What is Nocturia [Interview][Transcript]

dr_sangeeta_mahajan_nocturiaGuest: Dr. Sangeeta Mahajan
Presenter: Neal Howard
Guest Bio: Division Chief, Female Pelvic Medicine and Reconstructive Surgery, UH Cleveland Medical Center Fellowship Program Director, Female Pelvic Medicine and Reconstructive Surgery, UH Cleveland Medical Center Chair, Gynecology Quality Assurance Committee, UH Cleveland Medical Center Assistant Professor, Urology, CWRU School of Medicine Associate Professor, Obstetrics and Gynecology, CWRU School of Medicine.

Segment overview: Dr. Sangeeta Mahajan, Division Chief of Female Pelvic Medicine and Reconstructive Surgery at University Hospitals in Cleveland, Ohio talks about Nocturia, a highly prevalent urological condition characterized by repeated awaking from sleep to empty the bladder.

Health Professional Radio – Nocturia

Neal Howard:   Welcome to Health Professional Radio, I’m your host Neal Howard. Thank you so much for joining us today. Our guest in studio for today is Dr. Tina Mahajan, Division Chief of Female Pelvic Medicine and Reconstructive Surgery at the University Hospitals in Cleveland Ohio. And she’s with us today to talk about the condition known as Nocturia. Welcome to the program Doctor.

Dr. Tina Mahajan:   Thank you very much for having me.

N:   Thank you. You’re the Division Chief of Female Pelvic Medicine and Reconstructive Surgery, how long have you been a Doctor?

M:   I have been a physician for, well that’s a good question, almost eighteen years since I finished Medical School. And I’ve been at University Hospitals Cleveland Medical Center for eleven years and started the Division, so they really had nobody who does what I do until I came.

N:   Well having no one that does what you do at a Hospital, especially in a place as large as Cleveland. How did you become a specialist in Urological conditions?

M:   Well I did four years of residency at Washington University in Saint Louis in Obstetrics & Gynecology. And then I spent three years of fellowship focusing on just female Urologic and Prolapse Issues at Loyola University in Chicago and then they plucked me out of fellowship and had me come here and start a Division.

N:   Were there some personal issues that made you go toward this particular field?

M:   Well that’s a good question, I knew that I wanted to go into Gynecology ever since I was in College. I was very interested in Women’s Health and Women’s issues and back in the days before you could even major in Women’s Studies or anything like that and I knew I wanted to go into Medicine. I come from a Medical family but everyone is a lung specialist in my family. But I knew I wanted to be a Surgeon because I’ve always been good with my hands. And when I got to Medical School and did some OB, I was not as interested in the babies, I was more interested in the moms and I love Plastic Surgery, but I didn’t want to be a Plastic Surgeon. So the nice thing about what I do is it’s sort of like Plastic Surgery for down there. I tell my patients no matter how old they are, I’ll make them look like they’re twenty again. Nobody ever sees my work, not many people see my work, hopefully but its Plastic Surgery meets urology meets Gynecology. My husband likes to say that I give women dignity and keep women out of diapers and other things. So let’s you have your life back and do the things that you enjoy and not feel like there’s something limiting you.

N:   We mentioned or at least I mentioned a condition known as Nocturia, one that I’ve never heard of yet more than a third of adults over the age of thirty seem to meet the clinical definition of Nocturia. What exactly is Nocturia?

M:   So by definition, Nocturia is defined as any getting up at night time when you should be sleeping to urinate. You should be sleeping before, it should be preceded by sleep and followed by sleep and basically the specific reason of urinating, it shouldn’t be because my husband snores, my dog’s barking or whatever but I specifically have to get up at night to empty my bladder and then I can go back to sleep. Now the difference is, most of us get up maybe one time a night some nights but sometimes it’s per variety of reasons: not sleeping well, distractions, other things wake us, but … of Nocturia is defined is getting up two or more times a night. And I have patients in my practice who get up seven or eight times a night and that’s no way you can get rest if you’re getting up every hour or an hour and a half.

N:   Nocturia, you’re getting up that much, I’ve heard different causes for people getting up: overactive bladder. Is overactive bladder separate from Nocturia or is Nocturia a severe overactive bladder?

M:   Well it’s a very interesting paradigm. Overactive bladder includes one of four symptoms: an urge to go that I cannot defer, urging incontinence that urge to go so bad that I leak, Nocturia getting up at night to urinate and frequency, I define as I feel like I pee too often. So the average number of times, what do you think? An average person in the United States urinates how many times a day?

