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Does Flomax help nighttime urination?

Is Flomax the problem? Nocturia, or frequent nighttime urination, is a common problem for men. It is one of the lower urinary tract symptoms attributed to benign prostatic enlargement. Flomax, the medication you were prescribed, is designed to improve lower urinary tract symptoms caused by prostatic enlargement.

everydayhealth.com - Treating Urinary Incontinence Effectively - Everyday Health

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Q1. From the time I lie down to sleep, I have to urinate every five minutes for about an hour. When I finally get to sleep, I still wake up to go every hour or two. During the day I have to urinate maybe three times. I don't drink much, especially closer to bedtime. This has been going on for about five years and has been getting worse instead of better. Any suggestions?

— Dalya, South Carolina

You have what is called nocturia, or the need to urinate at night, which typically occurs in the first hour after a person lies down to sleep and then continues progressively throughout the night. Nocturia may result from changes in the way the body handles fluid. For example, people who experience ankle swelling or significant amounts of peripheral edema (swelling in the legs) may find that on lying down at night, they reabsorb some of that fluid into their blood vessels, thus increasing their need to urinate. There are other causes of nocturia as well, including disruption of the normal hormone-release cycle, bladder outlet obstruction, and an overactive bladder. The evaluation of severe lower urinary tract symptoms requires a detailed medical history and a physical examination to check for organ prolapse and urethral abnormalities, as well as a urinalysis. In the absence of any severe underlying abnormalities, some nocturia may respond to antispasm medication, which can reduce the urgency to urinate. Of course, any medical treatment must be preceded by a careful evaluation by a physician.

Q2. I have been taking Flomax for several weeks but my problem with excessive night time urination has increased. I thought Flomax was supposed to decrease this problem! Now, I have to get up five or six times a night when it used to be about three. Is Flomax the problem?

Nocturia, or frequent nighttime urination, is a common problem for men. It is one of the lower urinary tract symptoms attributed to benign prostatic enlargement. Flomax, the medication you were prescribed, is designed to improve lower urinary tract symptoms caused by prostatic enlargement. The medicine works by relaxing the tone of the muscle at the bladder neck and prostate. Usually symptom improvements occur within the first few weeks of therapy. The fact that your nocturia seems to be worsening may indicate that the symptoms are being caused by something other than a prostatic enlargement. Nocturia may also caused by excessive nighttime fluid intake, redistribution of fluid from the body spaces into the vascular space thus increasing nighttime urine output, or the loss of nighttime internal hormone release that normally suppresses nighttime urine output. Most men with lower urinary tract symptoms due to benign prostatic enlargement are treated empirically, without extensive testing. However, when symptoms worsen or do not respond appropriately to medication, other tests may be indicated. Of course lower urinary tract symptoms can come from a variety of sources, including urinary tract infection, bladder stones, malignant and pre-malignant masses in the bladder, as well as neurological causes. Furthermore, the total symptom picture, including daytime frequency, force of urinary stream, urinary retention, and other features need to be considered. I suggest that you be evaluated, or reevaluated, by a urologist in order to differentiate benign prostatic enlargement from other causes of lower urinary tract symptoms.

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Q3. I've heard that a stretched out bladder opening can be corrected with silicone injections. My bladder has been stretched from being overweight and childbearing and has lead to urinary incontinence. Would this work for me?

— Nancy, New York

It depends what your bladder problem really is. Urinary incontinence is a common problem among women, and childbearing and being overweight can certainly add to your risk. There are a number of approaches used to treat so-called "stress urinary incontinence" (SUI), and in your case, the association of SUI with pelvic organ prolapse (or as you put it, a stretched out bladder opening) needs to be identified before the right treatment is chosen. Injection procedures may indeed be effective for the treatment of your incontinence. These injections are made right underneath the mucosal lining of the urethra to bulk up the urethral tube and help treat urinary incontinence due to coughing, sneezing, and the like. The most established injection treatment used for this purpose is collagen. Some of the other injectable substances that are sometimes considered for urinary incontinence include silicone particles, calcium hydroxylapatite, ethylene vinyl alcohol, and carbon spheres. These all tend to provide moderate improvement for incontinence symptoms, equivalent to collagen injections, though the data to support these alternative therapies is limited. If your bladder opening has been damaged more significantly, or you have a lot of hypermobility of your urethra (it is excessively stretched), such injection procedures may not be particularly effective. In these cases, surgical procedures such as urethral slings, which act as a hammock and compress and suspend the bladder neck and urethra, may be more effective than injection therapy. Seeking care from a urologist or urogynecologist with expertise in stress urinary incontinence would be the best place to start.

Q4. What can I use to ease the irritation caused by wearing incontinence pads all the time? I have tried several different things to no avail. I know I have to keep as dry as possible, but how do I go about this?

Beverly, you are not alone in dealing with this issue. Urinary incontinence is a significant health problem in the United States and billions of dollars are spent each year on the condition. As you're experiencing, urinary incontinence can cause skin irritation, redness, and even breakdown of the skin, leading to ulceration. There are a couple of approaches that may help your problem. The first step is to make sure you're being evaluated by a physician who is an expert at treating incontinence. Many types of incontinence can be improved and corrected with an appropriate evaluation and through medical or surgical treatment to decrease leakage. It is also important that you be checked for an ongoing infection, either bacterial or fungal. Infections can cause increased leakage and exacerbation of irritation and should be treated with the appropriate topical antibiotic or antifungal cream. Second, if you haven't already, you can try changing pads more frequently. Of course, frequent pad changes can be expensive, but will help keep the skin drier. The more that the pad can wick the urine away from the skin — maintaining a dry interface — the better. Third, in the absence of obvious infection, a skin barrier cream can be very helpful. Desitin is a commonly used barrier cream that can be very helpful for such minor irritations.

Learn more in the Everyday Health Incontinence and Overactive Bladder Center.

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everydayhealth.com - Treating Urinary Incontinence Effectively - Everyday Health

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