Nocturnal Panic Attacks

Nocturnal Panic Attacks: Understanding the Nighttime Crisis

Nocturnal panic attacks are sudden episodes of intense fear or discomfort that occur during sleep, often waking individuals from their slumber. These episodes can be frightening and disorienting, leading to significant distress and anxiety about future occurrences. Understanding nocturnal panic attacks is important because they can negatively affect sleep quality, mental health, and overall well-being.

Why This Condition is Clinically Important

Nocturnal panic attacks are clinically significant because they can disrupt sleep patterns and contribute to the development of anxiety disorders. Individuals experiencing these attacks may avoid sleep, fearing another episode, which can lead to chronic sleep deprivation and associated health issues. Recognizing and addressing this condition is essential for improving quality of life and mental health.

Who is Commonly Affected

Nocturnal panic attacks can affect anyone, but certain groups may be more susceptible. These include:

• Individuals with a history of panic disorder or anxiety disorders
• Those with a family history of anxiety-related conditions
• People experiencing high levels of stress or trauma
• Individuals with sleep disorders, such as sleep apnea

Brief Overview of:

Causes

The exact causes of nocturnal panic attacks are not fully understood, but they may involve a combination of genetic, psychological, and environmental factors. Stressful life events, changes in sleep patterns, and certain medical conditions can also contribute.

Symptoms

Symptoms of nocturnal panic attacks can include:

• Sudden awakening with a racing heart
• Shortness of breath or difficulty breathing
• Sweating or chills
• Trembling or shaking
• Feelings of impending doom or loss of control

Possible Outcomes and Prognosis

While nocturnal panic attacks can be distressing, they are often manageable with appropriate treatment. Many individuals find relief through therapy, lifestyle changes, and, in some cases, medication. Early intervention can lead to a better prognosis and improved quality of life.

Definition & Medical Overview

Clear and Simple Medical Definition

Nocturnal panic attacks are defined as episodes of intense fear or discomfort that occur during sleep, typically characterized by physical symptoms such as palpitations, sweating, and a sense of impending doom. These episodes typically last several minutes and may persist for up to 30 minutes and often leave individuals feeling exhausted and anxious.

How the Condition Affects the Body

During a nocturnal panic attack, the body experiences a surge of adrenaline, triggering the fight or flight response. This response can lead to various physical symptoms, including increased heart rate, rapid breathing, and heightened awareness. The sudden activation of this response during sleep can be particularly alarming.

Organs or Body Systems Involved

The primary systems involved during a nocturnal panic attack include:

• Nervous System: The autonomic nervous system is responsible for the body's stress response.
• Cardiovascular System: Increased heart rate and blood pressure occur as part of the panic response.
• Respiratory System: Breathing may become rapid and shallow, leading to feelings of breathlessness.

Acute vs. Chronic Nature

Nocturnal panic attacks can be acute, occurring sporadically, or they may become chronic if left untreated. Chronic episodes can lead to ongoing anxiety about sleep and may contribute to the development of other anxiety disorders.

How it Differs from Similar Conditions

Nocturnal panic attacks differ from other sleep disorders, such as night terrors or sleepwalking, in that they are primarily characterized by intense fear and anxiety rather than confusion or disorientation. Unlike night terrors, individuals experiencing nocturnal panic attacks usually awaken fully alert and aware of their surroundings.

Epidemiology & Prevalence

Global Prevalence and Burden

Globally, panic disorder affects approximately 2-3% of the population during their lifetime, with nocturnal panic attacks being a common symptom. The prevalence of nocturnal panic attacks specifically is less well-documented, but they are recognized as a significant concern among those with panic disorder.

India-Specific Relevance or Trends

In India, mental health issues, including anxiety disorders, are on the rise. Cultural factors, lifestyle changes, and increased stress levels contribute to the growing prevalence of panic-related conditions. Awareness and understanding of nocturnal panic attacks are essential for addressing this emerging public health concern.

Age-Wise, Gender-Wise, and Risk Group Distribution

Nocturnal panic attacks can occur at any age, but they are most commonly reported in young adults and middle-aged individuals. Women are generally more likely to experience panic disorders than men. Risk factors include:

• Age: Young adults (ages 18-35) are often more affected.
• Gender: Women are more prone to anxiety disorders.
• Risk Groups: Individuals with a family history of anxiety, those experiencing significant life stressors, and people with existing mental health conditions are at higher risk.

