Many American men suffer from one form or another of urinary incontinence and they may not tell anyone about their symptoms as they may be embarrassed to discuss it with their physician.
Uwais Zaid, M.D discusses Overactive bladder (OAB) and how providers can start this discussion with their patients and offer them one of the many treatment options available.
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Overactive Bladder
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Learn more about Uwais Zaid, MD
Uwais Zaid, MD
Uwais Zaid, MD is an urology specialist in Urbana, IL.Learn more about Uwais Zaid, MD
Transcription:
Melanie Cole, MS (Host): Expert insights is an ongoing medical education podcast. The Carle division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.
Many American men suffer from one form or another of urinary incontinence, and many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done so they suffer in silence. My guest today is Dr. Uwais Zaid. He's a urologist with the Carle Foundation Hospital. Dr. Zaid, before we discuss the types of incontinence, is incontinence, whatever type it is, a normal part of aging?
Uwais Zaid, M.D. (Guest): Well thank you so much for having me. I really appreciate having the opportunity to discuss this very common and quite bothersome issue that a lot of men and women suffer for. In general, incontinence increases with aging, but it doesn’t have to be a normal part of someone’s life. It can reek significant negative quality of life issues for people and it’s something we can help people. In many cases, it can actually be a harbinger of something more sinister of something going on inside the bladder or somebody’s overall health.
Host: How do men describe this condition to you? Are they embarrassed to bring it up? Do you have to start that conversation? What does that look like?
Dr. Zaid: Yeah, that’s a great question. A lot of patients are quite embarrassed by it. They can't go out with their friends and family or go to church or have any social time or have significant intimacy as well. A lot of men just don’t feel comfortable talking about it. Usually it’s an afterthought to them. They’re like oh by the way, I have this issue, but it’s probably a normal part of aging, right doctor? Well not really. Sometimes it can be a source of some other issues going on. So, people do feel quite embarrassed by it.
Host: Tell us about the different types of incontinence that men suffer from.
Dr. Zaid: Of course, yes. So, in general incontinence refers to the loss of urine without any control and there are several different types of leakage of urine. The most important thing that dictate whether or not we do any treatment is the patient and how bothered they are by it. I make it very clear that they’re the captain here basically as well. One type of leakage is called stress incontinence. This is the kind of leakage you have when you cough or sneeze. A lot of times we see this after different kinds of cancer treatments, such as prostate cancer surgery or things of that nature.
The other kind of leakage is called overactive bladder or urge incontinence type of leakage, which is almost where the bladder has a mind of its own and people lose urine because they can’t control their urination. This is when you gotta go, you gotta go type of leakage basically as well. Then some men leak urine because their bladders just overfill. They have a big prostate or scar tissue in the urethra and they just can't empty their bladders all the way, so they retain a large volume, and water’s overflowing the dam so the speak. That’s what we call overflow incontinence.
Host: Then how do you determine the type that someone has? How is it diagnosed? Do you use a history? If they have had prostate cancer or they have BPH, does that send a red flag to you that this is possibly the backend cause?
Dr. Zaid: Yeah that’s a wonderful question and that’s exactly correct. The most important thing to determine the type of leakage is the patient and what they describe as their most bothersome symptom. A lot of men and women will have a mixture of leakages. They’ll have a little bit of stress incontinence or overactive bladder incontinence as well. So, it’s really important to give the patient time to talk and tell their story and that’s kind of, unfortunately, we’re rushed in many cases and we don’t get a chance to kind of go over all the little details. What triggers your leakage? Why do you leak urine? What makes it worse? What makes it better? How long has this been going on for?
Then, as you alluded to, things like their past history. Whether they’ve had surgery for prostate cancer or colorectal cancer. Whether they’ve had a history of any trauma to the lower abdomen. Whether they’ve a history of infections or kidney stones or things of that nature as so critical because all of these things are risk factors for developing trauma and issues in the urinary [inaudible] basically as well. So, talking to the patient is so critical.
Beyond that, there are some simple exams that we can do. Our physical exam is quite critical. Doing a rectal exam to look for an enlarged prostate or a nodule prostate. An abdominal exam to look for any scars in the belly and any fullness in the super pubic that could imply an incompletely emptying batter. Then your standard gentile urinary exam looking for any strictures or lesions in the penis or the opening of the penis called meatus or any abnormalities in the anatomy. Some men are born with an aberrantly placed meatus called hypospadias. These are all things that we look for on the examination as well.
