both parts of the question—What is this, and what is normal? The example above, nocturia, can be mild, and indeed a function of advancing age, auguring a review of easy therapies such as limiting fluids two to four hours before sleep, and restricting any diuretics (even caf- feine) to the hours before dinner. But, it is not nocturia if a person uses the loo more than eight times a day, and once at night (except- ing pregnancy or consuming an inordinate volume of liquids). Overactive Bladder What is called polyuria is indicated either by frequent urination or an urgent sensa- tion to urinate that manifests suddenly. The bladder has been described as an unreliable witness by no less than the National Insti- tutes of Health. Why? Nerves in the bladder and upper urinary tract proceed along both parasympathetic and sympathetic pathways, and symptoms or alerts may be sounded by wholly different pathologies. Today, we have simple noninvasive therapies like resched- uling or limiting diuretics, alcohol, and caf- feine intake, as well as advanced ones, such as nerve therapy, that stimulate the nerves controlling bladder function with electrical pulses. There is even an implantable pace- maker for bladder control. Poor Bladder Control Is it normal to “pee your pants a little?”No, and yes. This is a terribly embarrassing thing for any adult to admit, and terribly common. It is a problem that affects roughly two wom- en for every man, and a large number of all Americans suffer from occasional leaking when coughing or sneezing, or having such a sudden urge to urinate that it overwhelms control. The treatments vary, of course, but Is This When it comes to bumps, burning, wetting, and other discomfiting developments, normal is not the same as okay, and this doesn’t have to be the new normal. NORMAL?

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