Causes & Risk Factors

Primary and Secondary Causes

The causes of nocturnal panic attacks can be categorized into primary and secondary factors. Primary causes often relate to underlying anxiety disorders, while secondary causes may include medical conditions or external stressors.

Role of:

Genetics

Genetic predisposition plays a role in the development of anxiety disorders, including nocturnal panic attacks. Family history can increase the likelihood of experiencing these episodes.

Lifestyle

Lifestyle factors, such as poor sleep hygiene, high caffeine intake, and lack of physical activity, can contribute to the occurrence of nocturnal panic attacks. Stress management techniques and healthy lifestyle choices can help mitigate these risks.

Environmental Exposure

Environmental factors, including exposure to trauma or significant life changes, can trigger panic attacks. Stressful situations, such as job loss or relationship issues, may increase vulnerability.

Infections

Certain infections, particularly those affecting the central nervous system, may contribute to anxiety symptoms that can increase the likelihood of nocturnal panic attacks.

Autoimmune or Metabolic Factors

Autoimmune disorders and metabolic imbalances can also contribute to anxiety symptoms. Conditions such as thyroid disorders may exacerbate feelings of anxiety and panic.

Modifiable vs. Non-Modifiable Risk Factors

• Modifiable Risk Factors: Lifestyle choices, stress management, and sleep hygiene can be adjusted to reduce the risk of nocturnal panic attacks.
• Non-Modifiable Risk Factors: Genetic predisposition and family history cannot be changed but can be considered in treatment planning.

Pathophysiology (Explained Simply)

What Happens Inside the Body Step by Step

During a nocturnal panic attack, the body undergoes several physiological changes:

1. Trigger: A stressor or internal cue activates the brain's fear response.
2. Adrenaline Surge: The adrenal glands release adrenaline, leading to increased heart rate and blood pressure.
3. Physical Symptoms: The body experiences symptoms such as sweating, trembling, and rapid breathing.
4. Awareness: The individual becomes aware of these changes, often leading to heightened fear and anxiety.
5. Resolution: The episode typically subsides within minutes, but the individual may feel residual anxiety or fear about future attacks.

How the Disease Develops and Progresses Biologically

Nocturnal panic attacks may develop as a result of chronic anxiety or stress. Over time, repeated episodes can lead to a cycle of fear and avoidance, where individuals may begin to associate sleep with panic, further exacerbating the condition.

Simplified Explanation Suitable for Non-Medical Readers

In simple terms, when someone experiences a nocturnal panic attack, their body reacts as if it is in danger, even though there is no real threat. This reaction can cause a range of physical symptoms that are frightening, leading to a cycle of anxiety about sleeping and the potential for future attacks.

Symptoms, Clinical Presentation & Diagnosis

Signs & Symptoms

Common Early Symptoms

Nocturnal panic attacks often begin with sudden and intense feelings of fear or discomfort that can wake individuals from sleep. Common early symptoms include:

• Rapid heartbeat or palpitations
• Shortness of breath or a feeling of choking
• Sweating or chills
• Trembling or shaking
• Nausea or abdominal distress
• Dizziness, lightheadedness, or feeling faint
• Numbness or tingling sensations
• A sense of impending doom or fear of losing control

These symptoms can occur unexpectedly, often without any identifiable trigger, leading to confusion and distress.

Progressive and Advanced Symptoms

As nocturnal panic attacks progress, individuals may experience more severe manifestations, including:

• Increased frequency of attacks, leading to heightened anxiety about future episodes
• Sleep disturbances, such as insomnia or difficulty returning to sleep after an attack
• Avoidance behaviors, where individuals may start to avoid sleeping alone or sleeping in certain environments
• Heightened sensitivity to stressors, making everyday situations feel overwhelming

Differences Between Mild, Moderate, and Severe Presentations

The intensity and impact of nocturnal panic attacks can vary significantly:

• Mild Presentation: Occasional episodes with manageable symptoms that do not significantly disrupt daily life.
• Moderate Presentation: More frequent attacks that lead to anxiety about sleep and may cause some avoidance behaviors, affecting social interactions and work.
• Severe Presentation: Frequent and debilitating attacks that severely impact sleep quality, daily functioning, and overall mental health, often requiring professional intervention.

