As men age, they may find themselves rushing to the toilet a lot more frequently.
This usually gets dismissed as part of growing older.
Your hair gets greyer, your back aches and you need to pee a lot more.
Yet, despite being so common among older adults, OAB is not simply a part of aging.
The urinary tract is a system that ensures waste materials that are produced by the kidneys can be removed from the body.
When the kidneys remove waste, the waste is transferred to the bladder through the ureters. Urine then collects in the bladder.
Once full, a signal is sent to the brain, which makes the person feel the urge to urinate. During urination, the bladder empties urine through the urethra.
While the bladder will signal fullness in a healthy person, there are times when this part of the urinary tract can become overactive.
In this article, we will look at symptoms, causes, and treatment options available to patients with an overactive bladder (OAB).
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What is an Overactive Bladder?
An overactive bladder is a name for a group of urinary symptoms that cause a sudden urge to urinate (urinary urgency).
Overactive bladder syndrome, coupled with urinary leakage, is referred to as urgency urinary incontinence.
Another common type of urinary incontinence is stress incontinence.
This is caused by weakness in the pelvic floor muscles.
The symptoms of stress incontinence include leakage when coughing, straining, or physical activity. Treatment for stress incontinence is very different than urge incontinence
An estimated 33 million Americans have OAB, reports the Urology Care Foundation, and as many as 30 percent of men experience symptoms.
It can be a challenging condition, with many men often embarrassed to talk about their symptoms.
It can have a major impact on people’s lives, causing embarrassment and shame. It can also impair relationships and leave many people feeling isolated, affecting the quality of life.
While treatments are available for an overactive bladder, the options are not directly targeted at treating this as a condition.
Instead, a thorough diagnosis is needed. This is followed by a treatment plan that addresses the underlying factors that are causing the patient to experience these symptoms.
Patients must note an overactive bladder is not considered to be just another sign that they are getting older.
What causes Overactive Bladder?
An overactive bladder can cause a man to have an urge to urinate much more frequently normal.
Understanding the potential causes behind these symptoms is a critical part of initiating the right treatment plan.
To understand why a person may experience an overactive bladder, it is important to consider the causes, as well as potential risk factors behind this range of symptoms.
Some of the most common causes include:
- Enlarged prostate– Benign prostatic hyperplasia (BPH) is a common condition that affects the prostate gland. This condition refers to an enlargement of the prostate gland.
When the gland swells and becomes larger, it can put pressure not only on the urethra but also on the bladder. In turn, the man may experience frequent urination, along with an urge to urinate even when the bladder is empty.
This condition is known to cause other issues in men as well. Urinary retention is also a relatively common issue among men with an enlarged prostate.
- Type 2 Diabetes– Being previously diagnosed with type 2 diabetes, which can cause nerve-related damage.
- Bladder abnormalities-This may include the development of bladder stones. A person with a tumor in their bladder may also experience these symptoms.
- Neurological disorder-Multiple sclerosis is one particular neurological disorder known to contribute to an overactive bladder.
- Stroke- A stroke can cause neurological damage, which can make it more difficult for the body to effectively exchange messages between the body and the brain.
- Cognitive decline– When there is a decline in cognitive functioning, it can cause problems with the bladder’s ability to send and receive signals to (and from) the brain. In turn, several urinary symptoms may be experienced.
- Spinal cord injury– Injury to the spinal cord may interrupt communication between the nerves in the spinal cord that control bladder and bowel function and the brain. This can result in urinary incontinence.
- Fluid intake– Consumption of alcoholic beverages. The same goes for consuming too much caffeine. Both can cause a frequent urge to urinate.
- Urinary tract infection– The development of a urinary tract infection will cause not only frequent urination but also painful urination in men.
- Medication-Drugs known as diuretics can cause increased urine production.
These drugs may be provided to a patient when they have excessive amounts of fluids in their bodies, resulting in urinary frequency.
Some drugs also require a person to drink a large amount of fluids, such as water, with them. This can lead to the development of overactive bladder symptoms.
What are the symptoms of Overactive Bladder?
Symptoms of an overactive bladder may include the following:
- A sudden and uncontrollable urge to urinate– The urge can come and go, but some people do experience the symptoms for a more prolonged period at once.
- Urge incontinence– urge incontinence refers to some urine being expelled involuntarily when the person experiences the urge to urinate.
- Nocturia– Nocturia is a term used to describe frequent urination during the night. When a person needs to get up from sleep at least two times every night, then they are suffering from nocturia.
