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and so the classic for that is beer because it's a higher volume high volume intake so yeah so we have natural dial release of anti-diuretic hormone and that dial variation is attenuated kind of per decade as we get older so that peak of anti-d hormone goes down per decade and that can then kind of normalize your 24-hour urine production
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there's a naturally secreted hormone anti-diuretic hormone and it in younger Decades of life it has a a surge of release around 7 or 8:00 at night anti diuretic hormone prevents you from diuresing or producing more fluid
there's a there's a naturally secreted hormone anti-diuretic hormone and it in younger Decades of life it has a a surge of release around 7 or 8:00 at night anti- diuretic hormone prevents you from diuresing or producing more fluid
so the classic one for that is beer because it's a higher volume high volume intake so yeah so we have natural dial release of anti-diuretic hormone and that dial variation is attenuated kind of per decade as we get older so that peak of anti-d hormone goes down per decade and that can then kind of normalize your 24-hour urine production whereas when you're in your 20s or 30s you would produce let's just say 80 or 90% of your urine during waking hours during the night time when you have high levels of anti-diuretic hormone you're not going to produce as much urine and your kidneys and your body will save that extra fluid for the morning when you get up
yes in uh and yeah in in anti-diuretic hormone as we age and then there are other factors that are also similarly consistent among aging individuals male or female like the resiliency of the tight junctions in your capillaries and of your vascular system right so it's you know less resilient and less tight as we get older right so you have even if it's subtle and not fully appreciable you have some capillary leak and as you lie down when you're sleeping at night you know that fluid will leave the extracellular space ENT the intervascular space and your kidneys will read that yep as increased fluid so you know I'm a I have a very focused Urology practice but when I have people with urinary symptoms I try to do a a really full body assessment because one of the main drivers of uh nighttime urinary frequency one of them at that particularly tracks with age is you know just peripheral edema so are you are you developing edema and so forth so meaning people who have a lot of peripheral edema at the in nighttime you get uh basically revers some of the third spacing and it's almost like they have an IV drip that's taking fluid from their interstitial space into their vascular space it's like they're drinking at night yeah so one of my behavioral modifications it's not really behavioral but non-medical modifications is you know knee high Ted stockings for people who are having symptoms who if I see them at 8 or 9 or 10 o'clock in the morning they had any edema any kind of ringing around their socks or something like that then I definitely strongly encourage them to to to do that because it it you know I tell people if you're getting up twice a night and you have a little bit of Edema you do some behavioral modifications we can reduce your nocturnal urinary frequency by kind of one so you can go from two times at night to one time at night just by changing when you drink and wearing Ted stockings and that's a it's a maybe not true for everybody but it certainly encourages people to do simple things without doing the poly Pharmacy the other thing that um is a main issue related to nocturnal urinary frequency is sleep apnea and I'm sure you've talked a lot about sleep apnea on a variety of your different uh your shows it is driver of a lot of just bad pathology and one of them is nocturnal urinary frequency and and we'll talk about it later but in the post prostatectomy space it can actually result in profound nighttime urinary incontinence but it will produce uh really symptomatic profound uh nocturnal urinary urine production and nocturnal urinary frequency in individuals why is that it's I think it's also related to the the regulation of your anti diuretic hormones and um really there's profound you know whole body side effects from it so you know in many ways if there's a there's a subset of men who um this is a good way to encourage them to get their sleep apnea a diagnosed and then treated okay so so that's so that's behavioral yeah so then let's talk about the pharmacologic tools so you've already kind of alluded to one and it's one that we use in our practice um which is when we have a guy who otherwise we don't have a clear explanation for why he's getting up to PE um and he doesn't appear to have a particularly enlarged prostate and we can we're going to talk about of course all those things a very low dose of Desma pressin which is this I get is the synthetic version of the antidiuretic hormone uh typically two2 milligrams before bed uh has profound effects yeah um so talk a little bit about that and then maybe some of the other things and also are there any contraindications to the use of that I know certainly theoretically a contraindication or a concern would be hyponatremia as you would sort of increase uh plasma volume uh and therefore dilute sodium but maybe just talk a little bit about how you would use that yeah so there there are very straightforward you know Frontline medical management um Med you know pharmacologic agents to manage lower urinary tract symptoms and generally speaking the front line ways that we manage it would be with an alpha blocker so there are um that's a a a class of compounds that are nowadays very very specific to prevent activation of um set of smooth muscles that are really isolated mostly in the prostate and somewhat in the seminal vesicles and so if you just take a step back and look at the embryology of the prostate it obviously is a um it develops from urogenital the urogenital sinus and there's meenal and epitheloid components of that so there's a lot of smooth muscle within the prostate the smooth muscle exists within the prostate in part to help with ejaculation it's a effectively like it's a pump it's a pump so once you have when you're having an orgasm the the pump squeezes the prostate will squeeze and that will result in emission of the fluid so what you can do for individuals who have lower ear tract symptoms is that while you have this channel this tube going right through the
there's a naturally secreted hormone anti-diuretic hormone in younger Decades of life it has a a surge of release around 7 or 8:00 at night
so we have natural di urinal release of anti-diuretic hormone and that dial variation is attenuated per decade as we get older