UnderActive Bladder or BPH ???
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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
jimjames hank1953
Posted
It can get confusing, and part of the problem is that BPH (Benign Prostatic Hyperplasia) is often confused with LUTS (lower urinary tract symptons), and often by your friendly (and all to ready to operate) local urologist! The former is simply an enlarged prostate which could be entirely asymptomatic either because it’s not causing an obstruction, or because the bladder has enough integrity/elasticity to overcome the obstruction. So, a better term is really BPH/LUTS which is more accurate for symptomatic BPH.
The problem is that without proper investigtion, including urodynamics, it’s often hard to determine how much of your LUTS (lower urinary tract symptons) are being caused by the prostate (oversized or not) and how much by the bladder. The size model you mention would not be helpful in and of itself because there are studies that suggest men can have LUTS with small prostates and no symptons with large prostates, and of course vice versa. Urodynamics can not only help with this, but it can also help determine how successful a prostate reduction surgery or procedure might be.. It does this by measuring such things as flow rates, detrusor pressure and nerve activity. For this reason, more sophisticated urologists often recommend a period of catherization (Foley or CIC) for patients with significant retention, prior to urodynamic testing (or after a failed urodynamic test) as part of evaluating whether a particular procedure or surgery might work.
As to whether UAB in and of itself can be “cured”, that depends on how much damage was done to the bladder. I think in many cases “managed” would be a better term. UAB can sometimes be managed with drugs, CIC, or a prostate reduction surgery or procedure.
In my case, for example, I ended up rehabilitating my bladder to a significant degree with CIC, but I wouldn’t say anything is cured. Prior to CIC my IPSS score was in the 30’s (severe) and dropped as low as “5” (mild) four months after I stopped CIC. Now it’s about “9” (mild/moderate) and that’s fine. Should I get more symptomatic, the plan is to go back to CIC for a period of more rehab, per my “on/off” strategy outlined in another thread.
Jim
hank1953 jimjames
Posted
don30615 jimjames
Posted
Interesting, Jim. Two questions: 1) My undertstanding is that when it comes to BPH, it's not so much the size of the prostate as configuration that matters: A prostate, regardless of size, that isn't pressing on the urethra will be asymptomatic, whereas a prostate that is pressing on the urethra will cause LUTS. If that's right, then why the difficulty diagnosing BPH? Wouldn't a cystoscopy or MRI show if the prostate is pressing on the urethra? 2) if BPH medication--in my case, Finasteride and Cialis--eliminate or reduce symptoms, wouldn't that point to BPH as the main culprit? Or can BPH drugs also alleviate UAB symptoms?
Don
jimjames don30615
Posted
Don,
Yes, in terms of LUTS, configuration matters more than size, but the other factor is the bladder. As an example. Two patients with the same bladder configuration with say moderate obstruction. The first patient has a healthy, elastic bladder. The second patient has a stretched, flaccid bladder. The first patient could be almost entirely asymptomatic while the second patient could be moderatly or even severely affected by LUTS. So, it's not really even the configuration (how much it presses on the urethra) but the big picture of prostate and bladder together.
For this reason, functional testing like urodynamics will be more helpful then a cystoscopy or MRI which would show bladder size and obstruction, but not directly measure bladder function. That doesn't mean the cystoscopy or MRI can't be useful, but you really want functional testing as well.
Finesteride and Cialis do different things so if used together, hard to tell what is helping what, but a case could be made that BPH/LUTS is secondary to UAB. Still, there's no reason not to have a urodynamic study, preferably video urodynamics. These surgeries and procedures can be a big life decision, and the more information both you and your doctor have the better.
Jim
hank1953 don30615
Posted
hank1953
Posted
If you have retention, you most likely have UAB.
If your prostate is small (and assume that obstruction is also minimal), you may be able to rid of the retention by CICs. Surgeries probably will not make a big difference.
If your prostate is large (and with serious obtruction), what should you do ? Try surgeries first, but be warned that you may still have problems, because you still have UAB. Is it why so many people complained of unsuccessful procedures ? Or try to rehab the bladder first ? Hank
jimjames hank1953
Posted
@hank: If your prostate is large (and with serious obtruction), what should you do ? Try surgeries first, but be warned that you may still have problems, because you still have UAB. Is it why so many people complained of unsuccessful procedures ? Or try to rehab the bladder first ?
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Either decision can make sense as long as testing suggests a reasonable chance of improvement from the surgery or procedure.
The advantage of having the procedure first is that: (1) It might work; and (2) If it doesn't work, bladder rehab might be easier with less obstruction, plus you were going to do it anyway.
The advantage of trying CIC (or CIC rehab) first is that: (1) you will spare yourself any risks and side effects of a procedure that might not work; (2) you can buy time waiting for newer and possibly better procedures; (3) you may find out that CIC solves all your issues without a surgery, and if you're lucky you may even be able to stop CIC at some point.
Jim
hank1953 jimjames
Posted
jimjames hank1953
Posted
Given your history with this doc, I wouldn't do the urodynamic testing with him, or with any group or hospital he's affiliated with, for a number of reasons, including what you said. Find a major medical center that believes in urodynamic testing and uses video urodynamics.
Jim
hank1953 jimjames
Posted
oldbuzzard jimjames
Posted
hank1953 oldbuzzard
Posted
If I had not been already following this forum at the time, I would have gone along with the TURP, like most ignorant patients. Like my brother-in-law, in his 80s, who went for a complete prostate removal, at his uro suggestion, 5 days after he was told he had prostate cancer. And he did not even know his Gleason score (severity score - usually no removal unless it is 7 or higher, also the older the patient is, the less reason to cut it out) of his PCs. Now he has all kind of problems. Hank
oldbuzzard hank1953
Posted
Hank - prostate removal is another procedure that Urologists love to recommend and cite as the "gold standard". If you're young and have an agressive tumor (as evidenced by a high gleason score as you mentioned) removal may be your best option. But for someone in their 80s with no scoring? My guess is he had a better chance statistically of dying from the surgery than from the cancer. 5% of all prostate cancers ever grow to the point that they cause a problem - if any treatment at all was indicated (and the overwhelming liklihood is that none was) then somen thing less invasive almost surely would have held things at bay for his proabable life expectency. I hope things resolve for him - sometimes it takes months to years.