Male Over Active Bladder (OAB) or Urge incontinence
This problem is extremely common and found in men, women and children.
A man may experience frequency,urgency, urge incontinence and nocturia. It is not uncommon not to find any significant underlying problem. However,in some men it is commonly associated with prostate enlargement or BPH while in others it may be particularly troublesome after prostate surgery such as a laser prostate ablation. Conditions that may trigger OAB are previous bladder or prostate irradiation,brain injury,strokes, Parkinsonism etc.
Before seeking treatment it is important to ensure that you are not drinking too many fluids in a day. It is not uncommon for patients to present with symptoms of frequency from over drinking. There are no health benefits from normal drinking and adding 6 to 8 glasses of fluid to your intake. There is no scientific evidence to support fluid loading.
Evaluation will require a detailed examination,prostate exam (DRE),urinalysis and urine culture,% free PSA,an ultrasound to measure a post void residual (PVR) and possibly cystoscopy and urodynamics.
Men with BPH should first be treated with an alpha blocker such as flomax or cardura. If these medicines with or without 5 alpha reductase inhibitors such as proscar/avodart (which may shrink the prostate a little),fail to relieve symptoms then he may need surgery for his BPH first. However,if the medicines such as flomax/cardura provide satisfactory bladder emptying while documenting small post void residuals,an antispasmodic agent (anticholinergics such as vesicare/ditropan/detrol etc) may be administered if a man is still affected by OAB. If the OAB is worse during the day we will prescribe the antispasmodic for the morning and if more troublesome at night time, will prescribe it for after dinner.
Not all patients will respond to the first antispasmodic so after a 2 week trial with one fails to control the frequency and urgency we will prescribe another and possibly another after that one till frequency is tolerable.