Troublesome Urinary Problems: Symptoms We Don’t Talk About

Summer 2011 CSANews Issue 79  |  Posted date : Jul 08, 2011.Back to list

At my recent annual health checkup, my family doctor asked, along with countless other questions, about my bladder function. How often did I void during the day? How often at night? Was there trouble starting? Was there trouble stopping? How many times did I have to get up at night? When I responded that I was not aware of any changes and all seemed OK to me, he commented that this was unusual. It reminded me that, by the time we reach our 60s and 70s, most men and women will be experiencing some abnormal urinary symptoms, and may no longer enjoy normal daytime and nighttime bladder control. For men, the most common symptoms will be the need to get up once or more during the night to void, the need to go more frequently in the daytime and sometimes trouble starting and stopping the stream. For women, getting up at night is a similar experience, but women are also more vulnerable to two other problems, namely stress incontinence (wherein there is urine loss with coughing, sneezing or laughing), or overactive bladder (wherein there is urgency, frequency and often incontinence). The following information is useful for understanding the causes of these conditions, as well as some of the current remedies to at least lessen the symptoms.

For men, the most common problem is the increasing size of the prostate gland. This walnut-sized gland is located just in front of the rectum and below the bladder. The prostate surrounds the urethra, through which urine passes. The prostate gland commonly enlarges throughout adult life and this enlargement, called benign prostatic hypertrophy (BPH), can begin to obstruct the flow of urine through the urethra. Symptoms can include more frequent need to urinate -including the need to get up at night, changes in the stream such as slowing, hesitancy in starting, and dribbling. The bladder can become weakened and may not empty completely, adding to the increased frequency and risk of urinary tract infection, including prostatitis (infection of the prostate gland). It is estimated that more than 50% of males begin to experience symptoms of BPH in their 60s and the incidence increases sharply with age.

Mild symptoms can usually be handled without major intervention. As with all conditions that are associated with the need to void during the night, avoiding taking fluids after supper and pursuing measures to optimize sleep should be followed. If symptoms become more troublesome, there are medical and surgical interventions which are helpful. It is important for one's doctor to be involved at an early stage in assessing these symptoms, because prostate cancer can occasionally be the cause of such symptoms. A routine digital examination, a PSA test, a rectal ultrasound exam and, if necessary, a prostatic biopsy can differentiate between these two conditions. The PSA (Prostatic Specific Antigen) blood test remains controversial, especially in men over age 70. The test may be falsely positive or negative and may lead to unnecessary further investigation or treatment. It is estimated that the majority of men over 85 years of age have cancer of the prostate. At this age, surgical and other aggressive treatments are usually not indicated because the cancer is very slow-growing and unlikely to be a major problem. Fortunately, there are several drugs that are quite effective in reducing the symptoms of BPH in most men.

A cystoscopy examination, in which the urethra and prostate are visualized, may assist the urologist in determining both the cause and the best course of action to pursue. If symptoms worsen or do not effectively improve with medication, the risk of obstruction and acute urinary retention can occur, requiring immediate catheterization at a hospital. This risk is increased with certain medications -such as cold and allergy pills - as well as with cold, prolonged immobility and excessive alcohol consumption. Surgical treatment includes widening the urethral tract (transurethral resection of the prostate, or TURP). This does not involve an external incision and total prostatectomy, which is a more major total removal of the gland. Other types of treatment include procedures such as thermotherapy, microwave therapy and laser surgery.

Urinary tract infection can occur in both men and women, but is far more common in women. Symptoms can include frequency, urgency and the need to go at night, but a common additional symptom is a burning sensation when voiding. Confirmation must be made professionally with a microscopic examination of the urine, followed by laboratory bacterial confirmation. Early and complete antibiotic treatment is required and proper followup is necessary to confirm eradication of the infection - even when symptoms are entirely gone. Failure to adequately treat early urinary tract infection runs the risk of a more serious kidney infection. Women travellers who experience more frequent episodes of bladder infection (cystitis) and are quite familiar with the symptoms often obtain a prescribed supply of antibiotic prior to their departure, in case of recurrence while away.

