Your bladder is keeping you out of bed at night and on your toes during the day. You can’t enjoy your favorite movie because you’re constantly running to the restroom, and sometimes you have accidents on the way, leaving you embarrassed, according to an article in the March issue of Cleveland Clinic Men's Health Advisor.

These symptoms characterize overactive bladder, and the embarrassment it can cause may be why many men don’t seek immediate medical help. But, if you put off seeing your doctor, you may run the risk of complications, such as urinary stones, infections and even kidney damage.

There’s no need to delay, though, since effective treatments can keep you in your seat instead of hightailing it to the bathroom. As evidence, a study in the Nov. 15 Journal of the American Medical Association found that men given a combination of tolterodine and tamsulosin for 12 weeks saw significant improvements in lower urinary tract symptoms, including overactive bladder.

“If you can’t get through a movie or a church service without having to get up to urinate, or if you have accidents trying to get to the bathroom, there’s no reason to suffer,” said Julian Gordon, M.D., a Cleveland Clinic urologist. “Even in people with severe problems, help is available.”

CAUSES OF OVERACTIVE BLADDER
Most experts characterize overactive bladder as the need to urinate eight or more times a day or twice or more at night, frequently coupled with a failure to delay urination (urgency) and leakage of urine whenever the urge arises (incontinence). Overactive bladder occurs when the bladder’s detrusor muscle contracts while the bladder fills with urine, when it should remain at rest.

Researchers are unclear as to what triggers overactive bladder. Several neurological conditions, such as nerve damage from diabetes, stroke and Parkinson’s disease may cause a loss of bladder control. An enlarged prostate, urinary-tract infections, urinary stones and bladder cancer also may cause urinary symptoms.

FINDING THE CAUSE
Your physician will ask you about your medical history and have you keep a diary of your fluid intake, urination patterns and incontinence episodes. Based on your history and diary, the doctor often can suggest lifestyle changes (see “What You Can Do”) that can improve your symptoms.

Your doctor will do a urinalysis to check for, among other things, blood and signs of infection. The physician also will examine the size and consistency of your prostate, and will check your urine flow rates to see if an enlarged prostate or other obstruction is restricting the urine exiting your bladder.

You may undergo an ultrasound to determine if your bladder is emptying adequately and, depending on your symptoms, an electromyogram to measure nerve and muscle activity affecting bladder control.

SLOWING THE FLOW
Your physician may work with you to “retrain” your bladder to resist urinary urgency, postpone urination and increase the time between bathroom visits. As part of retraining, your doctor may counsel you on pelvic-floor (Kegel) exercises to strengthen your pelvic muscles and help keep urine in the bladder.

Most patients find relief from a class of medications known as anticholinergics, or antimuscarinics. Also, your doctor may prescribe drugs known as alpha blockers or 5-alpha reductase inhibitors if an enlarged prostate or obstruction is contributing to your urinary symptoms. When an obstruction is the cause and medications are not the answer, a urologist can use a variety of minimally invasive treatments that can be done in the office.

“There’s no reason to have [overactive bladder] affect your quality of life,” Dr. Gordon said. “Within a couple of office visits, we can usually work this out and get you treated.” 

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