by Pratik Desai, MD
An overactive bladder may show up as: urinary frequency, urinary urgency, or trouble holding your urine until you can make it to the restroom. It can also show up as a feeling of not emptying your bladder all the way. This can involve going to the bathroom, and very shortly after needing to use the restroom again. The symptoms of an enlarged prostate, and an overactive bladder have some overlap. Oftentimes, it will take some diagnostic ability to tell the difference between an enlarged prostate and a purely overactive bladder. Truthfully, both are overlapping disease processes. Some men with an enlarged prostate will also have dysfunction of their bladder. Oftentimes this can be acquired, so it is something that is related to the underlying enlargement of the prostate. In some cases it may be organic to the bladder itself, so some men may not necessarily have a large prostate, but have some overactivity of their bladder. This can happen in women as well, but there is no prostate present in women. When looking at men with urinary frequency, or urgency, we need to be able to tell the difference between someone who has an enlarged prostate causing difficulty emptying, and irritation of the bladder as a result of that obstruction, versus someone who has a bladder that is overactive or irritable.
In order to differentiate between the two, we have a few easy tests that we perform. If there is some question beyond the initial test, we then will perform more complex testing. The easiest test starts with a questionnaire to delineate if there are any obstructive symptoms, such as a slow stream (dribbling with urine), or difficulty getting your urinary stream started. This is associated with the urinary urgency, or frequency. The second part of the evaluation would be an exam. This would be a digital rectal exam, which involves feeling for an enlarged prostate. Lastly, there would be an interview of causitivation. This would include a discussion with the doctor about things like: effective caffeine, alcohol etc. We also want to rule out any associated medical illnesses that may contribute to this like, diabetes or neurologic problems. The first step really is a medical exam, questionnaire and evaluation. The second part of the evaluation will involve some diagnostic testing and trials of medications. This can be something as easy as a test to see how strong your urinary stream is, and an ultrasound to see how efficiently your bladder empties. If we're showing indications of an enlarged prostate it may involve a trial of medications to see if that improves the symptoms. It can be more complex, as people can have contributing medical problems they may have a prostate that is slightly enlarged, but not too enlarged etc. We may try medications to help the bladder be more stable. If that is incomplete this may involve a cystoscopy, and a test called urodynamics.
Interested in learning more about Overactive Bladder or BPH (Enlarged Prostate)? Please email us at info@prostatecentersusa.com or call 703-783-5353