If these symptoms of oab are present, it is important to take note of how frequently they need to urinate.
In many cases, a patient with an overactive bladder will find that they have to urinate at least eight times – sometimes more – in a single 24-hour period.
What are the complications of Overactive Bladder?
Common complications that can result from overactive bladder include
- urinary tract infections (UTIs)
- dehydration
- skin irritation
- skin infection
- bladder stones
- falls/fractures
- sleep disturbances
- negative impact on the quality of life
- negative impact on sex life
- depression
How is Overactive Bladder diagnosed?
A diagnosis is essential before initiating a plan to treat overactive bladder.
As discussed, some numerous conditions and factors can contribute to these symptoms. Therefore, the treatment approach that needs to be taken for each of these potential causes differs from each other.
The first step is for the patient experiencing the symptoms to visit a physician.
The person should provide details about the symptoms that they are experiencing.
The information provided will help the physician determine if they will be able to assist or if a referral to a urologist might be needed.
Several steps may be required to make an accurate diagnosis. These steps may include:
Medical history
In most cases, the patient’s medical history will be requested. The healthcare provider will ask the patient about any existing conditions. This can help them determine if there might be a link.
For example, a person with diabetes might be suspected of nerve damage when they experience an overactive bladder.
The patient will also be asked about any pharmaceutical drugs that they are taking. This will include both over-the-counter medications, as well as prescription drugs.
In most cases, the urologist will also want to know about the patient’s lifestyle, their diet, and when they drink most of their fluids.
Physical examination
The urologist will examine the pelvis, as well as the abdomen. In men, a digital rectal exam may also be done to determine if there is an enlargement of the prostate.
During the examination, any abnormalities detected by the provider will be noted and inspected. These may indicate the underlying cause.
Urinalysis
A urine sample may be collected from the patient to determine if there might be an infection in the urinary tract. This sample can also be used to determine if blood is present in the patient’s urine.
A postvoid residual test is also typically administered, to determine the amount of urine left in the bladder afr#ter urination.
A bladder scan can also be used to determine if the bladder is not emptying during urination. In some cases, a urologist may also advise the patient to undergo urodynamic testing, as well as a cystoscopy.
Bladder diary
The patient may also be advised to carry a bladder diary with them. The diary will usually need to be used for at least a couple of weeks. Different data should be marked in the diary.
They might also be advised to write down the type of fluid consumed. Urination needs to be tracked as well, as well as urinary frequency associated with an overactive bladder.
Furthermore, the patient should also note down any time they experience a leak directly after such an urge.
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Treatment options for Overactive Bladder
The best treatment for an overactive bladder varies between patients, as the underlying cause needs to be targeted.
Surgery
Surgical procedures are considered a last line of treatment. They are only offered to a patient when no other treatment options have improved symptoms.
Two general surgical procedures may be used to help reduce the symptoms of an overactive bladder.
- Augmentation cystoplasty may be used to make the bladder larger. This could help provide a larger area for urine to collect. It may be useful when the consistent urge to urinate is caused by insufficient space in the bladder.
- A urinary diversion is sometimes used to re-route how urine flows from the bladder. Usually, the bladder is emptied at the bladder neck into the urethra, where the urine is then expelled from the body.
Less-invasive surgical options (injection of botulinum toxin into the bladder wall) and electrical stimulation therapies, including sacral neuromodulation (Interstim), may also be suggested.
In cases where a male patient has an enlarged prostate that is not responding to any treatments, a surgical procedure may also be used.
Different types of enlarged prostate surgery exist, but men should understand both the pros and cons of these procedures.
Medication
Certain pharmaceutical drugs may be provided to a patient when they experience an overactive bladder.
The specific drugs depend on the findings of tests conducted to identify a potential underlying cause.
Two of the most common drugs that are generally prescribed to patients when they experience overactive bladder symptoms include:
- Beta-3 agonists
- Antimuscarinic
These drugs both work by helping the bladder muscle to relax.
The idea behind the use of these drugs is to reduce the squeezing or spasm in the bladder that occurs when the person has an urge to urinate.
This is what often causes some urine to leak from the bladder.
In some cases, the patient may only be provided with one of these drugs.
There are, however, cases where combination therapy offers a more effective approach for the treatment of overactive bladder.
In these cases, both of these drugs will be used to provide a more potent effect on relaxing the bladder’s muscle.
Men with benign prostatic hyperplasia experiencing an overactive bladder may be provided with alpha-blockers to help ease oab symptoms.
