DEAR DR. ROACH: I am a 77-year-old woman who suffered with urinary tract infections until my gynecologist prescribed estradiol, which I currently take.
The UTIs are now infrequent, but I am sleep deprived from waking up four or five times per night to go to the bathroom. I relieve myself before I go to bed and do not drink liquid after 4:00 p.m. I have bags under my eyes and am totally exhausted during the day. Do I suffer from overactive bladder, or is it something more serious? — W.S.
ANSWER: You have nocturia, from the Latin word for night ("nox") and Greek for urine ("ouron"). Many conditions can cause this symptom. Making the correct diagnosis is essential in order to treat you effectively.
Overactive bladder is a likely cause. OAB is caused by spasmodic contraction of the smooth muscle deep in the walls of the bladder. These spasms may be caused by neurological conditions, bacteria in the bladder or have no identifiable reason. Incontinence may or may not be involved, but men and women with this condition usually note a sudden need to go to the bathroom — the medical term, "urgency," is very apropos. OAB is treated with a combination of pelvic floor exercises, lifestyle changes and medications, if needed.
Before making the diagnosis of OAB, other conditions besides urine infection should be considered. People with OAB go to the bathroom many times, but usually with relatively small amounts of urine. Many voids with large volumes of urine suggests other conditions, such as uncontrolled diabetes, heart failure or primary polydipsia, which refers to people who drink a great deal of water. I don't think you have any of these.
Sleep disturbances can show up with waking up with a need to urinate. Obstructive sleep apnea and restless legs are common. High blood pressure by itself can also sometimes cause nocturia. Finally, one mechanism to suppress urinating at night (arginine vasopressin, or "anti-diuretic hormone") can sometimes work the wrong way, making the kidneys preferentially make more urine at nighttime.
In a situation like yours, you could begin a treatment trial for OAB or visit a urologist for a more thorough evaluation. Start with your primary care doctor.
DEAR DR. ROACH: I have a concern with all the disinfectant wipes and hand sanitizers we are using now. A while ago, I was told that overusing disinfectants allows bacteria to become resistant to them, and then they will not respond to antibiotics. Are we setting ourselves up for larger problems in the future with drug resistant bacteria? — B.I.F.
ANSWER: Drug-resistant bacteria are indeed a large potential problem, but the main driver for this is antibiotic use: for example, when one is given inappropriately, for an illness that is not bacterial; when they are taken for too long; and when used for animals in the food chain, which can lead to antibiotics in the water supply. Bacteria may acquire antibiotic resistance through relatively small changes in their genetic material, either through mutation or acquisition of outside DNA.
By contrast, disinfectants kill bacteria through many different pathways, and acquisition of resistance is much harder. There is little evidence that frequent use of disinfectants could lead to resistance to those disinfectants or to antibiotics. Moreover, the benefit from having clean surfaces and hands is large and immediate.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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