Dr. Keith Roach

DEAR DR. ROACH: I am writing in regarding my husband, who has had nocturia since around the age of 24. He gets up three to four times a night, sometimes more if he drank liquids before bed or had a salty meal. He has undergone a bladder emptying study with a urologist that was normal, and they didn’t offer any solutions to the problem. On our own, we incidentally found that when he takes ibuprofen for just a day or two, his nocturia improves greatly (only getting up once per night) for about three weeks, then gradually returns to the usual frequency.
I remain concerned that this is a prostate issue, given his normal bladder emptying studies and the fact that an anti-inflammatory has such a marked effect on his symptoms. Is prostate enlargement or hyperplasia possible at such a young age? Or could this be a bladder sensitivity issue? His nocturia has mostly remained stable over the years, and he is now 33 years old. I’ve tried to get him to see another urologist, but he feels that there’s little they can do to find the issue or help him. — L.H.
ANSWER: Nocturia — getting up from bed to urinate — is a common symptom, especially as men get older. Three or four times a night is not common in young men without a reason such as prostate enlargement.
Ibuprofen has been shown to both treat and prevent prostate enlargement. Every time I write a column about this, I get letters from men who have experienced marked relief with ibuprofen for symptoms of benign prostatic hyperplasia. The usual dose of 400 mg three times daily is much greater than what it seems your husband is taking, which may have to do with his being so young.
About 8% of men in their 30s will have enlargement of the prostate (not due to cancer). Twenty-four is younger than I normally hear for men to develop symptoms, but it is, by no means, impossible. The relief he gets is strong evidence that the prostate is the issue here, as his normal bladder studies support that.
It’s hard to imagine better results than his current ones with ibuprofen. He may require additional treatments in a few years or decades, but continuing the ibuprofen is a very reasonable treatment.
DEAR DR. ROACH: I am a 60-year-old woman who has sore, achy muscles, especially in my arms and legs. I take atorvastatin for high cholesterol. Do you think that could be causing my soreness? I also wonder if it could be fibromyalgia. — C.K.
ANSWER: Both fibromyalgia and a side effect from statins are possible reasons for muscle aches. With fibromyalgia, people not only have widespread pain, they usually have identifiable tender spots, which your doctor can look for during a physical exam. Most people with fibromyalgia also report sleep disturbances, fatigue and difficulty with tasks that require constant attention (“fibro fog”). If your doctor isn’t an expert in this diagnosis, a rheumatologist is.
Muscle aches due to statins often cause elevations in a blood test called creatine kinase (CK), which represents muscle damage. However, some people with muscle aches from statins have a normal CK level. Sometimes switching statins can help.
Muscle aches can be very common in people without diagnosable conditions. During a large study of people thought to have muscle aches due to statins, in which they alternated a statin with an inactive drug (participants didn’t know what they were taking at anytime), there were no differences in self-reported aches for most participants.
* * *
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.
(c) 2023 North America Syndicate Inc.
All Rights Reserved