"MY BLADDER IS RUINING my life," Mr. X said as he sat down on the exam table, already nervous about his first time seeing a urologist. He had considered skipping his appointment, but he simply can't stand his urinary symptoms anymore. He feels like he's constantly rushing to the bathroom, and he worries that if he doesn't get there in time, he'll leak urine. He's tried medication for his prostate, but nothing seems to help. If this description was of a 60-year-old woman, the leading diagnosis would be overactive bladder syndrome, given that obstruction is much less common in women. However, in a man, the leading diagnosis is often urinary symptoms associated with an enlarged prostate or benign prostatic hyperplasia. While this may often be the case, we must also consider the possibility that these symptoms are caused primarily by the bladder itself. In fact, several large population-based studies have shown that overactive bladder symptoms affect both men and women, and symptoms increase in both sexes with age. One study showed that overactive bladder symptoms affect 27 percent of men over age 40 at least sometimes. Is the problem with the prostate? The American Urological Association has published recommendations regarding the evaluation of men with lower urinary tract symptoms like those described by Mr. X. All men should undergo a thorough medical history, including questions regarding symptoms, concurrent medical problems, medications and behavioral habits. People should also complete validated questionnaires during their office visit. Additionally, patients should have a complete physical examination, including an exam of the prostate. Finally, a urine sample should be analyzed to assess for microscopic blood in the urine or any evidence of infection. Additional testing may be required if the underlying cause of the patient's symptoms remains unclear. Even after an in-depth evaluation, it's not always easy to separate whether there's a problem with the bladder (overactive bladder syndrome) vs. a problem with the prostate (urinary symptoms associated with BPH). This is especially true in men who have both of these issues. When do you need prostate treatment vs. bladder treatment? Several studies have tried to differentiate between symptoms related to bladder emptying, which would suggest that you should treat the prostate, compared to symptoms related to bladder storage, which would suggest that you should treat the bladder. If you're scratching your head wondering what this means, you aren't alone. If the prostate is the primary problem, typical symptoms include a weak urine stream, difficulty getting the urine to come out and the feeling that you can't empty your bladder completely. Primary bladder problems are typically associated with a significant urge to urinate, having to rush to urinate or the fear that you'll leak urine if you can't get to the bathroom quickly enough. If this distinction in symptoms can be made, treatment can be focused on the appropriate organ. Finally, sometimes patients need treatment for both the prostate and bladder. There have been several widely respected studies that have shown that men with both prostate and bladder problems are most effectively treated with combination therapy aimed at both the prostate and the bladder. What are treatment options for over active bladder? After an in-depth conversation with Mr. X, we identified that his symptoms are most likely related to a problem with his bladder – so what comes next? The first step in treating overactive bladder syndrome is to make necessary lifestyle changes. This includes: Eliminating foods that contain caffeine, a known bladder irritant, often found in coffee, tea, soda or chocolate. Research has shown that consuming more than 250 milligrams of caffeine is associated with moderate to severe urinary leakage in men. An average 16-ounce cup of coffee contains between 225 to 300 milligrams of caffeine, so you can imagine the effect that quenching our coffee fix has on our bladders. Weight loss. Treatment of other medical problems like diabetes. Avoiding toxins like cigarette smoke. If there is no significant improvement in symptoms with lifestyle changes, there are medications that can be offered to address overactive bladder syndrome. Two classes of medications exist for treatment: anticholinergic medications and beta 3-adrenoceptor agonists. Finally, if symptoms are not controlled with medication, alternative therapies can be offered, including: injection of Botox into the muscular wall of the bladder, peripheral tibial nerve stimulation and sacral neuromodulation. Consult with a specialist to find out more. For people who are struggling with urinary complaints like Mr. X, we encourage you to seek out an evaluation by a urologist. These issues are not a normal part of aging, and with treatment, you can greatly improve your quality of life. Source
