Featured Article

Urinary Problems

By: Daniel Higgins M.D.

Q: As men age, what changes in urination can be expected?

A: Urination problems are common as men age, but just because they are common doesn’t mean they are a normal part of aging. In some cases, urination symptoms are caused by bladder problems. Many times however, the cause is the prostate, which is a walnut (or larger) sized organ just below the bladder, through which urine passes through with voiding. It’s purpose is to make certain substances involved with fathering a child.

As men age, their prostate can enlarge; this growth is a different issue from prostate cancer. Part of the enlargement may be inward, causing the channel through the prostate to narrow, and may not be felt when a rectal exam is done by a doctor. An important thing to consider then is if there are symptoms of slow stream, incomplete emptying, or voiding frequently day and/or night.

If a man is bothered by his voiding, there are a number of treatment options. Medications that attempt to relax or shrink the prostate to help increase the flow are usually tried first. They are taken long term and generally provide relief, although they may not work forever. Side effects are usually minimal.

For men that aren’t helped by medications or who want to avoid the inconvenience or cost of long term medications, several procedure options are available. Office based procedures may provide symptom relief in selected men. In addition, an update of the well known ‘roto rooter’ procedure can be performed using a laser. It usually has minimal bleeding, is done as an outpatient procedure, and provides excellent results for improvement in urinary symptoms.

Q: What can be done about urinary leakage for women?

A: There are several types of urinary leakage (or incontinence). Many women experience one or both of the two most common types: stress and urge incontinence.

Stress leakage tends to occur with aging, especially in women who have had vaginal births. This type of leakage occurs with laughing, sneezing, coughing or from rising from sitting to standing. It is caused by changes in the tissues of the pelvis resulting in decreased tone and support for some of the pelvic organs such as the bladder. Medications are usually of limited value in treatment. Kegel muscle exercises (using the muscles of the pelvis) can improve dryness for some women. Other women may need outpatient ‘sling’ type procedures to help support the tissues and other newer office based procedures can be done. These newer procedures are usually well tolerated by patients and can provide excellent results in gaining dryness.

Urge incontinence is also very common and occurs when the bladder becomes overactive and tries to empty more often and more urgently then a woman would like. Multiple causes are seen although often it occurs just with aging alone. Treatment involves making sure there are no significant other correctable causes first. Sometimes changing the diet can improve things, including stopping smoking. Medications are often used to calm the bladder as well and make up a large part of treatment. Side effects can be a problem as women can get dry mouth and constipation. For instances where medication fails, a device can be implanted to gently stimulate the bladder nerves, similar to a pacemaker, which can often make the urination problems much better, even when medications fail.

Lastly, it’s common to have a mix of types of leakage. Careful evaluation is required in these cases with special bladder testing and often a mix of treatments. Thankfully, in many cases, urinary leakage can be reasonably controlled, if not cured.