Stress incontinence can affect both women and men, but is also far more common in women. Although it can occur at middle age, it becomes far more frequent in seniors. Unfortunately, many people do not disclose this embarrassing problem to their health-care practitioners, thereby preventing them from being medically treated. The causes in women are most often associated with a weakening of the muscles that support the bladder. Causative factors include pregnancy and childbirth, uterine prolapse, obesity and past surgeries. 

Men can experience this problem after prostatectomy and, if persistent, may require surgery to treat it effectively. Certain prescribed medications can aggravate the condition. Initial treatment usually includes behavioural modifications and pelvic muscle-strengthening exercises (Kegel exercises). 

Changes in lifestyle may prove helpful, such as limiting fluid intake before activities and bed, losing weight if necessary, stopping smoking, reducing any excess fluid intake, avoiding alcohol, caffeine, certain spicy foods and carbonated beverages and avoiding constipation. For this condition - as with other urinary problems - incontinence pads may be useful, but seeking professional help may often make these unnecessary. Certain drugs may be indicated and prescribed by your doctor and some patients, especially women, may benefit from specific surgical procedures.

In people, most commonly women, symptoms of recurrent and frequent urge to urinate even when the bladder is not full is the usual symptom of overactive bladder. This type of incontinence is by far the most common type in seniors and is sometimes referred to as urge incontinence. When the sudden urge to void occurs and facilities are not readily available, incontinence may result. This very common condition causes embarrassment, restrictions in one's daily life and undue anxiety and depression. The condition is caused by involuntary contraction of the bladder muscle wall (detrusor muscle), often when the bladder is not even full. There is a sudden urge to urinate and more frequent urges to go to the bathroom occur, both during the day and at night. Most cases of these abnormal bladder spasms cannot yet be associated with any specific cause. In some cases, the condition can be caused by multiple sclerosis, spinal cord injuries, diabetes and Parkinson's disease. 

Early and thorough evaluation of this condition is essential. Many women go untreated because they do not seek professional help. Treatment includes bladder training, along with exercises to strengthen the pelvic floor muscles. Certain prescribed medications called anticholinergics may be helpful in stopping some of the nerve pathways to the detrusor muscle. Avoiding drinking liquids, especially caffeinated beverages, before activities and bedtime is important. Any sign of infection must be vigorously treated and attention must be paid to diet, if being overweight is an issue. 

Another type of incontinence is called overflow incontinence, which occurs when there is obstruction at the bladder outlet and urine is lost involuntarily due to the overfilled bladder. Debilitated elderly persons (especially those in institutions) can suffer from functional incontinence caused by a number of factors, such as physical and mental disability, arthritis, MS and Parkinson's disease.

a is two to three times more common in men. It is the fourth most common type of cancer in men and the eighth most common in women. It most often presents as blood seen in the urine. Anyone who notices this should immediately see their doctor. Early diagnosis provides for excellent treatment results, usually by surgically resecting the tumour. In some cases, further treatment such as radiation or chemotherapy may be required, depending on the stage of the growth.

Even though there are urinary symptoms which can affect us as we age, there are many opportunities to improve the situation and, in some cases, cure the problem. It is important that you discuss your problems with your doctor and seek more specialized care, if indicated. There are many websites that now provide valuable information relating to these conditions, including the Canadian Continence Foundation at www.canadiancontinence.ca and MedlinePlus at www.nlm.nih.gov/medlineplus/.
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If you thought you were one of the few people suffering from incontinence, you may be surprised to learn that it is estimated that the following groups of people are affected:

• 10% of six-year-olds
• One in four women middle-aged or older
• 15% of all men aged 60 years and over

Approximately 3.3 million Canadians experience incontinence.

Source: canadiancontinence.ca