Different types of alpha-blockers may be prescribed to the patient. These include:
- Prazosin
- Alfuzosin
- Terazosin
- Silodosin
- Tamsulosin
In addition to alpha-blockers, drugs classified as 5-Alpha Reductase Inhibitors may also be used to treat an enlarged prostate.
This helps to reduce the production of specific hormones that have been linked to benign prostatic hyperplasia.
While alpha-blocker medication may provide relief for urinary symptoms, they do have adverse side effects.
Common side effects that have been reported include; hypotension, dizziness, headaches, and low blood pressure.
Pelvic muscle rehabilitation
This treatment program may help some people experience a reduction in bladder symptoms.
Bladder training, Pelvic floor muscle exercises, or Kegel exercises, are often included as part of these programs to help improve bladder control.
Bladder training is an important form of behavior therapy that can help to treat treating urinary incontinence. It aims to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold.
Bladder retraining requires following a fixed voiding schedule, whether or not you feel the urge to urinate. This therapy can be combined with pelvic floor exercises.
Pelvic exercises host a range of health benefits for men, especially when it comes to prostate health.
During prostate treatment, the muscles surrounding the prostate can become gradually weakened, resulting in urine leakage and even incontinence.
By implementing kegel exercises in your treatment plan, you can strengthen your pelvic muscles, helping to improve urinary symptoms.
Additionally, there might also be electrical stimulation (tibial nerve stimulation) that specifically targets the pelvic floor muscles.
Biofeedback is also sometimes used as part of a pelvic muscle rehabilitation program and can help identify the pelvic floor muscles to ensure proper muscle contractions.
Diet and lifestyle adjustments
Certain changes to a patient’s lifestyle can sometimes lead to a significant improvement in symptoms experienced.
The process is referred to as behavioral therapy and will teach the patient-specific adjustments that can be made to help improve bladder function and bladder control.
In this type of treatment approach, certain foods and drinks known to irritate the bladder are limited, including:
- Alcohol
- Soda
- Spicy foods
- Caffeine
- Certain citrus foods
While Kegel exercises are often included in a lifestyle adjustment plan, other types of physical activities may also be recommended.
Natural supplements
Some supplements have shown potential when it comes to improving urinary tract symptoms.
A man with urinary tract problems that include symptoms classified in the term “overactive bladder” might want to look at some supplements known to help with an enlarged prostate, for example.
Up to three-quarters of OAB sufferers seek out complementary and alternative medicines.
Some further supplements that have been studied and proven to improve urinary symptoms include:
- Ryegrass Pollen– Rye Grass Pollen is a natural source of antioxidants, amino acids, fatty acids, vitamins and minerals (Rzepecka-Stojko, 2015).
Pollen extract may improve urinary function by relaxing smooth muscle tone and increasing bladder muscle contraction (Kimura, 1986) and/or relaxing sphincter muscles (Nakase, 1988).
- Beta-sitosterol- Beta-sitosterol is a sterol, similar to cholesterol, found in plant foods. One 2000 review of four randomized, placebo-controlled, double-blind studies examined over 500 men suffering BPH.
The results found that beta-sitosterol significantly improved urinary symptoms, residual volume, and urine flow. - Saw Palmetto– Saw palmetto is the most commonly used herbal supplement for treating lower urinary tract symptoms.
During a Chinese study, saw palmetto was given to 165 BPH patients for a period of 3 months.
The dose was small (160mg), yet the symptom score of the patients improved significantly after only 6 weeks. It got even better at the 12-week mark. The patients could urinate with a fuller stream, and they also had fewer feelings of retention.
- Pygeum– Pygeum is an herb that comes from the African Cherry tree.
A review of 17 double-blinded studies examined the effects of pygeum africancum for treating BPH (Ishani, 2000).
The study found that patients were 35% more likely to show symptom improvement. There was also a reduction in urinary retention, improved urine flow and a reduction in night time incontinence.
- Gosha-jinki-gan– Gosha-jinki-gan (GJG) is a traditional Chinese blended herbal medicine composed of 10 different herbs.
In a double-blind, placebo-controlled, randomized study, GL was studied in 50 healthy volunteer men.24,25 IPSS scores improved by a mean of 3.22 over 8 weeks.
Conclusion
The inability to control one’s own urge to urinate can be unpleasant and even lead to embarrassing situations in public.
There are various reasons why a person may experience symptoms associated with an overactive bladder.
A thorough diagnosis of the underlying health problems is needed for an appropriate treatment plan to be provided.
Treatments may also differ between male and female patients, due to specific differences in the urinary tract, which often leads to different underlying causes.