N:   Maybe three?

M:   Actually it’s eight.

N:   Really?

M:   Eight is the average. I’m not average, I definitely don’t have time to go eight times a day. Yes, we did a study when I was a Fellow and we interviewed people and anywhere from six to ten is the range and eight is normal.

N:   Now does that matter if you’re drinking eight glasses of water a day (crosstalk) that people recommend or?

M:   Right. So that definitely affect things or even many of my patients, if I’m drinking a pot of coffee on their way to work of course I have to pee a bunch of times when I get there, my bladder cannot hold that. So there are many factors that can affect how often we urinate but for the average of eight times a day and if you go more than eight times a day or let’s say you’ve always gone three times a day and now you’re suddenly going eight times a day, that’s considered going too often for you – that’s a change. So but it’s definitely affected by if you drink a lot of water, if you drink a lot of caffeine, alcohol, you take a diuretic to lose water. But they’re definitely factors so getting back to your question about Nocturia, there’s a large population in the US of people who have overactive bladder and many of those patients with overactive bladder have Nocturia. And if we’d look at just people who are bothered by getting up at night, it’s sixty three million people in United States. About 33% of women and 21% of men get up two or more times a night.

N:   Now I’m thinking about the water drinking. Many of us decide at some point to embark on this healthy lifestyle as far as diet is concerned. And of course drinking more water is crucial and a lot of us who do that, we’re used to coffee and soda and the assorted juices. So I’m going 3 times a day and I got less than healthy liquid intake and that being the content as well as the quantity but then I start drinking a healthy amount of water and I’m going more. This is specifically talking about night time, right? Just night time, it has nothing to do with going as a result of drinking more?

M:   No, this is during the daytime, that’s fine. In an ideal world when you sleep your body secretes a hormone called vasopressin which is supposed to concentrate urine and make you make less urine at night time. But as we go older, that desire, that release of that hormone decreases so we don’t concentrate as well. So we make too much urine at night time and we have to get up and urinate so that’s the fundamental issue. Now what happens during the daytime and people are drinking a lot, that’s normal. I always tell people fluid in, fluid out. If you take it in, you got to take it out and that’s to be expected but people aren’t usually bothered by that, this is getting up at night in a bothersome way. And again usually I tell people more than 2 times a night is bothersome. Once in a while I’ll catch somebody who takes a water until bedtime and it’s sabotaging themselves or let’s say they take three or four of supplements at bedtime and they’re drinking each one with a big glass of water and they’re just sabotaging themselves because again fluid in, fluid out. So we can easily modify things like that, take your supplements before dinner with one big glass for everything, move your diuretic to the daytime but those are easy fixes but majority of our patients are not as easy.

N:   Are there other things that are affected by Nocturia? I mean if your sleep is being interrupted to such a degree and it’s bothersome, well more than bothersome – what are some of the other things that could be affect this simply because you’re not getting enough sleep? And is that the main thing as far as Nocturia affecting other organs or other systems, is it because of the lack of sleep?

M:   Well we all know that especially like when you have a new baby and you’re home every two or three hours feeding your newborn, lack of sleep makes you exhausted. You are not as good at cognitive tasks, things that you have to think about, your memory goes, you just don’t feel well and the biggest thing that I worry about my patients is falls. If the patient falls and break the hip they have almost a 50% of risk dying from that or significant medical issues and many of patients who get up at night are getting up and they’re falling at night time. So one of the big reasons when people fall is because they’re getting up to use the bathroom at night. So in my patients you just don’t feel good, you don’t feel well, you’re not as on your game, you’re not mentally as good as you should be and you’re at risk for harming yourself, so there are many things that helps. And then the other thing can be obstructive sleep apnea, many people snore, wake up with the dry mouth, wake up with headaches and a lot of people don’t want to get their sleep apnea checked out or if they do get it checked out and they do have sleep apnea they don’t want to wear their machine, their CPAP. And that puts stain at your heart, put strain on your lungs and can definitely take years off their life.

N:   And where can our listeners go and get more information about Nocturia?

M:   They can definitely go to our national website www.augs.org or plenty of other resources in the …

N:   Thank you so much. You’ve been listening to Health Professional Radio, I’m your host Neal Howard with Dr. Tina Mahajan. She’s the Division Chief of Female Pelvic Medicine and Reconstructive Surgery at University Hospital in Cleveland Ohio. Being great having you here with us today Doctor.

M:   Thank you very much for having me Neal.

N:   Thank you. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.

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