The Most Common Urology Issues Facing Fiftysomethings

Conditions that send us racing to the bathroom are not unusual and potentially manageable

For Canadian writer Sue Richards, entering the golden years turned out to be more “golden” than she had anticipated. A trip on her brother’s boat epitomized the change when, at an inconvenient distance from shore, she felt a sudden urge from her bladder.

“Leaning forward and sucking in my innards no longer helped,” Richards reported on her website, My Menopause Blog. “Sitting on my heel was not a real option thanks to the bashing waves that made the boat hammer up and down on the surface of the bay.” Fortunately, her brother had a Tupperware container on board, which he gallantly offered her. “My menopause is really kicking the [expletive deleted] out of my bladder,” she told him. “Thanks for understanding.”

Lots of people can relate to Richards, especially those of us who hit middle age and begin to wonder if we should move our bed closer to (or just into) the bathroom. In midlife, it’s not uncommon to need to urinate more often, and to feel more urgency when you have to go, says Stephen Reznicek, a urologist in Aberdeen, Wash. Frequency and urgency are the most common urological complaints for people in middle age and beyond.

What Women Experience and Why

For women, menopause is the primary cause. Estrogen produced by the body keeps the bladder moist and functioning smoothly. But as production declines in menopause, the tissue that lines the bladder can become dry and irritated, producing the feelings of urgency that many women experience, Reznicek says. Reduced estrogen levels also cause the pelvic muscles, involved in bladder control, to weaken.

These are some of the urological conditions women can subsequently experience:

Urge incontinence, that strong, sudden need to urinate because of contractions or spasms in the bladder, can lead to leaking. It’s not uncommon after menopause. But while it can be a sign of a more serious concern, such as infection or even bladder cancer, in most cases no specific cause or threat can be found.

Stress incontinence — the most common urinary condition among women — can cause urine to leak when you cough, sneeze, laugh or exercise. People who are overweight are more prone to this, and weight loss often eases the problem.

The effects of both conditions can be reduced by avoiding smoking, alcohol, caffeine and highly acidic foods, which can irritate the bladder, and by practicing Kegel exercises as often as three times a day, to strengthen the muscles of the pelvic floor. Hydrating and going to the bathroom on a routine schedule can also help. For those with more persistent or disruptive incontinence, there are also surgical options.

Meanwhile, in the Men’s Room …

Most men’s urological concerns are related to the prostate, Reznicek says, which tends to become larger at around age 45. Prostate growth, or benign prostatic hyperplasia, occurs in nearly all men, for reasons that are unclear but appear to be connected to hormonal changes in men’s bodies as they age. In most cases, prostate growth is unrelated to prostate cancer. But for many men, prostate growth does put pressure on the bladder, increasing frequency and urgency. To ease the problem, Reznicek advises a low-fat diet, as well as saw palmetto extract, which some studies have found to be effective.

(MORE: Should We Stop Routine Prostate Cancer Testing?)

Smoking can also contribute to urinary problems. It can cause vascular damage throughout the body, limiting the supply of oxygen to the bladder and creating more urgency as well as false signals.

Hematuria, or blood in the urine, is another condition that can affect men over 50. It is typically caused, again, by an enlarged prostate, or in some cases by a urinary tract infection, which can be treated with antibiotics. However, since hematuria could also be caused by a kidney infection, a kidney stone or even kidney, prostate or bladder cancer, you should contact your doctor immediately if you see blood when you urinate. If no serious underlying cause or infection can be detected, hematuria generally does not require treatment.

Men can also benefit from Kegel exercises. If your only experience with Kegels is knowing that your wife did them while she was pregnant, you’ve got a lot to learn. Done properly and regularly (and discreetly), the exercises can help you limit the effects of incontinence and reduce “dribbling” while urinating.

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