Nocturnia (night time urination) and Coffee

Hi Frank,

The caffeine in coffee is a diuretic which by definition stimulates more urination. By timing the use of diuretics (coffee in this instance) you can also may be able to effect to some degree when your kidneys unload urine into the bladder. 

The problem many of us have as we get older is that the kidneys seem to unload more at night than during the day (nocturia) which can result in more trips to the bathroom at night.

Urologists like to blame these night time bathroom trips solely on BPH, which could be the problem in whole or part, but the real culprit in many cases can be nocturia and not BPH.  All the urologist has to do is ask the patient to do a simple fluid in/out log but they often do not, the reasoning of which really escapes me as it is so fundamental to diagnosing the problem. 

This is why many of us can empty our bladders entirely before we go to sleep (naturally and/or with a catheter) and still get up multiple times at night with full voids. 

What the coffee seems to do with me, and apparently with "ptientx" (see his above post) as well, is to force more urination prior to bed time which results in less bathroom trips at night. It really comes down to simple math because the 24 hour urine is fairly constant if other factors such as fluid intake remain the same.

Coffee in the afternoon may not help everyone, and there are also other factors at play with nocturia such as total fluid intake, fluid timing, diet, salt intake, exercise, etc, -- however it's one thing that might be worthwhile experimenting with. For me, two cups seems to work the best in the late afternoon but YMMV.

Jim 

Jim, I'm going to try this. I find that if i don't drink much water ,but drink other liquids ,milk,cranberry juice orang juice,i can hold caterization for at least 5 hours.I don't know if drinking less water is a good idea?What do you think?

I'm saying that the caffeine in coffee is a diuretic so if you time taking the coffee correctly then your kidneys can potentially make more urine during the day and therefore less at night. Less urine at night means getting up less at night. And if you're able to empty completely prior to bedtime, either naturally or self cathing, it means you have a much better chance of sleeping through the night. Got to experiment as we all are different.

Jim

You don't want to dehydrate yourself but on the other hand you don't necessarily need the "8 glasses" a day so talked about. Six 8 ounce glasses (those are not big glasses) should be OK depending on your activity level, and those six glasses include coffee, tea, juice, soda, etc. You can also check the color of your urine to make sure you're not dehydrated or check the specific gravity with a dip stick, or just go by thirst which is usually reliable.

Jim

Just as an example, I had some coffee around 5PM today and between 6 and 11:30PM I have voided three times for a total of around 800cc. Not doing a log these days but probably voided three other times since 7am for maybe another 800cc.  So doing the math (1600cc voided before bed time) that means I should be able to get through the night or at least until 6-7am. Note that the caffeine in the late afternoon seemed to accelerate the voids (three voids in less than six hours compared to three voids in ten hours earlier in the day). The example I gave is without any self cathing, all natural voids but since I'm not retaining very much it should work the sam way regardless.

Jim

I believe Tea has a lot less caffeine than coffee. For me, it's not so much that the coffee will keep me awake if I drink it after 6PM, but that if I drink it earlier than 6, there's more time for my kidneys to produce more urine before I go to bed. And the more urine output before bed time, the less output during the night. Again, simple math. Really got to experiment with the timing, how much coffee, etc. If you want to see an improvement from where you are, why don't you try 2 cups of coffee around 4PM and see if that helps thing. 

Jim

Jim

I do a similar thing, 2-4 cups of black coffee in the morning then switch to tea in the afternoon up until around 6pm then herbal tea /water or some wine after that.  I find I that means I get off to sleep well and wake up 1-2 times to pee with a very full bladder.   I have a few nights a month when I'm up 3-5 times but that's life. My uro told 3 years ago I have BPH but find symptoms not too bad other than weak stream, I take no meds currently.  

Hi Twig,

Try experimenting by changing it up. Keep a cup or two of coffee in the morning but have another two cups of coffee around 5PM. That could force some extra urination between 5PM and bed time which means you could make it through the night or maybe just get up once.

Jim

I will thanks!....On another matter, does Flomax make your urine "smell stronger"?.......

I haven't take Flomax for several years so really can't remember if it made my urine smell stronger. A strong urine smell could also be from dehydration, certain foods, other medications or a UTI, symptomatic or not.

Jim

Makes mine stick. I take fernasteride also

Hi Jim, I always find your info very interesting.. You contribute a lot to this forum. Tell Me if you would? How long have you been self catherizing?