Variations in Symptoms Among Different Age Groups

• Children: Symptoms may manifest as nightmares, night terrors, or sudden awakenings with crying. They may not articulate their feelings of fear but may show signs of distress or clinginess.
• Adults: Adults typically experience the classic symptoms of panic attacks, including physical manifestations and cognitive distortions about their health or safety.
• Elderly Patients: Older adults may present with atypical symptoms, such as confusion or increased agitation, which can be mistaken for other medical conditions. They may also have comorbidities that complicate the presentation.

Atypical or Less Common Symptoms

Some individuals may experience less common symptoms during nocturnal panic attacks, such as:

• Visual disturbances or hallucinations
• Feelings of detachment from reality or oneself
• Gastrointestinal symptoms that mimic other conditions, such as irritable bowel syndrome

Red-Flag Symptoms & When to Seek Medical Attention

Certain symptoms associated with nocturnal panic attacks may indicate a more serious underlying condition and require immediate medical attention:

• Chest Pain: This could signify a cardiac issue and should be evaluated immediately.
• Severe Shortness of Breath: If accompanied by wheezing or a feeling of suffocation, it may indicate a respiratory emergency.
• Persistent Symptoms: If panic attacks occur frequently and disrupt daily life, it is crucial to seek help.
• Suicidal Thoughts: Any thoughts of self-harm or suicide should be addressed immediately.

Situations Where Immediate Hospital Evaluation is Needed

Seek emergency care if you experience:

• Severe chest pain or pressure
• Loss of consciousness or severe dizziness
• Symptoms that do not improve with rest or reassurance

Risks Associated with Ignoring or Delaying Medical Consultation

Ignoring symptoms can lead to:

• Worsening of panic attacks and increased anxiety
• Development of agoraphobia or avoidance behaviors
• Deterioration of overall mental health, potentially leading to depression or other mood disorders

Clinical Evaluation & Initial Assessment

When evaluating nocturnal panic attacks, healthcare providers typically follow a structured approach:

Role of Medical History

A thorough medical history is essential. This includes:

• Previous episodes of panic attacks or anxiety disorders
• Any history of mental health conditions in the patient or family
• Current medications and substance use, including caffeine and alcohol

Family History

Understanding family history can help identify genetic predispositions to anxiety disorders, which may influence treatment options.

Lifestyle and Risk Assessment

Doctors will assess lifestyle factors that may contribute to panic attacks, such as:

• Sleep patterns and quality
• Stress levels and coping mechanisms
• Physical activity and diet

Physical Examination Findings Relevant to the Condition

A physical examination may focus on:

• Vital signs to rule out cardiovascular issues
• Neurological assessments to exclude other causes of symptoms
• General health checks to identify any underlying medical conditions

Diagnostic Tests & Investigations

While nocturnal panic attacks are primarily diagnosed through clinical evaluation, certain tests may be conducted to rule out other conditions:

Blood Tests

• Complete blood count (CBC) to check for anemia or infection
• Thyroid function tests to rule out hyperthyroidism, which can mimic anxiety symptoms

Imaging Studies

• Chest X-ray or ECG to evaluate heart health if chest pain is present
• Brain imaging (CT or MRI) is not routinely required but may be considered if atypical neurological symptoms are present.

Functional Tests or Specialized Diagnostics

• Sleep studies (polysomnography) may be useful if sleep disorders are suspected.
• Psychological assessments to evaluate the severity of anxiety and panic symptoms.

Purpose and Interpretation of Key Investigations

The results of these tests help to confirm the diagnosis of nocturnal panic attacks and rule out other medical conditions that may present with similar symptoms.

Differential Diagnosis

Several conditions can present with symptoms similar to nocturnal panic attacks, making accurate diagnosis crucial:

• Generalized Anxiety Disorder (GAD): Characterized by excessive worry and anxiety that may not be limited to sleep.
• Post-Traumatic Stress Disorder (PTSD): May involve nightmares and panic-like symptoms related to trauma.
• Sleep Disorders: Conditions like sleep apnea can cause sudden awakenings with panic-like symptoms.
• Cardiac Conditions: Angina or arrhythmias can mimic panic attack symptoms, necessitating careful evaluation.

