All about bladder problems in men

Bladder problems in men is all about urinary incontinence and prostate gland problems.

Gary was so embarrassed by this incontinence that he tried to hide it from his wife. He would wash his underwear and then take them to the garage to dry. He also got to the point where he didn’t want to golf anymore, fearing that his swing would trigger some leakage. One thing he could not give up was playing with his grandchildren but he was afraid that if he turned the wrong way while wrestling on the floor with them, he might have an accident.

Gary’s condition is not unique. Worldwide over 43 million men suffer from incontinence.

Five types of incontinence occur in men.

Stress incontinence – You may involuntarily leak urine when coughing, sneezing, or doing anything that puts pressure on your abdomen. You may lose urine constantly if you have severe stress incontinence. This then is called total incontinence.
Urge incontinence – You have the abrupt and intense urge to urinate. Bladder contracts causing some urine to leak through the sphincter muscles. This is also the overactive bladder or bladder spasms.
Mixed incontinence – It is the combination of stress incontinence and urge incontinence.
Overflow incontinence –It is the involuntary release of urine when the bladder becomes overly full, even when you don’t have the urge to urinate. It occurs because of weak bladder muscle or due to blockage.
Functional incontinence – You may be aware of the need to urinate, but for some reason you are unable to get to the bathroom. You may leak a small amount of urine or it can be a full emptying of the bladder.

Causes of incontinence in men

Muscles and nerves work together to hold the urine and release it at the right time. Anything that goes wrong in this system can cause incontinence. Let’s take a look at some of the common causes of incontinence in men.

I. Nerve problems

Disease, injury or damage to these nerves can cause incontinence. For example, if you have diabetes, damage in the nerves that control bladder movement can cause incontinence.

Similarly, conditions like stroke, Parkinson’s disease, and multiple sclerosis that affect the brain and the nervous system can also cause bladder problems.

II. Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate gland that can make urination difficult. BPH is a common disorder that affects men, especially after the age of 50 years.

The prostate gland lies just under the bladder and surrounds the tube (urethra) that carries urine from the bladder. The gland produces fluid to feed and protect sperm cells. It is walnut sized in young men and continues to enlarge as they age.

The enlarging prostate compresses the urethra and blocks the flow of urine. If you have BPH your bladder may not empty completely after you urinate. Urine stagnates in the bladder and you may become susceptible to urinary tract infections and bladder stones. In the long run, it will weaken your bladder and increase the risk of kidney damage.

Symptoms:

You may have difficulty starting urination.
Urination may not feel complete.
Your need to urinate may become more urgent.
You may need to urinate more frequently and wake up a number of times at night to urinate (nocturia).
The volume and force of the urine flow may diminish and urine may dribble at the end of urination.

A number of complications may arise if urination is not complete. Because some urine is retained in the bladder, it increases the pressure in the bladder and consequently limits the flow of urine from the kidneys. This increases stress on the kidneys and may impede kidney function.

Again, as the bladder stretches, the small veins in the bladder and urethra also stretch. When you strain to urinate, the veins may burst causing the blood to enter the urine.

Prolonged obstruction of the urine flow can cause overflow incontinence and severe pain in the lower abdomen.

Risk factors:

Age – A study has found that prostate growth rate is 2.0 – 2.5 percent per year in older men. This goes to show that your risk of BPH rises remarkably as you grow older. [1]
Sex steroid hormones – Several studies have noted that those with the highest midlife levels of DHT (dihydrotesterone) had nearly 3 times the risk of subsequent BPH compared with those with the lowest levels. [1]
Genetics – Men with inherited forms of BPH tend to have a larger volume prostates and earlier age of onset of symptoms than men who develop BPH for other reasons.
Medical conditions – Metabolic syndrome, obesity, cardiovascular disease, and diabetes are all associated with the prostate volume. That means if you have any of these conditions you are more prone to BPH than others.
Physical exercise – Studies have shown that moderate to vigorous physical activity can reduce the risk of BPH by 25 percent relative to a sedentary lifestyle.
Diet – Increased total energy intake, energy-adjusted total protein intake, red meat, fat, milk and dairy products, cereals, bread, poultry and starch potentially increase the risks of BPH.
Inflammation – Although scientists are not clear about the mechanism, but studies have definitely shown that inflammation increases the risk of BPH.

