Men’s Overactive Bladder: It’s Not Just a Prostate Issue
Overactive bladder (OAB) is common and can feel like it is consuming your life, but it doesn’t have to. OAB feels like sudden, uncontrollable urges to go pee NOW and may have associated leaking or be urgency alone. The cause of men’s overactive bladder can be a mechanical or sensory issue, and a detailed exam is needed to determine which one it is. Typical “default” medical explanations (like enlarged prostate) are often incorrect or incomplete - but it’s what they can do in a 3-5 minute visit. There are better and less invasive options than injections or medications with serious side effects including pelvic floor physical therapy. Men’s pelvic health can help get to the root cause of the issue so that you can strategically tackle the problem and use your time and energy in more fulfilling ways than constantly looking for the next bathroom.
Urinary Urgency and Frequency in Men
As men, we stereotypically have a pretty good sense of geospatial relationships and directions. This serves us well exiting a busy event center, finding the best campsite around Rainier, wrenching on cars, or figuring out the most efficient use of a sheet of plywood. But, some of us are spending this capacity to keep track of bathrooms everywhere we go; which gas stations have the cleanest and most accessible bathrooms, where bathrooms are on each floor of the office building, and which parks have toilet access or trees to duck behind. What a frustrating use of our bandwidth! We might also be going about our days with a background stress of not knowing when a sudden and unrelenting urge to pee is going to surprise us. Perhaps our partners are starting to call us out for having to stop twice on the way to our kid’s soccer game, or for waking them up 4 times last night. Living like this does not have to be the reality forever!
Normal Bladder Function in Men
Before diving into what is going wrong to cause overactive bladder - how does a normal bladder work? The below steps are simplified for ease of understanding.
The kidneys make urine by filtering water and waste from our bloodstream. Kidneys are constantly trying to balance hydration, blood pressure, and manage waste from body functions.
Urine travels down tubes called the ureters into the bladder which rests behind the pubic bone. At the bottom of the bladder is a valve that is under automatic (not voluntary) control, which remains shut for filling.
As the bladder fills with more and more urine the walls stretch like a balloon taking up more space in the abdomen.
Stretch sensors on the bladder’s wall eventually stretch enough to send a signal to the brain “Hey! We’re getting pretty full down here. Can he go to the bathroom now, please?” That is when we feel the urge to go; nature is calling. That valve on the bladder starts to open.
Since that bladder valve is opening but we might not be in the right place yet we subconsciously start turning on our pelvic floor muscles (voluntary).
Once we are in the right place to go pee, we relax the pelvic floor muscles, urine starts to travel towards the outside, sensors along the way tell the brain it is emptying time, which in turn sends the signal to squeeze the bladder muscle. This squeeze helps us empty the bladder.
Once empty enough (but rarely completely empty) the bladder valve turns back on to stop the flow and start storing urine again. Now repeat roughly every 2-3 hours.
What is Men’s Overactive Bladder?
Men’s overactive bladder is when a man experiences STRONG and SUDDEN feelings of needing to pee (urgency). Men with this condition can also experience leakage, but not always. Unfortunately, there are still sources and professionals around that perpetuate the myths that either A) overactive bladder is only a women’s issue, or B) all male urinary issues must be due to the prostate.
What Causes Overactive Bladder in Men?
While overactive bladder can stem from several different root cause issues, the cause of the day-to-day symptoms are often coming from a mechanical issue or sensory issue.
Mechanical: The bladder has a muscle, the detrusor muscle, which can become twitchy and quake or spasm. These rumblings trigger stretch sensors that tell the brain “we’re trying to empty our bladder NOW,” which then leaves us with a sudden, uncontrollable urge to find a restroom. This origin is called “Detrusor Overactivity.” An analogy here would be that you are driving your car at a constant speed and suddenly the engine revs up to redline without warning or cause. Will it ever slow back down, or will it blow itself up first?
Sensory: The bladder muscle may not be quaking or spasming, but the stretch sensors can become too sensitive. They can be so sensitive that they signal for the need to empty the bladder even if the tank is only partially full and typically nowhere near capacity. This origin is called “Bladder Hypersensitivity.” In your car, this would be like if that light on the dash for low fuel came on when you pulled out of the gas station or when the gauge still reads ¾ of a tank. Why are you warning me now?! I should be able to go so many more miles before having to stop again.
