Diagnosis And Treatment

With advancing age come several health issues, urinary problems being one of them, especially in old age men. Marketing Avenues had a word with Dr. Shailesh Chandra sahay, Senior Consultant Urologist, Max Superspeciality Hospital, Patparganj, regarding urinary problems in older men; their causes, diagnosis and treatment.

Marketing Avenues: What are the most common urinary complaints that you get to hear from elderly people, Doctor Sahay?

Dr. Sahay: Most common problems are difficulty in passing urine, slowing of the urine sream, frequently getting up in the night to pass urine, feeling the need to visit washroom again just after emptying the bladder, difficulty in controlling the bladder and leakage of urine. The symptoms are usually divided into Storage symptoms and Voiding symptoms. Storage symptoms include increased frequency and urgency of passing urine, urinary leakage while going to toilet and frequently getting up at night to pass urine. Voiding symptoms include: poor stream, hesitancy, intermittent flow and straining while passing urine.

M.A.: Would you please throw some light as to the causes behind these symptoms.

Dr. Sahay: The most common causes include: *Prostrate enlargement- Since the prostate gland is situated around the neck of your bladder, its enlargement can cause voiding symptoms. *Overactive bladder- With increasing age, muscles weaken and it becomes difficult to control the bladder which leads to frequent urination and leakage (incontinence). *Water balance problems-With age it becomes harder for the body to reduce the amount of urine it produces at night hence above the age of 65, one has to get up at least once in the night. Other causes include – diabetes, urinary infections, bladder stones or cancer, prostate cancer and some neurological conditions.

M.A.: What all diagnostic tests are advised in the above problems?

Dr. Sahay: *Rectal examination (palpation of prostrate through the rectum) may reveal a markedly enlarged prostrate. Blood tests are performed to rule out prostate cancer. *Serum PSA- Prostate Specific Antigen level is a marker of prostate cancer. * Blood sugar test to rule out diabetes mellitus. *Ultrasound- To know prostate size, kidney status, residual urine volume and urinary stone problems. The line of treatment varies according to the causes. Whereas some will benefit from lifestyle changes, others need medication, while still others might need surgery. *Lifestyle modification- Reduce the amount of fluid intake, especially in the evening, after 4 pm. However do not reduce the total amount of fluid to less than 1 .5 liters per day. * Avoid alcohol and smoking. * Gradually try to increase the time between visits to the toilet at the same time trying to increase the amount that you pass each time. The bladder muscle can be trained to expand more in this way. * Pelvic floor exercises. There are certain medicines which can be effective in improving the symptoms of BPH (Benign Prostatic Hyperplasia or enlarged prostate), overactive bladder etc. When medical treatment fails to alleviate the symptoms, surgical management is required. Surgical options- There are two main surgical options for treating BPH:- TURP or Transurethral resection- An instrument is passed through the urethra and extra prostate tissue is trimmed. The recovery period is quite short. *HOLEP or Holmium-Laser Prostactomy is the most advanced form of surgery with advantages of less bleeding and early recovery.

M.A.: Thank you Dr. Sahay for giving time to our readers. There are a lot of elderly people who suffer from urinary incontinence or loss of bladder control but remain mute about their suffering. This discussion could make them come forth and talk about their problems and get them treated.

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