Did you have surgery?I need some info  on this to make a decision on my urine retention. I was told to have turp done. After reading all these bad reports on turp,it completly turned me off.

Thanks Jim,

Hi Frank,

I've been self cathing for several years now. No operations. It took over a year before my bladder rehabilitated to the point where I could empty my bladder most of the time without a catheter. My bladder still continues to improve and I can sometimes go for days (or weeks) with pretty normal bladder function and no self catherizations. I had a difficult time with self catheization the first couple of months, much worse than what I've read others had. But I can say without hyperbole. self cathing is now about as eventful and traumatic as brushing my teeth. The difference is that it takes two to three minutes to brush my teeth but only 60 seconds to self cath.

Jim

Same here...I want to stop Flomax. ...My urologist will advise me next week after checking my retention...Also, I feel Flomax makes me pee more than normal...I had a REZUM in August of this year...

Jim and Old Buzzard - New Bladder Issues - Now I'm peeing too many times at night & early AM (4-6) and 4-6 times through-out the day....The Frequency is Way Too High....I've heard 6-8 times within 24 hours is more normal....I think the Flomax is making me pee more often than I should. ...What do you think?...

Why are you still on Flowmax after Rezum?

My urologist has ordered me to stay on it until he checks my retention next week...Likewise, antibiotics...

Hi Jim,Thanks for that info. I have tryed speedi cath coloplast,and bard sure grip sleeve cather. Is their a catheter that you could recommend that has the least pain,which is prelubed?I have to touch the catheter when i use the speedi cath, i don't think thats a good way to do this.Is  their a catheter that has the least pain and one you don't touch that you could recommend?Did you take the medicine avordart and flomax also?

Thanks very much for this info Jim,

Hi Frank, I suggest you contact one of the catheter distributors and get a variety of hydrophilic free samples to test. That's what I did. Ask for the ones with the sleeve, but you also might try the Speedicath using a surgical glove to feed it in which should take care of any contamination concerns.  I took Flomax a few years back but not much help and really don't need it now anyway. Daily Cialis worked a little better for me than Flomax but not a dramatic change. If you're self cathing don't see the need for either one, only see the need if the medication will get you off self cathing and you can live with the med's side effects.

Jim

Hi Randy,

What is the volume of your natural voids? You also might want to check your post void residual with the catheter. The sum of your natural void plus your catherized volume is what your bladder is holding before your urinate. I would log all this for a couple of days. This would be useful information in figuring out what is going on. I'm assuming your fluid intake hasn't changed much? As to the Flomax, all that does is help your bladder empty more completely so I would therefore assume that's not the problem plus you were taking it before the frequency increased anyway. Still think you should get off it but for other reasons.

Jim

Hi Jim, Thanks again.Did you find that you had to have a Dr prescription to get catheters? Have you heard of Gentle Cath? 

My catheters are paid through Medicare which requires a doctors prescription. That said, you can purchase catheters on the internet without a prescription. I did that a few times to sample different catheters.

I sampled just about every hydrophillic on the market (as well as many non-hydrophillics) and Gentle Cath does ring a bell, but not 100% sure. In any event, I don't remember my experience other than I had best results with Speedicath. But it's really an individual thing because I have heard others say good things about other hydrophillics. We all have different anatomies, so what is most comfortable for me might not be best for you.

Jim

Hi Jim, Thanks for your reply on catheters. One other question? Do you use antibacterial hand wipes to to wipe your penis head before using catheter?

 ,also what kind of catheter do you use when your not at home ?

Thanks Jim for all your info.

I have used BZK wipes and Providone iodine swab sticks on both meatus and penis head, but currently just use an antibacterial spray called Vetericyn VF as it's a bit faster and less messy than the swab sticks. FWIW my first cath nurse told me it was unecessary to use anything. 

I don't cath everyday now and when I do it's invaribly at home. But when i did carry them in the past I carried the Speedicath's, usually in a cardboard tube tucked into a back pack, as they don't bend all that well.

Coloplast does make a compact model but it's two inches shorter which makes bladder emptying more difficult plus it doesn't come with a Coude tip.

Jim

Hi Jim ,Thanks for that info.Did you have surgery?You say you don't cath everyday?Did you take medicine, Avordat ,flomax,and did you have rentention? This is my problem?I don't know if getting surgery will be the answer for me?I sure would like to cut down on caterizing.

