MEN'S HEALTH MATTERS:A need to urinate often can be addressed through the use of muscle relaxing medication as well as retraining the bladder
Q I am 44 years old and it seems that I am always rushing to the toilet to pass urine, afraid that I won’t make it on time.
I run a large company and find it difficult to sit through meetings without taking a break to pass urine.
This has been going on for many years and a friend of mine with a similar problem was diagnosed with an irritable bladder. What does this mean? He told me about bladder retraining and that there are various medications available.
A The problem you describe is very common. However, a recent study from the United States revealed that less than one-quarter of men with this problem will seek advice.
It may be very severe or it might just be a bit bothersome whereby you might have to pass urine a little more often than your friends, for instance when you are out for a drink.
Irritable bladder is a condition that is typified by the sudden, irresistible urge to urinate. This urge may be difficult to suppress, and can even lead to the involuntary loss of urine (incontinence).
You may want to urinate frequently (can be eight or more times in 24 hours) and you may get up many times at night to pass urine. Although you may be able to get to the toilet in time when you sense an urge to urinate, frequent and night-time urination, as well as the need to suddenly “drop everything”, can definitely disrupt your life.
As you describe, this can occur in the most undesirable of situations and can be quite embarrassing. There is very little pain associated with irritable bladder, but there can be considerable discomfort. The particular problem can affect both men and women alike, and may be brought on by stress.
As irritable bladder can be confused with a mild bladder infection, it is important that your doctor rules out an infection. It can be difficult to diagnose but it can be treated in a number of ways.
The choice of treatment will depend on how severe your symptoms are, and how much they interfere with your lifestyle.
Anticholinergics, such as Oxybutynin, have a direct relaxant effect on urinary smooth muscle and are the most commonly used medications. These drugs reduce involuntary bladder contractions and increase bladder capacity. There are a number of anticholinergic drugs on the market and their efficacy is very similar and all can cause a dry mouth or constipation. If you take these drugs the need for continuing therapy should be reviewed after three to six months.
Urispas is an antispasmodic drug that can be effective in controlling symptoms.
Tricyclic antidepressants have also been used to treat urge incontinence because of their ability to “paralyse” the bladder smooth muscle. Possible side effects include:
- Blurred vision
- Dizziness
- Dry mouth
- Fatigue
- Insomnia
- Nausea
The fear of an accidental leak results in emptying the bladder more often than necessary. Consequently, the bladder shrinks and this aggravates the already irritable bladder.
The aim of retraining is to help you regain control of your bladder by suppressing the unwanted contractions and allowing it to fill to its proper capacity. The treatment requires determination and commitment on your part and so your own attitude of mind is a most important aspect.
It will be helpful to have a measuring jug (500ml size). Keep a chart of the time of voiding, the amount passed and of any leakage. This will show your bladder pattern to start with and the improvement as your exercises take effect.
The object of bladder training is gradually to lengthen the intervals between voiding and so improve the capacity of the bladder.
You must force yourself to wait between one and one-and-a-half hours between trips to the bathroom, despite any leakage or urge to urinate in between these times.
As you become skilled at waiting, gradually increase the intervals by half an hour until you are urinating every three to four hours.
You must try very hard to hold onto your water by contracting the pelvic floor muscles when the feeling of urgency first occurs, allowing time for the bladder-emptying muscles to relax.
When you succeed, the desire to pass water will fade and allow the bladder to continue filling up. As soon as the feeling has gone away, try to occupy yourself to divert your attention from your bladder.
You might become frustrated at first if the progress is very slow but gradually the intervals and volumes will increase. You are trying to increase voiding intervals to three to four hours with urine volumes of 300mls-400 mls and to abolish any leakage.
Pelvic floor muscle exercises are designed to strengthen the muscles which close off the bladder outlet and may help to prevent leakage when a strong or urgent desire to pass water occurs.
You should try to stop yourself passing urine mid stream and by doing this several times you will become aware of the muscles involved and how to contract them and you should do this regularly.
It is important to control your fluid intake during the day and not to drink large quantities at any one time.
You should stop drinking fluids about two to three hours before going to bed if getting up at night is proving to be a problem. It may also be helpful to eliminate food and drink that may irritate the bladder, such as:
- Caffeine
- Carbonated drinks
- Highly acidic foods such as citrus fruits and juices
- Spicy foods
There are other treatments available such as simple stretching of the bladder under a general anaesthetic, injection of Botox into the bladder and nerve stimulation.
Surgery to increase the size of the bladder is reserved for the most serious of cases.
** This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin