Jerry G. Blaivas, MD
Clinical Professor of Urology, Weil-Cornell Medical School
Adjunct Professor of Urology, SUNY-Downstate Medical School
You’ve all probably seen ads on television showing women rushing to the bathroom because of a severe or sudden urge to urinate. That’s overactive bladder (OAB). You’ve also seen ads of men rushing to the bathroom at football games. Those ads say it’s a prostate or “growing problem” – the prostate is getting too big or causing a blockage resulting in the bladder becoming overactive. Whether you are a man or a woman, if you have to rush to get to the bathroom to urinate, you have overactive bladder. Most of the time, there are other symptoms that accompany OAB – frequency of urination, loss of urine control on the way to the bathroom or waking from sleep to urinate. Sometimes OAB presents with other related symptoms such as difficulty starting urination, having to push or strain and having a weak stream. Occasionally it can get so bad that you cannot urinate at all and a tube (catheter) needs to be inserted temporarily into the bladder to let the urine out.
The causes of overactive bladder are different in men and women; in men, about two-thirds of the time, a blockage to the flow of urine by the prostate is the culprit, but there are other causes as well. These include weakness of the muscles of the bladder, infection of the bladder or prostate (prostatitis), bladder stones and even bladder cancer. Neurologic conditions such as Parkinson’s disease, nerve damage from a stroke, multiple sclerosis and diabetes can also cause symptoms of OAB.
So, if you’re a man and you have OAB, what should you do? The first step is to see your doctor. The doctor should take a brief history focusing on the urinary tract and previous medical conditions and procedures. The doctor then should examine you; typical examinations include a digital rectal examination, focus neurological examination and anal sphincter tone. The doctor should also check a urine specimen for infection or microscopic blood. He/she should also check how well you are emptying your bladder. That can be done by a simple examination or by an ultrasound– a simple, non-invasive, painless test done in the office. If there are signs of infection, you will be started on antibiotics and you should get better within a matter of days. Once you are better the doctor might suggest that you have more tests to determine why you got the infection in the first place. The usual reason is that there is a blockage by the prostate and he/she might recommend treatment for that.
If you are not emptying your bladder completely and/or if there are other signs of a blockage by the prostate, your doctor will probably recommend either a medication called an alpha-blocker or want you to see a urologist right away. An alpha-blocker is a medication that helps to relax the muscles in the wall of the prostate and that helps to relieve the blockage. It is also effective in relieving the OAB symptoms. If the medication alone or a combination with other medications does not alleviate your symptoms, then you should see a urologist. The urologist will likely recommend more tests to determine the cause of your symptoms. He/she may want you to complete a diary for 24 hours in which you record the time and amount of each urination, perform an uroflow test (urinating into a special toilet in the bathroom that measures how fast the urine comes out) and check for residual urine with an ultrasound. On the basis of these tests, he can determine whether there might be a blockage by the prostate. If there is, he will likely prescribe an alpha-blocker, if you are not already taking one, or possibly add another type of medication called a 5 alpha reductase inhibitor, if the prostate is enlarged. If there are no signs of a blockage he/she may recommend a behavior modification approach or prescribe an anticholinergic medication that relaxes the muscles in the walls of the bladder and diminishes the strong urge to urinate.
These treatments are effective in the majority of men and often have long lasting results. When they are not effective or if the effect wears off, surgical treatment of a blockage by the prostate is effective in the vast majority of men and those results are long lasting too. The two best operations are transurethral resection of the prostate (TURP) and laser ablation of the prostate. Both operations are done by passing a surgical instrument through the penis and cutting out (TURP) or vaporizing (laser) the prostate. The operations are very safe, require no incisions and either no or very short hospital stay. There are very few serious complications and the success rate is very high.
In conclusion, most men with OAB also have prostatic obstruction. Treatment of the obstruction is effective in majority of patients. For those without obstruction, there are a variety of effective treatments.