I had retention for at least ten years and it became signficant around three years ago. That's when my doctor recommended surgery (TURP) but I decided to self cath instead. So never had surgery. I started cathing 6x/day but as my bladder regained elasticity I was able to decrease the frequency. Today I don't need to cath every day, sometimes not every week and I have little or no retention. I have never taken Avodart. Took Flomax several years ago for a short time but it didn't improve my retention that much and I didn't like the side effects so I stopped.

Frankly, I didn't expect I would be able to stop self cathing, it came as an unexpected surprise. That said, after awhile it really was no big deal for me and if I had to cath several times a day for life I would probably still choose that route over the operations and procedures I read about today.

Jim

My fluid intake hasn't changed and I just have coffee, tea, or water with my meals plus an occasional beer from time to time....My Uro Doc will check my retention tomorrow that will be my first doctor's appointment after I passed my Trial Void and the Foley was removed, ~ 6 weeks(?)...

Hi Randy,

Since I assume you still have catheters around, why don't you check the retention yourself by self cathing? More accurate than the bladder scan in the doctor's office plus you can check during diffferent times of the day with normal fluid intake as opposed to fluid loading which often happens in the doctor's office. I think the data you can collect at home via self cathing will give both you and your doctor much better answers to both the condition of your bladder and newer urgency issues as opposed to a single bladder scan in the office. 

As to the Flomax, there are two things to consider. First, is the Flomax actually helping? And second, if the Flomax is helping, are you OK with the its side effects versus some self cathing with no Flomax side effects. Sounds like a trial off Flomax is in order.

Jim 

Hi Jim,

I followed your suggestion and stopped taking Doxazosin. The unexpected result is the worsening shoulder pain that I did not associate with Doxazosin has greatly diminished.

I currently self cath 4 times a day, a typical voiding is shown below:

10PM (before bed) : NV=100cc, CV=300cc

3AM : NV=60cc, CV=500cc

9AM: NV=120cc, CV=240cc

3PM: NV=120cc, CV=300cc

Any suggestions would be greatly appreciated.

Hank

Jim, What might be causing the increased frequency besides Flomax?...

Hi Hank,

Glad you had some additional benefits from stopping the Doxazosin. Did you notice a lot more retention after stopping?

Your cath schedule overall looks OK keeping total bladder volumes under 400ml expect for your 3am cath. Not unexpected as night time urination tends to increase as we get older.

So you could just leave it alone or experiment with some of the nocturnia strategies such as reducing fluid intake later in the day, reducing sodium consumption, afternoon naps or trying coffee in the afternoon. All to the end of moving urine production more toward the daytime.

You could alternatively (or in addition) throw in another self cath to see if that will more evenly distribute things. Not sure if it's worth getting up at night to do it (one possiblity) but you could maybe experiment by schedule the additional cath around 6 or 7pm. The act of completely emptying your bladder then, just could -- or could not-- force more urination before bedtime which might mean less at 3am. Got to experiment.

Jim

Randy,

While it's possible Flomax could be the cause it seems unlikely because in theory Flomax should reduce frequency not increase it.

There could be any number of causes for increased frequency, but assuming you don't have a UTI, I would think retention has to be one of the first things to look at.

That's  why I recommeded you do a retention log at home via self cathing. Measuring retention in your doc's office via bladder scan is OK, but it's only one point in time. Measuring retention at home at various times during the day and night gives you a much better picture of what is going on. It will give ou not only your retention numbers but also the total bladder volume at which your body signals you to urinate. All good information for you and your doc to figure things out.

Jim

Thanks Jim,

I did not notice any increase in retention after stopping Doxazosin. I did notice that the natural void volume (NV) went down and the cath volume (CV) went up. But that is to be expected.

I will try another cath at around 6-7PM as you suggested. I did trying to limit evening liquid intake but it only helped a little. I think most of the liquid comes from my dinner because I do eat lots of boiled vegetable. The few times that I had drier dinner, I did not wake until around 4AM, and then the CV was only about 350cc.

Hank

Hi, Hank - regarding your 3AM results - like you, I have noticed difficulty getting flow started when being woken up in the middle of the night from a sound sleep. And once flow starts, it is much slower compared to other times of the day. As an experiment, I have tried walking around the house for a few minutes before voiding, and have noticed that this helps quite a lot. Even though all I can think about is getting back to bed as soon as possible, I wonder if I might actually be getting back to bed sooner by taking that little walk first.

