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C O N R A D | PEARSON CLINIC OVERACTIVE BLADDER

BLOOD IN URINE medications. Treatments for BPH vary Anytime there is blood in the urine, further from watchful waiting for mild symptoms THE CONRAD PEARSON CLINIC CENTER OF THE SOUTH evaluation is needed. By far the most common to medications or for more severe Common Steps cause of the blood in the urine is infection, situations. Two classes of medication are in Evaluation even in the absence of any major symptoms. commonly used. Alpha-blocker medications While there are many other causes of blood (Flomax, Uroxatral, and Doxazocin) relax John R. Adams, Jr., M.D., FACS Perry J. Larimer, M.D., FACS History in the urine, your physicians will want to the muscle tone of the and relieve Ravi D. Chauhan, M.D., FACS H. Benjamin Maddux, Jr., M.D., FACS the blockage of BPH. 5-alpha-reductase make sure that there is no chance of bladder Physical Exam and Pelvic Exam Lynn W. Conrad, M.D., FACS H. Michael McSwain, M.D., FACS cancer as the cause. can give inhibitors (Proscar, Finasteride, and Avodart) Paul R. Eber, M.D. Richard M. Pearson, M.D., FACS the same symptoms as overactive bladder, can physically shrink the prostate and thus Urinalysis Howard B. Hasen, Jr., M.D.  omas B. Shelton, M.D., FACS but bladder cancer also usually has blood in help to reduce obstruction of urine  ow. If Ultrasound for Post Void Residual the urine. To rule out bladder cancer, your medications are unsuccessful, more aggressive H. David Hickey, Jr., M.D., FACS Carla Dirmann, FNP Voiding Diary physician will likely recommend a CT scan treatments can remove the blocking Robert S. Hollabaugh, Jr., M.D., FACS prostate tissue. Laser treatments, Microwave and a . Possible Procedures: treatments, and even surgical trimming of - Cystoscopy Overactive Bladder in Men the prostate may be helpful. Occasionally, a - CT Scan of Abdomen and Pelvis combination of overactive bladder medicines - Urodynamics By Robert S. Hollabaugh, Jr. MD Overactive bladder symptoms in a man may and prostate medicines will be needed. In Overactive Bladder indicate other problems. Urinary frequency, some cases of huge prostate enlargement, Overactive bladder (OAB) is a condition rechecked to see if any blood remains. If urgency and in a man are often use of an overactive bladder medicine may that a ects approximately 33 million blood is still present, further evaluation will related either to benign prostate hyperplasia Do you have an cause a man to be unable to urinate (urinary Americans. It can disrupt activities of daily be recommended to exclude bladder cancer, (BPH) or to prostatitis. Prostate-related Other Conditions with retention).  us, it is very important for an life. For many “Getting to the bathroom in kidney cancer, urinary stones, and urinary Overactive Bladder? urinary troubles need to be treated carefully, urologist to evaluate the urinary symptoms in Similar Symptoms time” and “knowing where the bathroom blockages as possible sources. and in general involve other types of men and decide on appropriate medical (or is” become major concerns.  e estimated medications. Prostatitis is generally treated  ough the underlying cause of OAB is  ese questions can help you decide surgical) treatment. economic impact of OAB in the U.S. with antibiotics and anti-in ammatory unknown, the nervous system is thought to if you need further evaluation for an exceeded $12 billion dollars in 2000. Women play an important role in the irritability and overactive bladder: () tend to be a ected more commonly than men, overactivity of the bladder. Processes such Do you go to the bathroom so often at Pelvic Radiation and it occurs more frequently as people age. as diabetes, Parkinson’s disease and multiple night that it interrupts your sleep (2 or BPH  e most common symptoms that suggest Neurologic Disorders sclerosis, which a ect the nervous system, can more times)? overactive bladder are: initially present with urinary complaints. Low Parkinson’s Disease Do you go to the bathroom so often that » urinating frequently (more than 8 times) back pain in association with OAB raises the it interferes with your daily activities during the day (frequency) possibility of a “slipped disc” with nerve root (more than 8 times in 24 hours)? irritation. Bladder pain accompanying OAB Disc Disease » Sudden strong urges to urinate (urgency) may be the  rst signs of , Do you always have to know where » Having to wake from sleep to urinate Colorectal Cancer which follows a di erent treatment approach. the bathroom is because of frequent, more than twice each night (nocturia) A thorough medical history and exam can strong, sudden urges to urinate? Bladder Cancer » Leaking urine before you get to the usually diagnose these problems. Do you sometimes have trouble making Gynecologic Conditions bathroom (urge incontinence) Once the doctor has eliminated other it to the bathroom in