Men’s Health
Men Have
Range of Treatments for Overactive Bladder by Joseph M. Khoury, MD, FACS
Bladder storage symptoms occur when bladder capacity is functionally diminished, resulting in frequent toileting, urgency and urge incontinence and frequent nighttime voiding, called “nocturia.” Lower urinary tract symptoms (LUTS)
First-line Treatment
commonly occur in men over the age of 45
Treatment for overactive bladder is based on
years. Classified as bladder storage and/or
the underlying cause. Unfortunately, many
bladder emptying symptoms, LUTS interferes
patients will have an unremarkable evaluation
with a patient’s quality of life and activities
and are thus treated empirically.
of daily living. As a first-line treatment, the physician will Symptoms can be caused by a urinary tract
recommend avoiding certain beverages and
infection; bladder cancer; bladder stones;
foods implicated in triggering overactive
neurological disease, such as multiple
bladder. They include caffeinated and
sclerosis, Parkinson’s disease and stroke; an
carbonated beverages and beverages with
enlarged obstructing prostate; and consump-
artificial sweeteners; as well as chocolate, nuts,
tion of alcoholic and caffeinated beverages,
tomatoes and citrus. Over-the-counter
and certain foods, many of which have a high
supplements that help neutralize acidity, such
acidic content.
as Prelief, bicarbonate of sodium and AlkaSeltzer, have been helpful in alleviating these
Bladder emptying symptoms include a weak
bothersome symptoms.
urinary stream, stuttering of the urinary stream, straining to urinate and hesitancy,
Pelvic floor rehabilitation that includes
which is difficulty initiating the stream. They
strength and relaxation techniques of the
are often caused by benign prostate hyperplasia
pubococcygeus muscles, in conjunction
(BPH), a condition covered in “Mechanics
with bladder retraining, often helps increase
of BPH Leads to Greater Understanding” on
The International Prostate Symptom Score
the functional capacity of the bladder and
page 26 in this issue of Triangle Physician.
(IPSS), a validated patient questionnaire, will
allows better bladder emptying. Scheduled
help determine the intensity of the symptoms Evaluation
voiding every two hours, while awake
and how those symptoms interfere with the
can decrease urgency and urge incontinence
Evaluation of overactive bladder begins with
patient’s quality of life. A three-day voiding
by 50 percent and is a useful strategy in
a thorough history and physical examination,
diary is invaluable in helping to determine
elderly patients, particularly those with
to include a digital-rectal examination,
if the patient is consuming large volumes of
dementia.
assessing prostate size, rectal tone and fecal
fluid and if nighttime output is a result of
impaction. A well-tailored neurologic
nocturnal polyuria or overactive bladder.
Medication
examination, to include gait assessment, deep-
Urine analysis will look for infection and/or
In some men, bladder outlet obstruction may
tendon reflexes, particularly of the lower
hematuria, and urine cytology will rule out
cause overactive bladder symptoms. Many men
extremities, and sensation within dermatomes
bladder cancer, particularly carcinoma in situ.
can be initially treated with an alpha-blocker,
S2 through S4, is an essential part of the
Postvoiding residual urine testing is important
such as Tamulosin, and then reevaluated in
evaluation.
to ensure appropriate bladder emptying.
two to four weeks.
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The Triangle Physician | JUNE 2010