DEAR DR. ROACH: I recently contracted a rather severe case of bacterial pneumonia, requiring 10 days of amoxicillin. It has left me with a problem — I have an enlarged prostate. Prior to getting pneumonia, I had to go to the bathroom three times a night, which I could handle. Now I have to urinate every hour on average, which is keeping me from getting a good night’s sleep. Why the change, and can anything be done about it? — E.W.
ANSWER: A sudden change in urinary frequency leads me to suspect that something has happened other than just an enlarged prostate. The first thing I would consider would be medication. Amoxicillin doesn’t worsen the prostate, so you should ask your doctor or pharmacist if you were given another medicine at the time you had pneumonia. Antihistamines are common causes.
I would also be concerned that you might have a urine infection. Some bacterial pneumonias can be complicated by bacteria in the blood, which can then go into the urinary system. Amoxicillin, however, is a pretty good antibiotic for the urinary system, so unless the bacteria is highly resistant, this doesn’t seem likely. Still, a urine test would be appropriate.
If you had a urinary catheter (Foley) placed, this can exacerbate prostate problems after it is removed due to trauma and inflammation. A stone can also cause these symptoms.
If none of these are the issue, then it is time to visit a urologist, who can do some flow studies and look at how much urine is in your bladder after you finish urinating. If it’s just the enlarged prostate, medicines like tamsulosin help immediately, while finasteride and similar medications shrink the prostate slowly over a span of months.
Finally, an overactive bladder and prostate enlargement sometimes go together, causing worse symptoms and requiring two different types of treatment.
DEAR DR. ROACH: Every morning, after drinking 1-2 cups of coffee, I spend a few hours having to clear my throat. It’s like having a chest cold. I’ve tried avoiding milk, using powdered creamer and drinking it black. Nothing helps. Any ideas? — L.M.
ANSWER: You might be getting gastroesophageal reflux, which is when stomach contents go backward from the stomach up into the esophagus. There is a muscular valve, the lower esophageal sphincter, that is supposed to prevent this, but caffeine in coffee weakens the muscle and can allow acid to go backward where it doesn’t belong. Most people notice heartburn (a burning sensation), while others have a cough. But throat-clearing is not an uncommon symptom for gastroesophageal reflux disease (GERD). The timing of the symptoms (after the coffee) is very suspicious.
Although there are medicines to promote movement of food and acid the correct way, we seldom use them due to their long-term side effects. Avoiding the offending foods (or beverages, in your case) is effective.
At least one study showed that switching to decaffeinated coffee improved symptoms; however, there seem to be substances even in decaf coffee that also promote reflux.
Medicines to reduce acid production by the stomach, like famotidine, are effective at improving symptoms. It would be a useful diagnostic test to see if the medicine can stop the throat-clearing after you have your coffee.
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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.
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