Overactive Bladder (OAB) in Men

Overactive bladder in men at a glance

  • Overactive bladder is the result of malfunctioning bladder muscles and nerves that send sensations to the brain, causing involuntary and unnecessary contraction of the bladder muscles.
  • The primary symptom of OAB is a sudden, uncontrollable urge to urinate, often resulting in leakage of urine, which is incontinence.
  • OAB, also called urge incontinence, affects up to 30 percent of males, preventing them from controlling when and how much they urinate.
  • Nearly two-thirds of cases of OAB in men are caused by an enlarged prostate.

What is overactive bladder?

Overactive bladder (OAB) is a urological condition that causes the urgent and frequent need to urinate. The urge may be difficult to stop and might lead to involuntary loss of urine (incontinence).

With OAB, bladder muscles and nerves do not operate properly, resulting in inaccurate and often frequent signals to the brain to contract the bladder muscles to release urine when the bladder does not need to be emptied. OAB can also occur because bladder muscles are too active, contracting frequently causing an urge to urinate.

Typically, adults urinate four to seven times a day. Patients with OAB, however, may use the bathroom up to 30 times a day and may be unable to reach the bathroom before urination.

OAB frequently disrupts the life of the men who have it. Many men are uncomfortable even talking about these problems so they fail to seek treatment. OAB can cause them to feel nervous about being out in public because they might release urine involuntarily. Frequent urges to urinate can send them to the bathroom constantly. Men can begin to shy away from social activities and can experience depression due to OAB.

Causes of overactive bladder in men

About two-thirds of overactive bladder cases in men are due to benign prostatic hyperplasia (BPH), also called an enlarged prostate. The prostate gland surrounds the urethra, which is the tube that urine passes through from the bladder out of the body.

Although an enlarged prostate does not account for all cases of OAB in men, many who are treated for the symptoms are assumed to have an obstruction in the bladder caused by an enlarged prostate.

Age increases a man’s risk of getting OAB. Age also increases a man’s risk for BPH, which can lead to OAB.

An infection in the bladder, bladder stones and bladder cancer can cause symptoms that lead to OAB. Neurological conditions, such as a stroke, multiple sclerosis or Parkinson’s disease, cause nerve damage that results in sending the incorrect signals to the bladder that causes OAB. Temporary factors, such as drinking a lot of caffeinated or alcoholic fluids, taking medications that increase urine output or having constipation, might increase the need to urinate.

Symptoms and diagnosis of overactive bladder in men

The major symptom of OAB is a strong urge to urinate that cannot be ignored. Men feel as if they “have to go” and worry about leaking urine before they can get to the bathroom. Normally, as the bladder stores urine the pelvic floor muscles contract to support the bladder and hold urine in without leaking. Bladder control problems occur when the pelvic muscles weaken. Other OAB symptoms include:

  • Frequent urges to urinate (more than eight times a day)
  • Leaking urine (incontinence)
  • Incomplete bladder emptying
  • Waking up in the night more than once to urinate.

To diagnose OAB a urologist utilizes a number of tests, beginning with a physical exam. The urologist will probably evaluate the patient’s health history and may have the patient fill out a symptom questionnaire. The patient may also be asked to keep a bladder diary to record how often he has the urge to urinate, urinates or leaks urine. More detailed tests include:

  • Bladder stress test ­– performed by filling up the bladder and having the patient cough to ascertain how much urine leaks.
  • Postvoid residual volume – assesses whether the bladder is fully emptying by inserting a catheter through the urethra and into the bladder after urination to measure any remaining urine.
  • Cytoscopy – a thin tube with a camera provides an interior view of the bladder to evaluate for structural problems.
  • Urine sample, or urinalysis – this screens for the presence of bacteria and may rule out other similar conditions such as a UTI.
  • Urodynamic testing – typically reserved for unusual cases and primarily measures urine flow to test for obstruction as well as evaluating urge sensation.

Treatment of overactive bladder in men

There are several treatment options for overactive bladder and the urologist may use one of those or combine more than one treatment option. Different OAB patients respond to different treatments, and doctor and patient should discuss each option before beginning treatment. Treatments generally involve lifestyle changes (behavioral therapy), products to manage leakage and medical treatments including procedures, medications and surgery.

Lifestyle changes

The first type of treatment the doctor will likely recommend is making healthy lifestyle changes by altering behavior. These changes don’t usually correct all symptoms but do generally provide degrees of relief.

Men with OAB should try to eliminate, or reduce, foods and drinks that irritate their bladder and trigger symptoms. These include:

  • Caffeine
  • Alcohol
  • Chocolate
  • Artificial sweeteners
  • Sodas
  • Citrus fruits
  • Spicy foods
  • Tomato-based foods.

Bladder training helps the patient learn how to delay urinating when he feels the urge to go. This can involve:

  • Double voiding, which is urinating, waiting a few seconds and trying to urinate again
  • Delayed voiding, not going to the bathroom when the urge first strikes but waiting a few minutes
  • Scheduled voiding, or establishing set times to urinate
  • Bladder muscle exercises, such as repeated quick flexing and releasing of the pelvic muscles when feeling an urge to urinate.

Medications

For men with an enlarged prostate, classes of drugs called alpha-blockers help relax the surrounding muscles to reduce urine blockage. Other drugs that may help with OAB symptoms include those that reduce spasms in the bladder. In cases not responding to lifestyle changes or other medications, injections of Botox may be made in the bladder muscle. These injections can prevent the bladder muscles from contracting too much.

Nerve stimulation

Some symptoms are related to nerves sending inappropriate signals to the bladder. If these nerve signals can be regulated, the symptoms of OAB can be reduced. For this type of treatment, called neuromodulation therapy, a small device is implanted under the skin near the tailbone, delivering electrical impulses to the nerves running to the bladder.

Like a pacemaker in the heart, the impulses control the contractions of the bladder. This treatment is reversible, and the device can be easily removed. Percutaneous tibial nerve stimulation is another neuromodulation therapy, involving electrical impulses to the tibial nerve that blocks faulty nerve signals causing bladder contractions.

Surgery

If severe symptoms continue, surgery might be the answer. This is common for men whose OAB is due to an enlarged prostate. A surgeon can remove part of the prostate, or ablate it with a laser.