Then beyond the exam there are some invasive imaging studies that we can do, such as an ultrasound of the kidneys and the bladder if we’re worried about any swelling in the kidneys or incomplete bladder emptying as well. Then lastly, in certain men and women for that matter as well, we can also look directly inside the bladder. We can look at the urethra, we can look at the prostate, we can look in the bladder for stones, tumors, enlarged prostates, strictures, and things of that nature as well. So, there’s a lot of tools we have at our disposal to kind of determine the etiology of their urinary leakage.
Host: When we talk about treatments, and for women we hear about Kegel exercise and pelvic floor physical therapy, are these similar for men or are you looking more toward bladder training or keeping a voiding diary, fluid management? Tell us some of the treatment options that might different between men and women.
Dr. Zaid: Absolutely. That’s a great question. A lot of the treatment options, again, are dictated by the type of leakage the patient has. So, for instance, if somebody has stress incontinence—this is coughing/sneezing leakage. In women, we often talk about pelvic physical therapy or the Impressa, which is made by Poise is a vaginal insert, or a surgery like a mid-urethral splint surgery. Well in men, we have different options. So, for stress incontinence, we talk about doing an artificial sphincter surgery which is where we can actually surgically implant a sphincter in somebody which the patient controls. We can do a sling in men as well. It’s called a mid-urethral sling for men as well.
Physical therapy plays an important role in men as well who leak because they cough or sneeze. When we talk about overactive bladder or urge incontinence, many of the treatments for men and women are very similar. So, in men, the unique component would be the presence of an enlarged prostate. So, we do talk about making sure that that’s not causing an obstruction and making sure their bladder is emptying out okay. The treatments are, there is a lot of overlap.
The American Urologic Association have guidelines on how we help patients with overactive bladder or urge incontinence. It’s basically a step by step approach. The first thing we tell folks is look, there’s certain things that you eat or drink that are going to make your bladder irritable. This applies to both men and women. Things like caffeine, alcoholic beverages, spicy foods, acidic foods like citrus based things and things of that nature as well.
Beyond that we have a whole host of medications. The two big families are the anticholinergic. This is stuff like Vesicare or Sanctura or trospium or oxybutynin. Then the latest generation medication is something called mirabegron, or a beta-3 agonist. Then for patients who still have ongoing urgency or urge incontinence that doesn’t respond to medications, or if they don’t tolerate the medications well, there’s a whole host of other options. Something called InterStim, which is like a bladder pacemaker. We can inject Botox in the bladder. Or we can to PTNS, which is a non-invasive means of stimulating nerves that go to the bladder as well. So, we have a lot of tools in our arsenal to help men and women who have all types of leakage.
Host: What would you like other providers to know, Dr. Zaid, about discussing this, bringing it up? Even at the regular annual wellness exams. If they're working with their primary care provider, how would you like them to broach the subject and bring it up and get their patients to talk about it?
Dr. Zaid: Yeah. That’s a wonderful, wonderful question. The first thing I think that’s important to appreciate is how common this is. Some data suggests that up to 27% of men and 43% of women have components of overactive bladder or urge incontinence. The costs are upwards of $12 billion per year as well, but there’s a hidden cost that people don’t realize. This is the cost in intrapersonal relationships, outings, social depression. Then it’s dangerous. I mean this could be a sign of something more serious going on. Bladder cancer can cause this, bladder stones can cause this, kidney stones can cause this. So, there could be some sort of something that’s more sinister that’s causing these symptoms as well.
On top of it, getting up at night time has been shown to increase the rates of falls and trauma associated with that. So, the first thing that, and many providers already realize this, is that this is not a trivial issue. This is a pretty major issue as well. I think it’s really important to normalize it, to let your patient know that look you're not alone. Many men and women suffer through this. This is a very common thing. Just because your parents had or your grandparents have had it, it does not have to be a normal part of your life. It’s important to let the patient tell their story. If you give them time, they’ll give you the information you need to make the right diagnosis.
Then the last important thing is to let them know there’s a lot of treatment options. We can help people. We can get them better. We can make to get them drier as well. It’s dictated by the patient and how bothered they are by it. There’s a lot of resources here that we can help with in all these different domains as well.
Host: Thank you so much doctor for being on with us today and sharing your expertise. What great information for men and for their partners to help them over come something they might feel is embarrassing, but they should be talking with their providers about. You're listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com. That’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole. Thanks so much for tuning in.
Melanie Cole, MS (Host): Expert insights is an ongoing medical education podcast. The Carle division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.
Many American men suffer from one form or another of urinary incontinence, and many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done so they suffer in silence. My guest today is Dr. Uwais Zaid. He's a urologist with the Carle Foundation Hospital. Dr. Zaid, before we discuss the types of incontinence, is incontinence, whatever type it is, a normal part of aging?
Uwais Zaid, M.D. (Guest): Well thank you so much for having me. I really appreciate having the opportunity to discuss this very common and quite bothersome issue that a lot of men and women suffer for. In general, incontinence increases with aging, but it doesn’t have to be a normal part of someone’s life. It can reek significant negative quality of life issues for people and it’s something we can help people. In many cases, it can actually be a harbinger of something more sinister of something going on inside the bladder or somebody’s overall health.
Host: How do men describe this condition to you? Are they embarrassed to bring it up? Do you have to start that conversation? What does that look like?
Dr. Zaid: Yeah, that’s a great question. A lot of patients are quite embarrassed by it. They can't go out with their friends and family or go to church or have any social time or have significant intimacy as well. A lot of men just don’t feel comfortable talking about it. Usually it’s an afterthought to them. They’re like oh by the way, I have this issue, but it’s probably a normal part of aging, right doctor? Well not really. Sometimes it can be a source of some other issues going on. So, people do feel quite embarrassed by it.
Host: Tell us about the different types of incontinence that men suffer from.
Dr. Zaid: Of course, yes. So, in general incontinence refers to the loss of urine without any control and there are several different types of leakage of urine. The most important thing that dictate whether or not we do any treatment is the patient and how bothered they are by it. I make it very clear that they’re the captain here basically as well. One type of leakage is called stress incontinence. This is the kind of leakage you have when you cough or sneeze. A lot of times we see this after different kinds of cancer treatments, such as prostate cancer surgery or things of that nature.
The other kind of leakage is called overactive bladder or urge incontinence type of leakage, which is almost where the bladder has a mind of its own and people lose urine because they can’t control their urination. This is when you gotta go, you gotta go type of leakage basically as well. Then some men leak urine because their bladders just overfill. They have a big prostate or scar tissue in the urethra and they just can't empty their bladders all the way, so they retain a large volume, and water’s overflowing the dam so the speak. That’s what we call overflow incontinence.
Host: Then how do you determine the type that someone has? How is it diagnosed? Do you use a history? If they have had prostate cancer or they have BPH, does that send a red flag to you that this is possibly the backend cause?
Dr. Zaid: Yeah that’s a wonderful question and that’s exactly correct. The most important thing to determine the type of leakage is the patient and what they describe as their most bothersome symptom. A lot of men and women will have a mixture of leakages. They’ll have a little bit of stress incontinence or overactive bladder incontinence as well. So, it’s really important to give the patient time to talk and tell their story and that’s kind of, unfortunately, we’re rushed in many cases and we don’t get a chance to kind of go over all the little details. What triggers your leakage? Why do you leak urine? What makes it worse? What makes it better? How long has this been going on for?
Then, as you alluded to, things like their past history. Whether they’ve had surgery for prostate cancer or colorectal cancer. Whether they’ve had a history of any trauma to the lower abdomen. Whether they’ve a history of infections or kidney stones or things of that nature as so critical because all of these things are risk factors for developing trauma and issues in the urinary [inaudible] basically as well. So, talking to the patient is so critical.
Beyond that, there are some simple exams that we can do. Our physical exam is quite critical. Doing a rectal exam to look for an enlarged prostate or a nodule prostate. An abdominal exam to look for any scars in the belly and any fullness in the super pubic that could imply an incompletely emptying batter. Then your standard gentile urinary exam looking for any strictures or lesions in the penis or the opening of the penis called meatus or any abnormalities in the anatomy. Some men are born with an aberrantly placed meatus called hypospadias. These are all things that we look for on the examination as well.
Then beyond the exam there are some invasive imaging studies that we can do, such as an ultrasound of the kidneys and the bladder if we’re worried about any swelling in the kidneys or incomplete bladder emptying as well. Then lastly, in certain men and women for that matter as well, we can also look directly inside the bladder. We can look at the urethra, we can look at the prostate, we can look in the bladder for stones, tumors, enlarged prostates, strictures, and things of that nature as well. So, there’s a lot of tools we have at our disposal to kind of determine the etiology of their urinary leakage.
Host: When we talk about treatments, and for women we hear about Kegel exercise and pelvic floor physical therapy, are these similar for men or are you looking more toward bladder training or keeping a voiding diary, fluid management? Tell us some of the treatment options that might different between men and women.
Dr. Zaid: Absolutely. That’s a great question. A lot of the treatment options, again, are dictated by the type of leakage the patient has. So, for instance, if somebody has stress incontinence—this is coughing/sneezing leakage. In women, we often talk about pelvic physical therapy or the Impressa, which is made by Poise is a vaginal insert, or a surgery like a mid-urethral splint surgery. Well in men, we have different options. So, for stress incontinence, we talk about doing an artificial sphincter surgery which is where we can actually surgically implant a sphincter in somebody which the patient controls. We can do a sling in men as well. It’s called a mid-urethral sling for men as well.
Physical therapy plays an important role in men as well who leak because they cough or sneeze. When we talk about overactive bladder or urge incontinence, many of the treatments for men and women are very similar. So, in men, the unique component would be the presence of an enlarged prostate. So, we do talk about making sure that that’s not causing an obstruction and making sure their bladder is emptying out okay. The treatments are, there is a lot of overlap.
The American Urologic Association have guidelines on how we help patients with overactive bladder or urge incontinence. It’s basically a step by step approach. The first thing we tell folks is look, there’s certain things that you eat or drink that are going to make your bladder irritable. This applies to both men and women. Things like caffeine, alcoholic beverages, spicy foods, acidic foods like citrus based things and things of that nature as well.
Beyond that we have a whole host of medications. The two big families are the anticholinergic. This is stuff like Vesicare or Sanctura or trospium or oxybutynin. Then the latest generation medication is something called mirabegron, or a beta-3 agonist. Then for patients who still have ongoing urgency or urge incontinence that doesn’t respond to medications, or if they don’t tolerate the medications well, there’s a whole host of other options. Something called InterStim, which is like a bladder pacemaker. We can inject Botox in the bladder. Or we can to PTNS, which is a non-invasive means of stimulating nerves that go to the bladder as well. So, we have a lot of tools in our arsenal to help men and women who have all types of leakage.
Host: What would you like other providers to know, Dr. Zaid, about discussing this, bringing it up? Even at the regular annual wellness exams. If they're working with their primary care provider, how would you like them to broach the subject and bring it up and get their patients to talk about it?
Dr. Zaid: Yeah. That’s a wonderful, wonderful question. The first thing I think that’s important to appreciate is how common this is. Some data suggests that up to 27% of men and 43% of women have components of overactive bladder or urge incontinence. The costs are upwards of $12 billion per year as well, but there’s a hidden cost that people don’t realize. This is the cost in intrapersonal relationships, outings, social depression. Then it’s dangerous. I mean this could be a sign of something more serious going on. Bladder cancer can cause this, bladder stones can cause this, kidney stones can cause this. So, there could be some sort of something that’s more sinister that’s causing these symptoms as well.
On top of it, getting up at night time has been shown to increase the rates of falls and trauma associated with that. So, the first thing that, and many providers already realize this, is that this is not a trivial issue. This is a pretty major issue as well. I think it’s really important to normalize it, to let your patient know that look you're not alone. Many men and women suffer through this. This is a very common thing. Just because your parents had or your grandparents have had it, it does not have to be a normal part of your life. It’s important to let the patient tell their story. If you give them time, they’ll give you the information you need to make the right diagnosis.
Then the last important thing is to let them know there’s a lot of treatment options. We can help people. We can get them better. We can make to get them drier as well. It’s dictated by the patient and how bothered they are by it. There’s a lot of resources here that we can help with in all these different domains as well.
Host: Thank you so much doctor for being on with us today and sharing your expertise. What great information for men and for their partners to help them over come something they might feel is embarrassing, but they should be talking with their providers about. You're listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com. That’s carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole. Thanks so much for tuning in.