UnderActive Bladder or BPH ???
Posted , 10 users are following.
UnderActive Bladder (UAB) or BPH ?
UAB:
"Detrusor underactivity, urinary retention, high residual urine, and incomplete bladder emptying have been used. Detrusor underactivity is defined by the International Continence Society as a contraction of reduced strength and/or duration resulting in prolonged or incomplete emptying of the bladder, but has received only minimal attention. Patients with UAB have a diminished sense of when the bladder is full and are not able to contract the muscles sufficiently, resulting in incomplete bladder emptying."
UAB also is known as Hypotonic Bladder, Flaccid bladder, Lazy bladder and Detrusor Hypoactivity. The most common symptoms are urinary retention, hesitancy, difficult starting and stopping, stops and pauses during urination, dribbling afterward, urgency, and frequency problems.
Treatments for UAB are generally to protect the kidneys from urinary retention, including:
- Time scheduled voiding, since UAB sufferers can not tell if bladder is full.
- Double voiding, to empty bladder as much as you can.
- Bladder relaxants like Bethanechol, Doxazosin.
- Intermittent self-catheterization (ISC or CIC) and indwelling catheters.
Unfortunately, many of the listed symptoms and treatments are similar to BPHs, while the causes of UAB are many (too many to be listed here), not just prostate obstruction, and affecting men as well as women. This gives ways to many cases where unneeded prostate procedures were suggested or even coerced by ignorant or unscrupulous professionals. The results sometimes can be devastating for the patients.
So the question is how to know if it is UAB or BPH ? I've read some where that the simplest way to tell is by your prostate size. If it is less than 30cc, then it is most likely UAB. If it is higher than 40cc, then it is probably BPH. There might be also one read using PSA readings as indicators.
Another way which was suggested by Jimjames on this forum many times is with urodynamics, where your flow can be measured. Maybe Jim will elaborate more on this test. However, urodynamics was known to be more accurate to show that there is no obstruction (good flow) than whether or not the poor flow is caused by UAB or obtruction.
Now comes my story: 63, blood test shown decline kidney function in 2016. High blood pressure. Symptoms were exactly as UAB now that I know better. Asked for a kidney scan. results : urinary retention + kidneys flooded with urine. Referred to a urologist. Without any test or exam or even a handshake, uro suggested TURP. Said "No", asked for CICs and doxazosin. Have been doing CICs since, 4 times at the beginning. Since kidney functions and retention have improved, I have reduced to 2 times a day. Doxazosin still taking on and off. UAB symptoms are still here, but are more tolerable. Normal blood pressure now. Don't know prostate size. PSA has been around 3.0 for the last 9 years. Some one on this forum (I think it was kenneth1955) gave me an estimate of 35cc for PSA of 3.
How did I get UAB (even though I think I have BPH as well, I think the dominant one is really UAB) ? I have few suspicions:
- I used to donate blood very often for years, until one day I was refused because they said I was anemic. One of the cause of UAB is nerve problem, and B12 deficiency is one of them).
- Years of bladder abuse finally caught up with me. I used drink a lot and then tried to hold it in, especially overnight. I definitely over-stretched my bladder many times over.
- Years of taking antihistamines as a sleep aid.
How about a cure for UAB ? Unfortunately, there is none, at least at the moment. The only thing we can do is to take care of our unique situations, making sure UAB will not cause any further kidney damage.In a way, UAB is worse to have than BPH. Because with BPH we may find a fix via a procedure. However, if you have UAB, it is good to know it since it may save you from unneeded BPH procedures, which is the main purpose of this discussion. I am not anti surgeries or anti drugs. Just make sure what you have and what will help you.
But there is hope !!! My symptoms have improved after a year of CICs, doxazosin, and watching my liquid intake. I am very hopeful that it will get even better. Then here comes Jimjames, who is well known in this forum for his sardines and spinach. Jim had a similar problem 3 years ago. UAB with BPH! Jim self cathed for 2 years + and was able to rehabilitate his bladder and now is free of UAB. No CICs + no drugs.