How You Might be Making Overactive Bladder Worse
Unfortunately, the most intuitive responses or strategies to manage these feelings can reinforce the problem - a real vicious cycle! Common strategies seen in men’s overactive bladder:
Just In Case Peeing: “If there is a toilet I will use it even if I don’t need to yet.”
Problem: If hypersensitivity is the origin this is feeding into that cycle and reinforcing at best, encouraging at worst.
Reduce Fluids: “If I drink less fluid then maybe I won’t have to go as much, right!?”
Problem: Beyond the general health concerns of underhydrating, reduced fluids can result in more concentrated and more acidic urine which will encourage the bladder to try and empty sooner.
Just Hold It: “I’m strong, I will just hold it!”
Problem: White-knuckling the urge can actually be helpful in some cases, but squeezing the muscles to 💯, breath holding, and not getting up from the chair can all get pretty uncomfortable and inconvenient.
Treatment for Men’s Overactive Bladder
There are absolutely ways you can resolve overactive bladder! Because the issue is commonly coming from either mechanical or sensory issues it is very solvable but determining the source and all related factors is extremely important to getting relief. The main treatment pathways include:
Medications
There are several classes and generations of medications available through general practitioners and/or urologists. The problem is that they come with some pretty unfortunate side effects and because overactive bladder is not an infection/pathology, no medication will cure the condition; they can only reduce symptoms while actively taking the pill. The two most common drug classes are:
Anticholenergics/Antimuscurinics: These medications target the bladder muscle to reduce its overactivity. Unfortunately, if overactivity isn’t the tissue, there is a risk of urinary retention (underactivity). Additionally, studies show that using these drugs for more than 3 months increases the risk of dementia by an average of 46% which doesn’t revert back once the medication is stopped.. Examples: oxybutynin, tolterodine, solifenacin
Alpha-Blockers: These can often be the “default” prescription for men complaining of urinary issues because the provider assumes it must be a prostate issue. The medications work to relax muscle around the bladder and prostate to improve the ability of the bladder to empty. But what if there isn’t an issue with how well the bladder empties? Leaking can worsen. Examples: tamsulosin, alfuzosin, silodosin
Injections
Botox can be injected into the bladder muscle to temporarily paralyze small sections. This can reduce the intensity of the quaking/spasming, but also reduces the overall strength of the muscle which can lead to incomplete emptying. In skilled hands, this management option can be very useful but would need to be repeated on a 3 to 6 month basis as the body will eventually break down the chemical and muscle activity resumes. Injections always come with a risk of infection, over dosing (leading to a paralyzed bladder requiring catheter use for 3-6 months), or not impacting the issue at all because it is a sensitivity issue.
Pelvic Floor Physical Therapy
A pelvic health physical therapist will utilize specific questioning to help identify what exactly is happening with your system. Taking a detailed history is the most important part to set off on a successful care plan - and it often takes more than the 3-5minutes other medical providers have to be in the room with you. Pelvic health physical therapists will also then do a thorough physical examination to determine all factors that are contributing to your overactive bladder. With a history and a physical exam, we can then develop a plan of care that fits your specific life circumstances. That plan might include interventions like:
Learning what are and how to use Urge Suppression techniques
Hands-on, manual therapy or dry needling to reduce tension in relevant muscle groups
Exercise to help stretch and strengthen relevant muscle groups
Neuromuscular electrical stimulation to retrain bladder signals
If there are signs or symptoms that suggest physical therapy might not be the right or only help needed, we are trained to refer to other medical and health colleagues to ensure safety and the best outcome.
Now, start imaging a life without overactive bladder - that unpredictable and sudden life-interruptor. If you weren’t keeping track of where the best and most accessible toilets (or trees) are, what would you do with all that extra mental bandwidth?
A Note for the Partners: If you're the one planning road trips around rest stops, or if you’ve noticed him getting frustrated by frequent "pit stops," he isn't just "getting old." This is a coordination issue that can be retrained. Encourage him that it’s a mechanical fix, not a permanent decline.
Where to Get Help for Men’s Overactive Bladder
If you are local to Richland, WA, Tri Cities Pelvic Health provides men’s pelvic floor physical therapy. We specialize in pelvic floor therapy and have some of the only providers in Eastern Washington trained specifically in men’s pelvic health issues. We would be happy to help you get clarity about what is going on and then make sure you have the tools to fix it so that you can take your life back.