How Doctors Distinguish Nocturnal Panic Attacks from Other Disorders

Healthcare providers rely on a combination of patient history, symptom patterns, and diagnostic tests to differentiate nocturnal panic attacks from other disorders. A detailed assessment of the timing, triggers, and nature of symptoms is essential.

Importance of Accurate Diagnosis

An accurate diagnosis is vital for effective treatment planning. Misdiagnosis can lead to inappropriate treatments and prolonged suffering.

Staging, Grading, or Classification (If Applicable)

Currently, there is no formal staging or grading system specifically for nocturnal panic attacks. However, understanding the severity of symptoms can guide treatment decisions:

• Mild: Occasional attacks with minimal impact on daily life.
• Moderate: Frequent attacks that cause significant distress and avoidance behaviors.
• Severe: Persistent attacks that severely disrupt sleep and daily functioning.

What Each Stage or Grade Means Clinically

The classification of severity helps healthcare providers tailor interventions, ranging from lifestyle modifications and therapy to medication management.

How Staging Influences Treatment Decisions and Outcomes

Understanding the severity of nocturnal panic attacks can influence treatment strategies, including the choice of therapy, medication, and the need for ongoing support.

Treatment, Management, Recovery & Prevention

Treatment Options

Medical Management and Medications

The treatment of nocturnal panic attacks often begins with a comprehensive evaluation by a healthcare professional. This assessment helps determine the most appropriate treatment plan tailored to the individual's needs. Common medical management strategies include:

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are frequently prescribed to help manage anxiety and panic symptoms.
• Benzodiazepines: These medications may be used for short-term relief of severe anxiety symptoms but are generally not recommended for long-term use due to the risk of dependence.
• Beta-blockers: Sometimes prescribed to manage physical symptoms of anxiety, such as rapid heartbeat and sweating.
• Anticonvulsants: In some cases, these may be used to stabilize mood and reduce anxiety.

Non-Surgical Therapies and Supportive Treatments

In addition to medication, various non-surgical therapies can be beneficial:

• Cognitive Behavioral Therapy (CBT): This evidence-based therapy helps individuals identify and change negative thought patterns and behaviors associated with panic attacks.
• Exposure Therapy: Gradual exposure to panic-inducing situations can help reduce fear and anxiety over time.
• Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, and progressive muscle relaxation can help manage anxiety levels.

Surgical or Interventional Procedures

While surgical options are not typically indicated for nocturnal panic attacks, certain interventional procedures may be considered in severe cases where other treatments have failed. These may include:

• Transcranial Magnetic Stimulation (TMS): A non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain, potentially alleviating symptoms of anxiety and depression.
• Vagus Nerve Stimulation (VNS): This involves implanting a device that sends electrical signals to the brain, which may help reduce anxiety symptoms.

Advanced or Minimally Invasive Treatment Options

For individuals who do not respond to standard treatments, advanced options may be explored:

• Ketamine Infusion Therapy: Emerging evidence suggests that ketamine may provide rapid relief from severe anxiety and panic symptoms.
• Psychedelic-Assisted Therapy: Research into the use of psychedelics, such as psilocybin, for anxiety disorders is still experimental and not part of standard treatment recommendations.

Individualized Treatment Planning

Effective treatment for nocturnal panic attacks should be individualized based on:

• Severity of Symptoms: More severe symptoms may require a combination of medications and therapies.
• Age: Treatment approaches may vary for children, adolescents, and older adults.
• Comorbidities: Coexisting conditions, such as depression or other anxiety disorders, should be considered in the treatment plan.

Lifestyle & Supportive Care

Dietary Recommendations

A balanced diet can play a significant role in managing anxiety. Recommendations include:

• Whole Foods: Emphasize fruits, vegetables, whole grains, and lean proteins.
• Limit Caffeine and Sugar: These can exacerbate anxiety symptoms.
• Stay Hydrated: Adequate water intake is essential for overall health.

Physical Activity and Rehabilitation

Regular physical activity is crucial for mental health. Benefits include:

• Stress Reduction: Exercise releases endorphins, which can improve mood.
• Improved Sleep: Regular activity can enhance sleep quality, reducing the likelihood of nocturnal panic attacks.

