Symptoms of Enlarged Prostate May Be Similar to Bladder Control Problems
Overactive bladder is a common bladder control problem in which a frequent and intense urge to urinate may be accompanied by wetting accidents. Approximately 33 million Americans are affected by overactive bladder, and the risk increases with age. Contrary to popular belief, men are just as likely as women to develop the problem, although women are more likely to experience wetting accidents.
In men, the symptoms of overactive bladder can be mistakenly attributed to benign prostatic hyperplasia (BPH). In fact, some men suffer from both overactive bladder and BPH. Bladder control problems may also be caused by stress incontinence, a leakage of urine brought on by activities such as coughing, sneezing, laughing, or exercising.
Because stress incontinence can overlap with both overactive bladder and BPH, proper evaluation by a physician is essential for an accurate diagnosis. If overactive bladder is the problem, a variety of effective OAB treatments are available.
How the Urinary Tract Functions
Urine is produced by the kidneys and transported to the bladder via two tubes called ureters. Urine leaves the bladder and exits the body through another tube, the urethra. Urination is primarily controlled by two types of muscles: the detrusor and the sphincters. The detrusor is a large smooth muscle in the wall of the bladder that squeezes urine out of the bladder at the time of urination. The sphincters are muscles located at the bladder neck (smooth muscle sphincter) and below the prostate (skeletal muscle sphincter). Sphincter tone prevents urine from passing through the urethra.
As the bladder fills, the sensation to urinate becomes evident, and through coordination with the voiding center in the brain, urine is squeezed out of the bladder when the sphincters relax and the detrusor contracts.
How Overactive Bladder Develops
When nerves carrying messages to and from the bladder don't work properly, the detrusor muscle can become overactive and squeeze the bladder before it has filled adequately. In many cases, the reason for this overactivity is unclear. Experts speculate that overactive bladder may be related to aging. Damage to the nerves in the pelvic area during surgery may be another contributing factor.
Medications, such as some sedatives, diuretics and sleeping pills, can contribute to overactive bladder. Products found at your local supermarket also can irritate the bladder and cause problems. For example, concentrated citrus products are a common cause of bladder problems, and caffeine can reduce the body's ability to retain urine. Other items that may exacerbate overactive bladder in some people include:
- carbonated beverages (with or without caffeine)
- milk or milk products
- tomatoes or tomato-based products
- highly spiced foods
- sugar, honey and corn syrup
- artificial sweeteners
If any of these products increases urinary symptoms, it should be eliminated from your diet.
The Best Way To Treat Overactive Bladder
The best program for someone with overactive bladder involves
- eliminating bladder irritants
- drinking four to eight glasses of water a day (because restricting fluid intake results in concentrated urine that can irritate the bladder)
- strengthening the pelvic floor muscles
- retraining the bladder
- taking medication
A complete bladder-training program can take as long as 60 days to produce results. The goals are to be able to hold about 1 pint of urine in the bladder and to urinate every two to four hours during the day. To begin the program, keep a detailed bladder control diary for at least 72 hours. The diary helps you keep track of what you drink, how much you drink, how many times you urinate and how much each time (a minimal, moderate, or large amount), whether you felt a strong, sudden urge to urinate, and what activity was interrupted by the need to urinate. Wetting accidents are also noted.
Kegel exercises are performed daily. These exercises strengthen the pelvic floor muscles and help reconnect the transmission of nerve impulses between the bladder and the brain. To retrain the bladder, when you feel the urge to urinate, try to hold the urine for five minutes before going to the bathroom. The pelvic floor exercises will help with this. Each week, add five minutes to the length of time the urine is held before going to the bathroom.
Prescription drugs for overactive bladder relax the bladder muscle and decrease its sensitivity to irritants. By reducing the sensation of urgency, the drugs also provide more time to get to the toilet. Medications for overactive bladder include
- darifenacin (Enablex)
- fesoterodine (Toviaz)
- oxybutynin (Ditropan, Ditropan XL, Gelnique, Oxytrol)
- solifenacin (Vesicare)
- tolterodine (Detrol, Detrol LA)
- trospium (Sanctura, Sanctura XR)
Common side effects of these drugs include dry mouth and constipation.
Options of Last Resort
When medication and behavioral therapies do not provide sufficient relief, doctors sometimes turn to neuromodulation. This minimally invasive procedure involves the implantation of a device that emits electrical impulses to stimulate the sacral nerves located in your lower back just above your tailbone. These nerves control the bladder and other muscles that are involved in urination.
Another option is injections of botulinum toxin type A (Botox) into the detrusor muscle, but this approach is still experimental.
When To Seek Medical Care for OAB
If you answer yes to one or more of the following questions, speak to your doctor about overactive bladder. Your doctor may refer you to a urologist for more detailed testing and treatment.
- Do you urinate more than eight times in a 24-hour period?
- Do you go to the bathroom so frequently that it interferes with the things you want to do?
- Do you have to get up two or more times at night to go to the bathroom?
- Do you frequently have strong, sudden urges to urinate?
- Do you have uncontrollable urges to urinate that sometimes result in wetting yourself?
- Do you use pads to protect your clothing from wetting?
- When you go out, do you make sure you know the location of available bathrooms?
- Do you avoid certain places if you think there won't be an available bathroom?