time? » Unconscious leakage of urine causes of frequency and urgency, treatment Many other symptoms may accompany these, Do you wear pads to protect your of OAB can proceed. Management of Uterine Fibroids clothes from getting wet? some of which deserve particular attention. If Overactive Bladder usually involves Ovarian Cysts there is burning on , the possibility medicines called anti-muscarinics (common Do you limit the amount of  uids that of urinary infection must be investigated brand name medications include Detrol, you drink? Endometriosis with a urinalysis. Once an infection has been Ditropan,Vesicare, Sanctura and Enablex). If you answered “YES” to more than Before Treatment After Treatment treated, any remaining symptoms should be  ese drugs are very safe, e ective, and quick two of these questions, make sure to re-evaluated. Many times, a urinary tract in onset.  ey improve quality of life by ask your doctor about evaluation and infection may have been causing all of the dramatically cutting down on the frequency treatment for an overactive bladder.  e symptoms, mimicking an overactive bladder. of urination, both daytime and nighttime, Wolf River O ce and Surgery Center Methodist North O ce sooner you begin, the sooner you can Blood in the urine (), whether and the severity of urgency. Overall, 1325 Wolf Park Drive, Suite 102 3950 New Covington Pike, Suite 340 phone: 901.252.3400 return to more normal living Germantown, TN 38138 Memphis, TN 38128 visible or microscopically detected, needs the side-e ects of the anti-muscarinic fax:901.763.4305 to be further evaluated.  e most common medications are minimal and may include Southaven O ce West Memphis O ce Please visit our website at cause of blood in the urine is a urinary dry mouth, and rarely mental 125 Guthrie Drive 228 West Tyler, Suite 202 www.conradpearson.com tract infection (UTI). Several weeks after confusion. Some medical conditions may Southaven, MS 38671 West Memphis, AR 72301 treatment of the UTI the urine should be C O N R A D | PEARSON CLINIC OVERACTIVE BLADDER C O N R A D | PEARSON CLINIC OVERACTIVE BLADDER

Bladder Retraining Technique FEMALE ANATOMY (helps the bladder hold urine better) Timed Voiding Technique Dietary and Lifestyle » (Helps to avoid abrupt urges to urinate) e uterus is the organ Modi cations When you feel the urge to urinate, that holds the baby when STOP what you are doing, sit down » Determine usual frequency you are pregnant » Avoid (Co ee, Tea, or STAND STILL, and remain still. of “emergencies.” Colas, Chocolate) » SQUEEZE your pelvic muscles quickly » For example, if you have emergencies e bladder » Avoid CARBONATED SODAS several times, but do not completely every 2 hours, plan trips to the collects and » Avoid CITRUS JUICES and relax the muscles in between. bathroom every 90 minutes holds urine. FRUITS » Relax the rest of your body by taking » When successful for several days in a e cervix is the narrow » Avoid ALCOHOL several DEEP BREATHS. row, increase the interval by lower part of the uterus. » Avoid SPICY FOODS (Italian, » CONCENTRATE on suppressing 15 minutes Chinese, and Mexican type dishes) the urge, and wait a few minutes to let » Target an interval of 4 – 6 hours e is the tube the urge subside. that carries the urine » Stop Smoking (Smoking causes » MUST stick to the plan out of the body. bladder muscle irritability) »  en WALK, DO NOT RUSH, to » Plan to devote 4 – 6 months » Lose Weight (Extra weight can the bathroom. to “recondition” place extra pressure on » REPEAT this routine whenever e urethral e is the canal your bladder) abrupt urges begin sphincter helps from your uterus to the keep urine in the outside of your body. bladder. is not exercising the proper muscles. Kegel’s count of 5, then relax it. A repetition of Kegels cause may be the prostate.  e symptoms, are NOT simply “tightening up the belly means you “Tighten-count to 5-Relax”  ve in general, are identical. Your urologist can muscles” or “clinching the buttocks.”  e times in a row.  is should be done multiple determine which is the appropriate focus of be worsened by these medications, such usually a last resort and is recommended only will give additional information to help your best way to correctly perform Kegels is as times each day as a daily exercise. Try to do treatment. follows. For the  rst week, learn to isolate the it every time you come to a stoplight in your as Alzheimer’s disease, gastroparesis, or when more conservative medications and doctor decide what other forms of treatment URINARY INFECTION proper muscle for urinary sphincter control. car or every time you see a commercial on the narrow-angle glaucoma. therapies are unsuccessful or poorly tolerated. may be considered. Urologists broadly UTI, urinary tract infection or bladder For patients with intractable OAB, however, categorize incontinence into two classes: Whenever you feel the urge to urinate, go television. Linking your Kegel Routine to an