Lifestyle Modifications

Making certain lifestyle changes can help manage symptoms:

• Establish a Sleep Routine: Consistent sleep patterns can improve sleep quality and reduce anxiety.
• Limit Screen Time Before Bed: Reducing exposure to screens can promote better sleep hygiene.

Mental Health and Emotional Support

Support from family, friends, and mental health professionals is vital. Consider:

• Support Groups: Connecting with others who experience similar challenges can provide comfort and understanding.
• Therapeutic Support: Regular sessions with a therapist can help individuals develop coping strategies.

Patient Education and Self-Management Strategies

Empowering patients with knowledge about their condition is essential. Strategies include:

• Understanding Triggers: Keeping a journal to identify panic triggers can help in managing symptoms.
• Developing Coping Mechanisms: Techniques such as grounding exercises can be useful during panic episodes.

Complications & Risks

Short-Term Complications

Nocturnal panic attacks can lead to immediate complications, including:

• Sleep Disturbances: Frequent attacks can disrupt sleep patterns, leading to insomnia.
• Increased Anxiety: The fear of experiencing another attack can lead to heightened anxiety levels.

Long-Term Complications

If left untreated, nocturnal panic attacks may result in:

• Chronic Anxiety Disorders: Persistent panic attacks can evolve into generalized anxiety disorder or other anxiety-related conditions.
• Social Isolation: Fear of panic attacks may lead individuals to avoid social situations, impacting relationships.

Risks Associated with Delayed Treatment or Poor Disease Control

Delaying treatment can exacerbate symptoms and lead to:

• Worsening Mental Health: Increased anxiety and depression can develop over time.
• Physical Health Issues: Chronic stress can contribute to various health problems, including cardiovascular issues.

Impact on Overall Health and Quality of Life

Nocturnal panic attacks can significantly affect daily functioning, leading to:

• Reduced Productivity: Difficulty concentrating and fatigue can hinder work performance.
• Impaired Relationships: Anxiety can strain personal and professional relationships.

Recovery & Prognosis

Expected Recovery Timeline

Recovery from nocturnal panic attacks varies by individual. With appropriate treatment, many people experience significant improvement within:

• Weeks to Months: Initial symptom relief may occur within weeks, while full recovery can take several months.

Factors Affecting Recovery and Outcomes

Several factors can influence recovery, including:

• Severity of Symptoms: More severe symptoms may require longer treatment.
• Adherence to Treatment: Consistent engagement in therapy and medication can enhance outcomes.

Long-Term Prognosis

With effective management, many individuals can expect:

• Significant Reduction in Symptoms: Many individuals experience panic attacks that become less frequent and less severe over time with appropriate treatment.
• Improved Quality of Life: Successful treatment can lead to better overall well-being.

Recurrence Risk

While many individuals experience relief, some may face:

• Recurrence of Symptoms: Panic attacks can return, especially during periods of stress or life changes.

Impact on Daily Functioning

Nocturnal panic attacks can disrupt daily life, but with treatment, individuals can regain control over their routines and activities.

Prevention & Risk Reduction

Primary Prevention Strategies

Preventive measures can help reduce the risk of developing nocturnal panic attacks:

• Stress Management: Learning stress-reduction techniques can help mitigate anxiety.
• Healthy Lifestyle Choices: Regular exercise and a balanced diet can promote mental well-being.

Secondary Prevention and Early Detection

Early intervention is crucial for those at risk:

• Regular Check-ups: Routine mental health evaluations can help identify early signs of anxiety disorders.

Lifestyle-Based Risk Reduction

Incorporating healthy habits can lower the risk of panic attacks:

• Mindfulness Practices: Engaging in mindfulness and relaxation techniques can help manage anxiety levels.

Screening or Monitoring Recommendations

For individuals with a history of panic attacks, regular monitoring may be beneficial:

• Mental Health Assessments: Periodic evaluations by a mental health professional can help track symptoms and adjust treatment as needed.

Living With Nocturnal Panic Attacks

Day-to-Day Life Considerations

Living with nocturnal panic attacks requires adjustments, including:

• Creating a Safe Sleep Environment: Ensuring a calm and comfortable sleeping space can help reduce anxiety.