Treatment:

Treatment options include [2] –

Drugs –

Alpha one adrenoreceptor blockers (α1-Adrenergic receptors)
5–alpha reductase inhibitors, such as, finasteride and dutasteride
Combination therapy, such as, doxazosin + finasteride, or, tolterodine (antimuscarinic agent) + tamsulosin

Surgery –

Transurethral microwave thermotherapy (TUMT): Here, a microwave antenna is inserted into the urethra via an endoscope. It emits a dose of microwave energy that heats up and destroys excess prostate tissue blocking urine flow. It is an outpatient procedure.

Transurethral resection of the prostate (TURP): This procedure takes place in an operating room under general or spinal anaesthesia. During the procedure, the surgeon threads aresectoscope through the penis to the prostate, then uses the electrical loop to cut away the overgrown tissue that’s pressing against the urethra.

Other invasive therapies include Other transurethral needle ablation of the prostate (TUNA), high-intensity focused ultrasound (HIFU), interstitial laser thermotherapy (ILTT), water-induced thermotherapy (WITT), intra prostatic injection therapy with ethanol or hyperosmolar sodium chloride, and transurethral enzyme ablation of the prostate. [2]

Prevention:

There is nothing you can do to prevent urination problems caused by BPH. However, weight loss, regular physical activity, vegetable consumption, and reduction of fatty food can reduce the probability of BPH. Disease progression can be prevented by taking 5–alpha reductase inhibitors.

III. Overactive bladder

‘Overactive bladder can result from physical problems that keep your body from halting involuntary bladder muscle contractions. Such problems include damage to the brain, the spine, or the nerves extending from the spine to the bladder — for example, from an accident, diabetes, or neurological disease. Irritating substances within the bladder, such as those produced during an infection, might also cause the bladder muscle to contract,’ say experts at Harvard Medical College. [3]

Often there is no identifiable cause for overactive bladder, but people are more likely to develop the problem as they age.

Symptoms:

You may experience urge incontinence and also loss of urine immediately following the urge to urinate because of sudden involuntary contraction of the bladder muscle.
More often than not, you will not be able to reach the toilet in time following the urge to void.
You may need to urinate frequently, the frequency being more than 8 times in 24 hours.
You will awaken more than 2 times in the night to urinate (nocturia).
Lot of urine will leak with each episode of incontinence.

Treatments:

Lifestyle interventions [5]:

Modifying excessive fluid intake
Engaging in regular exercise
Smoking cessation
Judicial limitation of caffeine
Increasing dietary intake of vegetables, beta carotene, lutein, and vitamin C may (it will lower the risk of BPH)
Bladder retraining (i.e. scheduled voiding, double voiding, judicious limitation of fluids at night)

As the incidence of OAB is high in men with obstructive sleep apnoea, addressing this comorbidity may offer additional symptom relief, according to a study published in the journal Sleep. [6]

Drugs: Most drugs for OAB target to decrease the over activity of the bladder muscle. They start to work within a couple of week and you may notice improvement by 12 weeks. Commonly used medications include [7]–

Alpha receptor antagonists, such as, alfuzosin, doxazosin, terazosin, tamsulosin, silodosin, and naftopidil
Antimuscarinic agents (improve the storage symptom of urgency and increase bladder capacity) such as tolterodine
Combination therapy of alpha receptor antagonists and antimuscarinic agents

However, the medicines may cause side effects such as dry mouth and dry eyes, but drinking water will aggravate OAB. Constipation is another side effect of the medicines.

Surgery: Your doctor will suggest surgery only when other treatments fail. Surgery is done either to increase bladder capacity, or as a last resort, removing the bladder.

IV. Interstitial cystitis (IC)

Interstitial cystitis is also called Painful Bladder Syndrome. Although this inflammation of the bladder is more common in women and is often missed in men, it is a challenging problem for men since its symptoms overlap with common conditions in men such as BPH or overactive bladder.

