As a 93-year-old doctor, I am thoroughly familiar with the effects of aging and the constant adjustments we all need to make to meet its rising challenges. A particularly concerning issue is nocturia, characterized by frequent, late-night trips to the bathroom. This not only disrupts sleep but also poses safety risks. Nocturia requires me to leave my bed, turn on a light, and navigate to the restroom, all of which heighten the chance of a fall.

My own experiences with urinary hesitancy and frequency motivated me to investigate straightforward solutions to minimize this risk. The aim was clear: to initiate and finish urination safely while staying in bed with the aid of a urinal. The solution was found not in medication, but in a lesser-known fact of neuroanatomy.

The Anatomical Insight

The crucial factor was to directly activate a reflex arc that I recognized as being functionally linked to the bladder and associated with the perineal branch of the pudendal nerve originating from S2-4. This nerve delivers both motor control and autonomic functions to the pelvic region, including the posterior skin of the scrotum. My intention was not to circumvent the entire system, but to manually “stimulate” this nerve; thereby assisting in activating the normal neurological pathways essential for effective urination.

The Technique I Use Every Night

The technique, which can complement the Crede maneuver, has proved effective for me consistently over five years. It is extraordinarily straightforward and can be executed whether lying in bed or standing:

– Position the urinal receptacle.
– Initiate gentle manual stimulation across the infero-posterior skin of the scrotum. This maneuver targets the perineal branch of the pudendal nerve, which manages sensory input from this area only and crucially regulates the urethral sphincter. A different nerve branch enervates the remainder of the scrotum and lacks effectiveness.
– Commence with a gentle rubbing or a pill-rolling motion over the infero-posterior region of the scrotum, adjusting the pressure or intensity as needed (occasionally requiring firm pinches to the skin) until urine flow starts, typically within seconds.

It is advisable to maintain this intermittent stimulation until the bladder feels drained. This technique often leads to the release of flatus, which serves as a physiological indicator. It can be attributed to the perineal branch’s involvement in relaxing both the anal and bladder sphincters.

This maneuver is generally sufficient on its own. Incorporating the Crede pressure before starting usually enhances the effectiveness of this technique.

For five years, this approach has reliably granted me control over urination during both day and night, and its efficacy has remained steady. The novelty lies in its simplicity: unlike the extensive studies on electrical stimulation of the pelvic plexus, pudendal, or tibial nerves documented in the literature, this is a harmless and readily accessible technique.

A Piece of Clinical Wisdom

As healthcare providers, we frequently emphasize intricate interventions, yet the most significant issues facing our elderly patients (such as safely resting through the night) can often be addressed through straightforward, low-tech methods. The relief I discovered in this “new” reflex provides a significant moral uplift; aging should not relegate anyone to the sidelines.

This uncomplicated, no-cost technique could be an invaluable, low-risk resource for primary care doctors, internists, and geriatricians to recommend to their male patients experiencing nocturia. The ramifications of a single serious fall far surpass the importance of this simple anatomical insight. I urge my colleagues to investigate and disseminate this observation.

Neil R. M. Buist is a pediatrician.