Work, Travel, and Social Life

Managing panic attacks in various settings involves:

• Open Communication: Discussing concerns with employers or friends can foster understanding and support.
• Planning Ahead: Preparing for potential triggers during travel or social events can alleviate anxiety.

Long-Term Monitoring and Follow-Up Care

Ongoing care is essential for managing nocturnal panic attacks:

• Regular Therapy Sessions: Continued therapy can help maintain progress and address any emerging issues.

Coping Strategies for Patients and Caregivers

Developing effective coping strategies is vital for both patients and their support systems:

• Establishing a Support Network: Encouraging open dialogue with family and friends can provide emotional support.
• Practicing Self-Care: Both patients and caregivers should prioritize self-care to manage stress and maintain well-being.

Conclusion

Nocturnal panic attacks can be distressing, but with the right treatment and support, individuals can manage their symptoms effectively. Understanding treatment options, lifestyle modifications, and the importance of ongoing care can empower patients to take control of their health. If you or someone you know is experiencing nocturnal panic attacks, seeking timely medical consultation is crucial for effective management and improved quality of life. Remember, you are not alone, and help is available.

FAQs

1. What are Nocturnal Panic Attacks?

Nocturnal panic attacks are sudden episodes of intense fear or discomfort that occur during sleep, often waking individuals from their slumber. Symptoms may include rapid heartbeat, sweating, trembling, and a feeling of impending doom. These attacks can be distressing and may lead to fear of sleeping.

2. Are Nocturnal Panic Attacks serious or life-threatening?

Nocturnal panic attacks are not life-threatening, but they can be serious if they occur frequently or go untreated. Repeated episodes may disrupt sleep quality, leading to chronic sleep deprivation, increased anxiety about sleeping, and a reduced overall quality of life. In some cases, they may also contribute to anxiety disorders, making it important to seek appropriate treatment and support.

3. Are Nocturnal Panic Attacks curable or only manageable?

Nocturnal panic attacks can often be managed with appropriate treatment through therapy, lifestyle changes, and, in some cases, medication. While some individuals may experience a complete resolution of symptoms, others may need ongoing management to prevent recurrence.

4. What causes Nocturnal Panic Attacks?

The exact cause of nocturnal panic attacks is not fully understood, but they may be linked to stress, anxiety disorders, sleep disturbances, or genetic predisposition. Certain triggers, such as caffeine or alcohol, can also contribute to their occurrence.

5. What are the early warning signs?

Early warning signs of nocturnal panic attacks may include increased anxiety during the day, difficulty sleeping, or experiencing heightened stress. Individuals may also notice physical symptoms like a racing heart or shallow breathing before an attack.

6. When should I see a doctor?

You should see a doctor if you experience recurrent nocturnal panic attacks, if they disrupt your sleep significantly, or if you have concerns about your mental health. A healthcare professional can help determine the underlying causes and recommend appropriate treatment.

7. Is this condition genetic or hereditary?

There is evidence suggesting that panic disorders, including nocturnal panic attacks, can have a genetic component. If you have a family history of anxiety or panic disorders, you may be at a higher risk of experiencing similar issues.

8. Can Nocturnal Panic Attacks be prevented?

While not all nocturnal panic attacks can be prevented, certain strategies may help reduce their frequency. These include managing stress, maintaining a regular sleep schedule, and avoiding stimulants like caffeine and nicotine before bedtime.

9. What foods should be avoided with this condition?

Individuals experiencing nocturnal panic attacks may benefit from avoiding caffeine, alcohol, and heavy meals close to bedtime. These substances can disrupt sleep and potentially trigger anxiety or panic symptoms.

10. Can lifestyle changes improve this condition?

Yes, lifestyle changes can significantly improve the frequency and severity of nocturnal panic attacks. Regular exercise, stress management techniques, and good sleep hygiene can help reduce anxiety and promote better sleep.

11. How is Nocturnal Panic Attacks treated in India?

In India, treatment for nocturnal panic attacks may include psychotherapy, such as cognitive-behavioral therapy (CBT), and medications like antidepressants or anti-anxiety drugs. A healthcare provider can tailor a treatment plan based on individual needs.

12. When is surgery required?

Surgery for nocturia may be considered if conservative treatments fail and the condition is due to anatomical issues, such as severe prostate enlargement or bladder dysfunction. A urologist can provide guidance on this option.