Behavioral Modi cations can also help infection, can give the same symptoms as it can mean resolution of their problem. and Urge Incontinence. to the restroom and let the urine  ow begin; activity of daily living will insure that you do symptom control. Some patients do not overactive bladder. In most cases of UTI, While the two classes share some similarities, then stop the stream midstream. Pay attention it multiple times every day- FOREVER. realistically consider these therapies because Another new option for treating severe cases treating the infection will lead to correction they are treated by very di erent approaches; to the muscle you are contracting to stop the they don’t seem as sophisticated as a pill of OAB is Botox. Nearly everyone has heard of the symptoms. In such cases, longterm so careful evaluation is important. Stress stream, as this is the sphincter muscle.  en Special Considerations: or medication. Studies, however, have of Botox related to cosmetic applications. OAB medications will not be necessary. Incontinence is leakage that occurs when in the weeks to come, you can exercise this repeatedly shown the bene ts of these Botox can also be injected into the bladder MALE PATIENTS Controlling the infections will often control physical pressure or “stress” is placed on the muscle at times other than when you are conservative therapies in helping bladder to control severe symptoms of OAB.  e Many men have symptoms of overactive the aggravating bladder symptoms. bladder and leakage of urine results. Most urinating. To do a repetition of Kegels, one behavior for those who adhere to them.  ese procedure is performed using a scope to bladder.  e cause may be the bladder or the commonly, these individuals will leak when must tighten up the muscle and hold it for a include Timed Voiding, Kegel Exercises, look into the bladder and inject areas of the they cough, laugh, sneeze, or lift heavy objects. Bladder Retraining, Dietary and Lifestyle lining of the bladder. While it is a relatively OAB medications will generally not help this Modi cation, and keeping a voiding diary. new therapy, it o ers yet another option if type of leakage. If you think you have OAB,  e simple task of keeping and paying traditional therapies are unsuccessful. Overactive Bladder:  ings You Might Not Know contact your doctor for an evaluation. attention to a voiding dairy can be therapy in and of itself. Dietary restriction avoiding Progression to Incontinence …Overactive Bladder can have dangerous consequences. If you …Many of the overactive bladder medications cause a mild dry alcohol, ca eine, and spicy foods can make a Routine are having to get up 3-4 times per night to urinate, the chances mouth.  is is usually well tolerated, but if not, sucking on hard  e urgency and frequency of OAB can major impact. Nearly everyone has heard of Kegel of tripping or stumbling in the dark increase. Elderly patients are candy can help increase saliva production and minimize the side progress to Urge incontinence, although not exercises, usually related to an OBGYN’s even more prone to falls during the nighttime. Elderly female e ect. Surgery is not usually helpful in cases all cases do. Patients will complain “I can no recommendation to women after . patients are also more prone to breaking a hip with a fall because of OAB or urge incontinence, because longer get there in time” and “I leak before I … Many patients decline to treat overactive bladder citing the high While Kegel exercises are generally used to of osteoporosis. Even in today’s world of modern medicine, a hip incontinence surgery is mainly designed to get there.” Because it is generally thought to be cost of the medications medication but still pay top dollar for huge help control stress , the fracture in an 80 year old patient has a mortality rate of 25-50%. restore pelvic support and usually does not a progression of the same symptoms (urgency quantities of adult diapers or “Depends.” Patients should consider Kegel routine can be e ective to exercise the help control bladder spasms. In severe cases and frequency of urination), it is usually …Controlling overactive bladder can help restore more normal sleep the overall cost of not treating the condition. pelvic  oor muscles and improve bladder of urge incontinence or intractable OAB, treated with the same class of medications. If patterns. If you have to wake up 3 – 4 times each night to urinate, hyperactivity. However, one must do the a “bladder pacemaker” (called Interstem) OAB medicines do not improve the leakage, normal sleep patterns are disrupted and patients don’t really get exercise properly. Many cases fail simply can be surgically implanted to help alleviate additional evaluation with cystoscopy and rested. If you rest better, you have more energy and are more alert. because the patient is not trained properly or symptoms of urgency and frequency.  is is urodynamics may be indicated.  ese tests