Actually, I did try to sweet talk (con) Jim into posting this discussion (to save me the hassle) but he is too smart (did I mention sardines and spinach ?) so he did not do it.
Finally, fellow UAB sufferers : You are not alone!
Hank
0 likes, 32 replies
Motoman hank1953
Posted
Since having the FLA procedure, I recently tried using a catheter to see if I have any retention going on. I could not insert the Speedicath 14 that I had no problem with prior to the procedure. I was even using #12 prior and after with no issues. So something changed in the healing process to make insertion more difficult.
But I guess my point in posting is I believe you can get relief from UAB symptoms by removing some of the obstruction of BPH.
hank1953 Motoman
Posted
" .you can get relief from UAB symptoms by removing some of the obstruction of BPH. ."
I agree Moto, some will definitely can use a procedure, actually some should. The question is which one ? But for some, like me, no procedure is needed, at least not yet. Hank
hank1953 Motoman
Posted
How is your progress with FLA ? I am interested in both iTind and FLA. Did you have retention before iTind and FLA ? I think I know the answer (clue: long motorcycle rides). Did iTind and FLA help your retention ? Thanks.
jimjames Motoman
Posted
Motoman,
That is strange, you would think the opposite, now that at least some of thee obstruction has been removed by FLA.
Did you meet resistance at the prostate, bladder sphincter, or somewhere else? If you didn't try a coude, that might help make navigation easier. Either the standard Speedicath coude or the new Speedicath FLEX coude.
In any even, further investigation might be useful, not just in regard to CIC, but to find out why you are having more difficulty inserting a catheter.
Jim
Motoman jimjames
Posted
I would have thought it would be easier, but it was more difficult for the prostate, and impossible to go past the sphincter. I twisted it a little, backed it out, etc, and finally gave up. Maybe a new false passage? I was able to use a coude a couple weeks prior, but that was really painful, so I thought I would try my old standby.
I did just order a few of the new flex coude, in both 14 and 16. Just a handful of each. Maybe they will work better. I don't really want to do it, but it is good to check my PVR now and again. Only done it once since my FLA.
Motoman hank1953
Posted
I did have retention before the Itind. I guess I did before the FLA as well, but knew how to self cath by then so not a big issue.
I am wondering if the motorcycle riding is causing some issues with my prostate. You are basically sitting on it the whole time. Plus it takes a beating when I am riding my dirt bike, which is at least weekly. I would never give it up. The prostate will be gone before the bikes at this point of my life.
As for the FLA, I would say it has worked great short term, but I am watching and waiting to see if it holds up for the long term. I have some hesitation, especially in the middle of the night, that was not there for the first three months after the procedure.
hank1953 Motoman
Posted
Ah hah, someone else other than cartoonman and myself has problem with those coude.
I tried flex coude, it's definitely a lot better. Hank
hank1953 Motoman
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jimjames Motoman
Posted
@Motoman: "....and impossible to go past the sphincter."
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I assume you're talking about the bladder sphicter?
False passage or stricture is one possiblity, possibly from the Foley post FLA. Post operative inflammation could be another although it's been some time. I think ordering the new flex coude in 14 and 16 was a good move. It's a softer, kinder, kind of catheter that I think you might be able to push through. But whatever catheter you try, I'd only use coudes until it goes in without resistance.
Still, I'd be more than curious what is going on inside and bring it up with my urologist and also run it by Dr. K. I know you're happy so far with your FLA results, but the possiblity exists that fixing (assuming it needs it) whatever is now giving you cathing issues might also give you even better overall relief.
Last thought, if you tried CIC after you natural void, it's possibly that the problem getting through the bladder sphincter is that your bladder is completely empty and therefore the sphincters have slammed shut. To test out this theory, you would try and self cath prior to a natural void when you know that you have some residual.
