Urinary Health

AHN physicians are skilled at diagnosing and treating male urinary disorders, including difficulty urinating as well as urinary incontinence.

Overactive Bladder: Urinary Incontinence

Urinary incontinence often results from issues with nerve signals from the brain to your bladder. Other times, issues are due to the urinary sphincter not working correctly. 

Types of urinary incontinence

• Stress urinary incontinence: This occurs with increased force on your pelvic floor — a collection of nerves, muscles, and ligaments — from common activities like sneezing, coughing, laughing, exercising, lifting, and standing up after sitting. It’s often caused by weakness in the urinary sphincter or pelvic floor, which most often occurs after surgery or as a result of trauma.
• Urge urinary incontinence: This is the sudden uncontrollable urge to urinate, which may result in incontinence. This is commonly associated with overactive bladder. Possible causes can include a urinary tract infection or neurologic conditions like multiple sclerosis, Parkinson’s disease, or a history of stroke. 

Diagnosing urinary incontinence

• History and physical exam: Your provider will discuss your urinary symptoms then perform a physical exam and digital rectal exam (DRE) to feel the prostate gland.
• Labs: A urinalysis will check for signs of protein, glucose, infection, and blood. A PSA blood test is sometimes recommended based on age, life expectancy, and other medical conditions. Other lab tests may also be necessary. Your physician will discuss the tests with you before ordering them.
• Post-void residual (PVR): A test performed using ultrasound and measures urine left in the bladder after urinating.
• Urodynamic pressure flow studies: These studies evaluate bladder function in more detail for complex cases. This involves the passage of a small catheter into the bladder and the rectum to record bladder and abdominal pressures.
• Cystoscopy: Sometimes a small camera is passed into the bladder to look for abnormalities within the urethra, prostate, or bladder.

Treatment options

Treatment usually depends on the cause of your problem. Often a combination of treatments is the most effective.

• Physical therapy: Pelvic floor physical therapy helps strengthen and control the muscles. This requires evaluation by a specially trained physical therapist.
• Lifestyle modifications: Strategies include avoiding foods and drinks that irritate your bladder or urinating on a regular basis without holding it for prolonged periods of time.

An overall healthy lifestyle, including weight control, smoking cessation, balanced and healthy diet, and regular exercise often helps. Keeping a bladder diary that includes your diet and how often you urinate and what your symptoms are can help determine what irritates your bladder. 

Urge urinary incontinence treatments:

• Medications: Overactive bladder medications can help relax your bladder and prevent it from squeezing when it isn’t full. This allows you to hold your urine for longer periods of time.
• Bladder BOTOX® surgery: A minimally invasive procedure. BOTOX injected into the bladder helps relax your muscles and gives you more time when you feel the urge to urinate. The results last about 3-4 months.
• Nerve stimulator placement: In more severe cases, patients may have a nerve stimulator placed. This is like a pacemaker that helps regulate nerves that control your bladder. 

Stress urinary incontinence treatments

• Nonsurgical: External collection devices such as a condom catheter can be placed around your penis to collect urine. It then drains into a bag attached to your leg. This can be discretely placed under your pants and can also be worn at night.
• A Cunningham clamp is a padded device that clamps around your penis to apply constant pressure to keep urine from leaking out. It can only be worn for short periods of time. 
• Surgical: One surgical option is a male sling. Made of mesh, it can be implanted inside the body to support the urethra and surrounding muscles. It can help with incontinence caused by a weak urinary sphincter.
• Artificial urinary sphincter: This surgically inserted device acts like a valve — it mimics the normal activity of opening and closing the urethra and is controlled by the patient. 

Benign prostate hyperplasia (BPH)

BPH is a natural enlarging of the prostate, which is very common with age. About half of men in their 50s have an enlarged prostate, and up to 90% of men over age 80 have it. The prostate is typically the size of a walnut but can grow as large as an orange. This noncancerous condition can result in difficulties with urination, though some men may not feel any symptoms at all.

BPH symptoms may include:

• Weak stream
• Having to strain or push to start your stream
• Dribbling after you’re done urinating
• Feeling like you’re not completely finished despite having just urinated
• Urinary urgency and frequency
• Waking up at night to urinate

Evaluating BPH

BPH may be diagnosed through a variety of examinations and tests, including:

• History: Answering questions to assess urinary symptoms.
• Physical exam: A physical exam, including a digital rectal exam (DRE), checks your prostate for enlargement or signs of cancer.
• Lab testing: Urinalysis is used to check for signs of protein, glucose, infection, and blood. A PSA blood test may be recommended to screen for cancer.
• Post-void residual: This test measures liquid left in the bladder after urinating. This helps evaluate whether an enlarged prostate is causing bladder dysfunction.
• Cystoscopy: A common procedure that involves inserting a camera into the urethra and the bladder to examine the anatomy of your prostate.

Treatment for BPH

• Lifestyle modifications: Some foods may irritate the bladder and should be avoided. These include coffee, tea, alcohol, soda, cocoa products, and acidic foods. Also, scheduling regular times to urinate can help — rather than holding it for prolonged periods of time.
• Observation with clinical monitoring: This is best for men who aren’t bothered by their symptoms and are able to empty their bladder well.

Medications

• Alpha blockers: Medication that relaxes the muscles of the prostate and a portion of the bladder. They don’t shrink the prostate, but they can improve urine flow.
• Alpha reductase inhibitors: Medication that shrinks the prostate by blocking the male hormone (DTH) that plays a role in prostate growth.
• Phosphodiesterase inhibitors: These can improve urine flow, and also treat erectile dysfunction. They’re often prescribed for men who have ED and urinary issues.

Surgery

Patients have access to surgical options for cases where medication is
not effective or when they don’t want to take medication.

• Transurethral resection of the prostate (TURP): An electric current resects or vaporizes and removes prostate tissue that’s obstructing urine flow.
• Photoselective vaporization (PVP): This eliminates obstructing prostate tissue with a high-power laser.
• Prostatic urethral lift (UroLift®): Small implants lift and hold back obstructing prostate tissue. Your medical provider will discuss each option with you and determine which is best based on your symptoms and exam findings.

Contact us

Call (412) DOCTORS (412) 362-8677 or, request an appointment to learn more about men’s urinary health issues.