DEAR DR. ROACH: I’m a 91-year-old male who makes frequent visits to the bathroom to urinate. I am in good health and I wonder what causes this. Where does all that liquid come from? — A.R.N.

ANSWER: What goes in must come out. All the liquid you urinate came from fluid you consumed when drinking and eating food.

But it may be more about perception than volume. Frequent urination is extremely common in both men and women, and although some causes are the same, such as an overactive bladder, men have an additional anatomical structure that can lead to urinary problems as they get older: the prostate, a normally walnut-sized gland that may increase in size as men age. It is through the prostate that the urethra, and thus all the urine, has to flow. If the prostate is enlarged, the urinary flow slows down.

As the prostate obstruction becomes worse, men may have trouble emptying the bladder completely. This has the effect of making men go to bathroom more frequently, since the bladder has less functional size. In this case, you aren’t urinating any more volume than before, just more often in smaller amounts.

Treatment needs to be directed at the underlying cause. Overactive bladder and enlarged prostate have similar symptoms and different treatments.

It is possible that you really are having excess volume, however. Diabetes is the biggest concern here, and you should be tested if you have truly large volumes of urine.

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DEAR DR. ROACH: I read an article about a study the Mayo Clinic did using 20 mg tablets of sildenafil for pulmonary arterial hypertension and that it improved walking distance by 75 percent. Is there an upper age limit for a person using this medication for pulmonary hypertension? — D.L.

ANSWER: Pulmonary hypertension is different from regular or systemic high blood pressure. It’s not the kind that is measured with a blood pressure cuff.

In pulmonary hypertension, the elevated pressures are inside the lungs. There are five general classes of pulmonary hypertension, and people must undergo extensive diagnostic testing to determine which subclass they have. The goal is to find a cause that has a specific treatment. For example, subclass 2 is pulmonary hypertension due to heart disease of the left side of the heart, such as heart failure or valvular heart disease. Treating those can make the pulmonary hypertension better.

However, many people do not have a treatable underlying cause that can be identified, so doctors rely on general treatments to improve symptoms. One such is sildenafil, which is called Revatio when used for pulmonary hypertension, but it is the same drug as Viagra. It prolongs the effect of nitric oxide, a chemical in the blood that relaxes blood vessels in the lungs and reduces pressure. Sildenafil, like other drugs in the same class, significantly improved the distance a person could walk in six minutes. The 75 percent increase you noted is higher than most studies showed, however.

The study included subjects up to 81 years old. I do not think age alone would be a reason not to use these kinds of medications. These medicines should not be used in people taking nitrates (such as nitroglycerine) or those with very low systemic blood pressure.

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Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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