Sure, the boiled vegetables at dinner could do it. Maybe try an earlier dinner or at least a "drier" dinner with the boiled vegetables for lunch. 

Jim

Hi patientx,

Exactly like you stated, it is more difficulty to get started and slower flow when just waken up in the middle of the night. But that is to be expected. I think walking around the house would help but I rather do my cathing quickly and go back to bed. It is already tough falling back to sleep at 3AM since you already had some good sleep and therefore not being sleepy anymore. The more activities you engage, the harder it will be to fall back to sleep, IMHO.

Back to the days that I was not cathing and taking high doses of Doxazosin, I was able to get up (or sometimes even in bed), peed about 300cc into a bottle, and went back to sleep right way, no problem. But the side effects were too much to handle, now especially I just found out another very uncommon side effect.

Hank

Thanks Jim,

I did just that today. I had a drier dinner at 2PM. I also took a celery seed (diuretic supposedly) to test your theory on coffee since I could not drink coffee, especially this late.

Hank

Hank - exactly, and therein lies the rub. . . it's potentially harder to fall back asleep if walking around the house at 3AM! Fortunately for me, I barely dodged the self-cath bullet, and can play around with things that can get me completely through the night without getting up even once.

Jim - just for grins, I switched to green tea yesterday afternoon, as the variety I drink seems to have a fair amount of caffeine in it, though not as much as coffee. I also limit liquids after, say, 6PM-ish, as I usually go to bed around midnight. Last night I slept eight hours without the need to get up to pee. Kind of a miracle. . .

I'm confused. So, if I'm having retention problems, that means the REZUM wasn't successful when the URO Doc stated it was successful and, the URO Doc will probably want to do a TURP which I don't want to do...

I understand what you mentioned regards Self Cathing....I would definitly know my retention amount...

Hi Randy,

Don't try and get too far ahead of things. I'm not saying you have retention, just that retention is one reason for frequency. And since your doc wants to check your retention anyway, you can do a better and more accurate job of it yourself via self cathing. That way you and your doc will have better information to figure out what is going on. It's quite possible you will have no retention, like before, and that the frequency has other causes which then can be explored.

Jim

Hank,

I used to do the walking around in the middle of the night thing as well, but for the reasons you gave, decided it was just easier to self cath and go right back to sleep. Fortunately, these days I either sleep through the night or when I do wake up at night it comes out easy.

Jim

Ptientx,

Congratulations on your 8 hours sleep "miracle"! Some time back, I bought some green tea at a Japanese market, which I swear had twice the amount of caffeine as your average cup of coffee! So, "yes", green tea can have a suitable (or in this case theraputic) dose of caffeine. 

Jim

The natural green tea I drink is indeed imported from Japan! It's called Sen-Cha, imported by Japan, Inc (maeda-en, usa).

Hi Patientx,

More details please. Exactly how much green tea did you drink in the afternoon and at what time did you drink it ? Did you drink anything else in the afternoon ?

I want to try it also. Maybe Jim got something good going on here.

Hank

Hank - I have been logging fluid in & out for a few months now. My goal is to drink about 1.5 liters (1,500 ml) per day. On a typical day, I measure around 1,600 ml (1.6 liters) of urine out. I start the day around 8AM with 500 ml of water in the form of a nutritious powdered shake. At around 11AM, I drink a 400 ml glass of green tea. At 2PM, I drink about 200 ml of water. At 5PM, reusing the same tea bag, I'll drink another 400 ml of green tea (I have always been able to get two full glasses of tea from this brand of green tea). I rarely drink any more liquids the rest of the day (unless I'm thirsty from, say, working outdoors), and go to bed around midnight.

Thanks, Patientx. When do you usually eat dinner ?

Hank

Dinner around 7:30PM

Thanks. So you don't drink anything during or after dinner ?

Hank

I have dinner around 5:00. I drink only a little for dinner then drink when taking night time meds.

I generally don't drink anything during or after dinner, though I may have a tiny bit of water to swallow a few multivitamins. I also may have a fruit snack like an apple around 10PM, which I'm sure has some quantity of liquid associated with it.

Thanks Patientx for all your info. I am trying to sleep longer than from 10PM to 3PM and will use your data in my plan. I think my problem is eating and drinking too much for dinner.

Hank