Old Lad

As the journey into old age progresses its natural to think of all the things that can go wrong. Most people worry about major events like heart attacks and strokes. We can take precautions to prevent these but they are events that are often out of our hands. Day to day of course we notice odd aches and pains, a sense of not being quite as fit as before and things that once were easy aren’t any more. A wise GP of my acquaintance used to tell his patients -“Its just the newness wearing off”! However the one thing that inevitably dominates getting older is bladder function. Its a problem for men and women alike but I can only speak from a male point of view. And in subtle ways it begins to influence what we do and how we plan our lives. And its irksome!

The first inkling I had that this bladder thing was upon me was the need to visit the bathroom once or twice a night. And sometimes it became 3 times. Its at this stage you realise what a significant advance en -suite bathrooms have become. A far cry from my childhood when the answer to a nocturnal urge to pee might well have been a chamber pot! (we did in fact have indoor bathroom facilities so were considered posh) Nothing that you do seems to affect this – restricting drinking in the evenings, restricting what you drink, its all of no avail. There are two physiological reasons behind these night time episodes. Firstly the body regulates its fluid balance via a hormone called ant-diuretic hormone (ADH) which tells the kidneys when to produce urine. Normally if you are drinking a lot through the day the ADH level will fall, and if you become dehydrated the ADH level goes up telling the kidneys to reduce urine output. Normally at night the ADH level will be higher so you don’t wee. However as we get older we produce less ADH and so through the night the kidneys produce more urine. The second problem is that wen we lie down the blood flow to the kidneys increases and this causes more urine to be produced. So getting up through the night is the new normal and the depressing fact is that there is not much you can do about it! So forget a camping holiday unless you don’t mind the rigmarole of getting out of your sleeping bag and wandering across a field to the toilet block. Holidays in hotels or guest houses are nowadays not a problem since the en-suite is usually the norm. Better than the good old days of shared bathrooms.

Gradually the bladder begins to make its presence felt through the day. And in subtle ways begins to direct how we plan our lives not least in the way that we begin to take an interest in toilet facilities! Train travel begins to be a better option that coach travel. Being “caught short” is always at the back of your mind. This of course is not helped by the steady decline in public toilets. Its a salutary fact that in the last decade 50% of public toilets have been closed by local authorities. As we oldies are increasing in number there needs to be a radical rethink about public policy on facilities. And the stern warning posted in pubs and shops that “These toilets are for the use of customers only” doesn’t help. I can’t be the only person who in desperation has gone into a pub and bought a lemonade simply to be able to use the toilet! Perhaps we need a law similar to other European Countries that allows compels bars and cafes to make their facilities available toall

Medically our options are limited. True there are certain conditions like Prostate enlargement or Irritable bladder syndrome that can be helped by medication but sadly in the majority of cases your bladder will change the way you behave Be prepared! A last plea to those who operate trains and planes – please avoid your facilities being “Out of Order”. Perhaps as well as punctuality league tables we should have data on how often toilet facilities are working – and refunds if they aren’t.