Symptoms:

Pelvic and bladder pain, especially pain that worsens with specific food or drink as your bladder fills
Pain and discomfort gets better with urination
Urgent need to urinate during day and night, which may be accompanied by pain, pressure, or spasms
Increased frequency of urination, up to 60 times a day in severe cases [4]
Testicular, scrotal, and/or perineal pain as well as painful ejaculation with sexual intercourse

Treatment:

Many men with IC find that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, high-acid foods, or artificial sweeteners may contribute to or aggravate bladder irritation and inflammation. Try eliminating these items from the diet and reintroduce them one at a time to determine which, if any, affects your symptoms.

Bladder instillation with dimethyl sulphoxide (DMSO) – It reduces bladder irritation and pain, helps relax the bladder and pelvic muscles, and increases bladder capacity. A measured amount of DMSO is passed through the catheter into the bladder, where it is retained for about 15 minutes before being expelled. Treatments are given every week or two for 6 to 8 weeks and repeated as needed. You may notice improvement 3 or 4 weeks after the first 6- to 8-week cycle of treatments.

Bladder distention–This is, both, a diagnostic test and initial therapy.

PentosanPolysulfate Sodium (Elmiron) oral drug – The oral dosage of Elmiron is 100 mg, three times a day. You may not feel relief from IC pain for the first 4 months and your doctor will ask you to continue for a total of 6 months. A study showed that this drug had a moderate to marked improvement in the quality of life as well. Diarrhoea, nausea and headache were the most common adverse events. [8]

Transcutaneous Electrical Nerve Stimulation (TENS) – In this treatment, mild electric pulses are sent to the body through special devices inserted into the rectum in men. The pulses are passed for minutes to hours, two or more times a day.Scientists believe that these pulses may increase blood flow to the bladder, strengthen pelvic muscles that help control the bladder, or trigger the release of substances that block pain.

Exercise and physical therapy too may help improve IC symptoms.

Surgery – Consider surgery only when other treatments have failed or pain is disabling. Two procedure are normally done –

Fulguration, in which the area of the bladder that is inflamed (lesions like patches) are burned with electricity or laser;

Resection, in which the ulcers are cut and removed.
Bladder removal, or cystectomy, is also a surgical option.

8 causes of urinary incontinence that you should know

How not drinking enough water can lead to urinary bladder infections

10 symptoms of enlarged prostate that all men should know

8 effective ways to treat urinary incontinence

6 reasons you could be urinating more frequently than normal

What your urine says about your health

Image source: Shutterstock

Reference

Patel ND, Parsons J K. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian Journal of Urology 2014;30:170-6

Shrivastava A, Gupta VB. Various treatment options for benign prostatic hyperplasia: A current update. Journal of Mid-Life Health. 2012;3(1):10-19. doi:10.4103/0976-7800.98811.

Harvard Health. Do you have an overactive bladder? Harvard Health Publications, Harvard Medical College. 2016.

Interstitial Cystitis Association. Know the Symptoms, Get the Facts – ICA – McLean, VA. Available at: http://www.ichelp.org/about-ic/getthefacts/.

Dmochowski RR, Gomelsky A. Overactive bladder in males. Therapeutic Advances in Urology. 2009;1(4):209-221. doi:10.1177/1756287209350383.

Kemmer H, Mathes AM, Dilk O, Gröschel A, Grass C, Stöckle M. Obstructive Sleep Apnea Syndrome Is Associated with Overactive Bladder and Urgency Incontinence in Men. Sleep. 2009;32(2):271-275.

Lee SH, Lee JY. Current role of treatment in men with lower urinary tract symptoms combined with overactive bladder. Prostate International. 2014;2(2):43-49. doi:10.12954/PI.14045.
NICKEL J, FORREST J, TOMERA K et al. PENTOSAN POLYSULFATE SODIUM THERAPY FOR MEN WITH CHRONIC PELVIC PAIN SYNDROME: A MULTICENTER, RANDOMIZED, PLACEBO CONTROLLED STUDY. The Journal of Urology. 2005;173(4):1252-1255. doi:10.1097/01.ju.0000159198.83103.01.

Published : March 3, 2016 5:04 pm | Updated:March 4, 2016 5:50 pm

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