OAB
As I age, and my friends age, I hear a lot about bladder problems. The most common troublesome symptoms are frequent trips to the bathroom, especially at night, and occasionally not making it to the bathroom in time. Many people just think this is a part of getting older, but there are many treatment options for Overactive Bladder.
For cisgender women, it’s part of what’s now called the Genitourinary Syndrome of Menopause. For cisgender men, it’s often a symptom of Benign Prostate Hyperplasia. The first step in improving symptoms is elimination of caffeine and other bladder irritants. If this is ineffective (or impossible) the next step is bladder retraining.
The tissues of the bladder, vulva and vagina are all very sensitive to estrogen, and when estrogen levels drop after menopause we see big changes in these tissues. Not only in strength and flexibility, but also in the levels of protective bacteria.
Adding back a tiny bit of estrogen is pretty easy. Your doctor can prescribe tablets to insert, creams to use or a 3 month vaginal ring. People worry that “estrogen causes cancer” so they often don’t fill the prescription, but the amount prescribed for the vagina is so low it doesn’t cause problems in the uterus, or make it into the bloodstream to affect other parts of the body.
Vaginal estrogen prevents bladder infections, improves symptoms of overactive bladder, fixes vaginal dryness and resolves painful intercourse.
There are over the counter vaginal moisturizers that can ease symptoms of dryness, and you can find safe sexual lubricants at goodforher.com (Uberlube is safe, and people like it).
But if bladder issues are driving you crazy in the menopause, a little dose of estrogen might do the trick. If your urge issues are still an issue after 6 months of estrogen treatment, go see your friendly neighbourhood pelvic physiotherapist for bladder training. You can also talk with your family doctor about are 2 other classes of medications that calm overactive bladder in women: anticholinergics and Mirabegron.
For people with penises: welcome to the BPH years! Most cisgender men will eventually develop Benign Prostatic Hyperplasia, a noncancerous enlargement of the prostate gland. A quarter of men will eventually have symptoms of obstruction or urgency severe enough to require treatment. The overactive bladder symptoms in this case are because the bladder muscle has gotten too strong after years of pushing to overcome the pressure!
Two classes of medications are available to treat this issue. Alpha blockers relax the smooth muscle of the bladder and prostate, and 5-alpha reductase inhibitors shrink the prostate. If these stop working, a TURP surgery can remove the obstruction.
If overactive bladder is making you miserable, visit your family doctor. Agony is optional and good treatments are available!