Jim
Motoman jimjames
Posted
I am guessing Bladder sphincter, yes. I have always had two points of resistance, and the one that stopped me was the second, so I am assuming that is the Bladder sphincter.
When I spoke with Dr K, he thought I could have a UTI or prostatitis causing the hesitation. I don't think I have either. I did take some D mannose this week just in case there was a UTI.
I am not sure what could be fixed at this point. I'm assuming I just live with whatever the results are.
And you have a good point about the possibility of the Bladder being empty. Maybe I will try it sometime when I know it's full just to see.
jimjames Motoman
Posted
If it's stricture or false passage, it could be fixed which might help you overall, so might be worth a look. Dr. K's idea of a UTI is worth at least a home dipstick test or a urine drop off at the urologists as D Mannose only works with some gram positive strains like e coli and will not help others. If it turns out that you're only having problem getting in on an empty bladder, I'd say that is good news, but easy enough to find out. Bladder doesn't have to be full, full, just not empty when the bladder sphincter is the tightest.
Jim
mike588 Motoman
Posted
Hi you can get some inexpensive urine testing strips online to check for UTI - also regarding CIC and "false passage" one time when I first started CIC I thought it was going in wrong and stopped because it felt wrong. I never really figured out what happened, maybe was my imagination.
j12080 hank1953
Posted
Thanks for your story Hank, I think this is a valid and improtant part of the diagnosis of what is going on for a majority of man with urinary issues. I would guess that in most cases of urinary retention issues it is a combination. I know that in my search for some answers a doctor in North Carolina looked an my MRI and told me, "what ever you do is your choice but my advise to you is to do it sooner rather than later as you have a case or tribeculation starting in your bladder wall. My prostate felt normal and seemed to work fine except for the BPH symptoms but it had grown to 125 cc. which is about 4 times normal size.
I have a question to ask you, why do you not know what size your prostate is? I would think a simple MRI even without contrast would tell you the size? With contrast the urethra stricture would be visible and messurable. So, I am sure you are correct that these symptoms we call "BPH" symptoms are, alot of times a combination of BPH and UAB.
jimjames is proof that UAB is cureable and with the correct tissue removal process, I would think both conditions could be dealt with over some time. UAB seems worse than BPH but I bet in reality they go in combination a lot of times. BPH is not cureable as you can only treat the growth and not the condition. jimjames has presented his situation and has evidence that he has cured his UAB at least for the moment. I would think since these two conditions seem to go hand in hand that treating them together may become a option that surfaces. But I don't count on it coming from the medical industry.
mike588 j12080
Posted
I agree with you John, hoping I can use Jim's methods.
hank1953 j12080
Posted
Actually, I looked up my note. It was Neil3149 that was kind enough to give me an guesstimate of 25mg from my PSA of 3. I had bad experience with my urology people so have not been able to get the actual size yet. Hank
oldbuzzard hank1953
Posted
I have both - and my prostate is only 30, but its growth is all inward, hence my symptoms. I had Rezum done and it helped alot - probably solved about 70% of my problem, but obviously not the bladder issues. Sometimes, my bladder is almost normal, other times I need to pump it to get empty. If you have significant prostate related blockage, you might want to consider one of the less invasive procedures as BPH can cause and/or exacerbate bladder issues.
Best to be scoped and have unrodynamics testing to get a baseline and see where you are. Some (like me) opt for a procedure, others (JimJames) don't think they are worth the risk and opt for CiC. Both can help dramatcially.
hank1953 oldbuzzard
Posted
hank1953 oldbuzzard
Posted
oldbuzzard hank1953
Posted
Hank - Went into full retention once and had some less severe issues (couldn't fully empty) twice after that over 4 years. Once after anesthesia and once with no apparent cause. Both times, a single self cath got me back to normal.
Yes - Ruzum helped a lot and while I'm not perfect, I haven't come close to retention since I recovered from the procedure. Unless/until my bladder gets worse or my prostate grows, I don't think I'm at much risk for retention.