It?s depressing to be getting old, especially (now that I?m) starting to get those medical problems I?ve heard my friends talk about for a few years.

It doesn?t help to know that many men, like me, have to get up more often at night to urinate.

What can I do to stop this problem? It?s now getting to the point where I can?t get enough sleep and feel depressed all day. ? V.L., Phillipsburg, New Jersey

As they get older, almost everyone finds they need to get up more frequently at night to urinate. However, because excessive urination at night (called nocturia) is a symptom, not a disorder itself, it is very important to find the cause.

Causes for this change include more restless sleep, an enlarged prostate, changes in muscles that control the bladder, and more urine being produced.

Decreased bladder capacity can be caused by obstruction of the bladder outlet, pressure on the bladder from the outside, and even anxiety. Having an overactive bladder, without the normal controls that occur during waking hours, increases the problem.

One of the most common reasons why men wake up at night to urinate is an enlarged prostate. In these men, the bladder is unable to be emptied fully, so it fills up a lot faster and thus causes them to urinate more frequently.

If this is the problem, several new drugs can be used to relax the muscles at the bladder outlet: terazosin, doxazosin, and tamsulosin.

Your condition may also occur in the early stages of kidney disease, when the kidneys can?t concentrate the urine as well. It?s also common in people with heart failure and liver failure.

You may need to urinate more frequently at night because your body is making more urine during the night. This commonly results from excess intake of fluids, especially just before bedtime. But it?s also caused by diseases such as diabetes and by drugs such as diuretics for high blood pressure.

Another common cause of increased nighttime production of urine is edema. During the day, standing increases pressure forcing fluid to collect in the legs. Then at night, because this pressure is relieved, the fluid flows back into the blood stream, and some of it is eliminated as urine.

Drinking alcohol during the evening can be a particular problem. Not only are you increasing fluid intake, but alcohol also suppresses the antidiuretic hormone, which results in increased fluid loss. It has also been recently found that decreased amounts of this hormone can occur ?naturally? and is a major cause of nocturia.

This has led to the use of desmopressin to successfully treat nocturia. About three-fourths of those tested cut their nighttime frequency from an average of 5 times per night to only 2.5 times.

If you?ve noticed that your ankles swell most at night and have gone down by the morning, then edema is contributing to, if not the primary cause of, your problem. Also, mild edema can occur without you noticing it, unless you look for it carefully.

My advice is for you to first determine if you are urinating more, not just more often. You can make a rough estimate without measuring the urine, but measuring it will provide better information.

Then try stopping all the things I?ve mentioned that are likely to cause increased urine output at night and see if your problem goes away. If not, seek medical advice, taking all of your information with you.

Even if your self-help measures do work, if you have edema that hasn?t been checked out or if you have other signs of problems with your prostate such difficulty in starting to urinate then you should seek medical advice anyway.

In doing so you should also know that a recent study found that men with depression had a sixfold increase in nocturia, so discussing this issue may be very helpful as well.

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