An overactive bladder causes sudden, strong urges to urinate, frequent trips to the bathroom, getting up at night, and sometimes leaking before you get there. It's common in men, and it can coexist with an enlarged prostate or appear after prostate treatment.

How I evaluate it

A history and a three-day bladder diary, a urine test to rule out infection or blood, and a flow test and bladder scan to make sure you're emptying well. Some men need cystoscopy or urodynamics, especially after radiation or when the picture is mixed.

Treatment

Treatment goes step by step:

• Habits: timed voiding, less caffeine and alcohol, and adjusting fluids in the evening

• Pelvic floor therapy with a specialized physical therapist

• Medication that relaxes the bladder

• Bladder Botox, injected through a cystoscope in the office

• Nerve stimulation: weekly tibial nerve stimulation (PTNS) or a sacral nerve stimulator

Bladder medications, and what to expect

• Beta-3 agonists (mirabegron, vibegron): taken once a day, with few side effects. Mirabegron can raise blood pressure slightly, so I check it.

• Anticholinergics (oxybutynin, solifenacin, trospium, and others): effective but can cause dry mouth and constipation. Long-term use of some of these has been linked with memory problems in older adults, so I choose them carefully.

• Give it time: most take four to eight weeks to show their full effect.

• Tell me if your stream gets weaker or you feel you can’t empty, especially with an enlarged prostate.

If medication doesn’t help enough, bladder Botox and nerve stimulation are done in the office. See office procedures.

Related

Office procedures · Medications and non-surgical care · Urinary symptom self-check (IPSS)