When The “Going Problem” Becomes A Growing Problem

urinary incontinence in men

Concluding his 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia, Dr. Richard Roach, of Advanced Urology in Oxford, FL, shares the story of a patient who found an alternative to chronic urinary catheter use.  

In my first two posts on the BHEALTH blog, I outlined the link between urinary retention and incontinence in men with benign prostatic hyperplasia (BPH) while highlighting some of the challenges of using indwelling catheters to treat BPH-related symptoms. For many individuals, there are significant drawbacks to long-term catheterization, among them a significantly heightened risk of infection and a variety of lifestyle restrictions. In this, my final post on BPH-related incontinence symptoms, I would like to share a story of one of my patients, and detail how an innovative treatment option transformed his life and ended his reliance on urinary catheters.  

Ray is a 65-year-old man who lives in The Villages, Florida. He was diagnosed with an enlarged prostate when he began experiencing severe BPH symptoms in October 2014. Like many men, he was placed on a Foley catheter, which drained his bladder but also led to discomfort, pain and self-consciousness. For more than six months, continuous use of the Foley catheter severely impacted even the most basic of Ray’s daily activities, and soon a series of urinary tract infections (UTI) led to frequent hospital stays. It was during one of his hospital visits that I was called to treat a UTI.

Ray had a very different future in mind before catheterization interrupted his life. He never envisioned himself spending the rest his days using a catheter; just six months earlier he was an avid golfer with a thriving social life and in relatively good health. Now he was weak, self-conscious about his leg bag and battling one infection after the other. 

During our first meeting he explained that much of his day revolved around catheter care. Ray explained that he was looking for a solution that worked with his lifestyle, not against it. Ray believed he was out of options, but he shared that he wanted just three things:

1.    Restore his continence and ability to naturally urinate

2.    End the recurring urinary tract infections

3.    Resume the daily activities he cherished most

And in Ray’s case, there was a solution. Several weeks after I first examined Ray, we inserted a temporary prostate stent to keep his urethra open and maintain urine flow. Prostatic stents are not yet widely adopted, but I have used them in my practice with great success. Like many patients using a temporary prostate stent with similar physical conditions, Ray immediately saw the benefits: he was able to fill and empty his bladder naturally, he had no more concerns about catheter maintenance, and he resumed nearly all of the daily activities that he couldn’t perform during his period of chronic catheterization. 

“Using the catheter was just not a nice way to live,” Ray told me. “With the stent in place, I felt normal again. Quite simply, I was able to resume my life. I felt healthier physically and mentally, just extremely fortunate to have found an option like the stent to replace the catheter and lead to a more permanent solution to my health problem. The stent saved me from using the Foley for the rest of my life.”

Ray’s case isn’t unique. Men all over the world struggle with incontinence due to BPH and other BPH symptoms. While some patients are not candidates for removal of the catheter, urologists have a wide variety of prostate treatment options. Every chronically catheterized patient should have a discussion with his urologist to understand if a catheter-free lifestyle is possible. 

As we close this series, I encourage all men suffering from symptoms of BPH (incontinence or otherwise) to bear in mind the importance of open dialogue and awareness of alternatives. Find out what treatment options are available to you; ask the right questions and be an informed healthcare consumer. It could make all the difference in the world. 

Best of health, and thanks for reading!

 
 

The Hidden (And Not-So-Hidden) Dangers Of Treating Incontinence With Urinary Catheters

Treating incontinence with catheters

Treating incontinence with catheters

This is the second in a 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia. Dr. Richard Roach, of Advanced Urology in Oxford, FL, discusses the challenges of using urinary catheters to treat men with BPH-related incontinence, and the drawbacks of long-term catheterization.  

In my last BHEALTH blog post, we touched on the peculiar, yet common link between BPH and incontinence. Among other topics, we reviewed the progression of BPH disease state, to the point that symptoms begin to manifest themselves through urge and stress incontinence. Likewise, we also discussed the role that urinary catheters play in men who are not good candidates for BPH therapies.

So let’s now take a closer look at this population of men who must rely on urinary catheters to manage BPH-related incontinence symptoms, and examine the shortcomings of long-term catheter use:

Losing the ability to void naturally 

The first (and most obvious) drawback of chronic catheter use is losing the ability to urinate at-will. Of course, managing supplies and components can be a hassle, but there are also health concerns associated with preventing your bladder to fill and empty on its own. Chronic catheterization, particularly with an indwelling catheter, can increase the risk for deterioration in overall bladder health, which can lead to a permanent inability to store and drain urine naturally, or even cancer.

Heightened infection risk 

Perhaps the most immediate health concern with chronic catheter use is the heightened risk of infection. According to the Centers for Disease Control, more than 500,000 patients each year in the U.S. develop urinary tract infections (UTIs) while in the hospital, and indwelling urinary catheters (commonly known as Foley catheters, which reside inside the bladder for either a short or long period of time) are the leading cause. And the CDC numbers only count UTIs acquired while in the hospital; many others develop infections from long-term indwelling catheter use at home.

Compromises to quality of life 

The last, but no less important, drawback of chronic catheter use is the impact on quality of life. Many men are simply unable to perform day-to-day activities inside and outside the home. The embarrassment or inconvenience of a drainage bag is a commonly lamented life-limiter, and some types of catheterization restrict a man’s ability to be sexually active, which can strain relationships.

These challenges represent the key reasons that healthcare professionals around the world are seeking alternatives to long-term catheter use. And though it’s not always feasible to have a catheter removed, it’s important to point out that there are alternatives to long-term catheterization.

The final post in this series will highlight the story of one such patient who stopped using a catheter after several challenge-fraught years, and gained back his ability to urinate when he wanted to – without components or supplies, without infections and (most importantly for him) without any significant compromises to his everyday life.

Read part 3 of this series here.

 
Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.
Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.
 

When Going Gets Tough, The Tough Become Incontinent

Incontinence in Men Due To Benign Prostatic Hyperplasia (BPH)

This is the first in a 3-part series on urinary incontinence in men suffering with benign prostatic hyperplasia (BPH). Dr. Richard Roach, of Advanced Urology in Oxford, FL, discusses disease state, symptoms and treatments.

Bearing in mind the fantastic wealth of resources available on the National Association for Continence BHEALTH blog, I thought I would take the opportunity to focus on a somewhat lesser known facet of continence: the unique link between urinary retention and incontinence in men with benign prostatic hyperplasia (BPH).

The classic male patient with BPH often experiences both filling and emptying symptoms. These could manifest themselves in the form of frequency, urgency or weak stream, among others. Patients with BPH will often tell me they feel like they have to go all the time, but can’t seem to go when they stand at the urinal. It’s a perplexing (and frustrating) feeling.

So why am I contributing to a continence blog writing about a population of men who can’t pee? In short, these men often experience stress and overflow incontinence.

It’s counterintuitive, but when you give it some thought, it makes sense.

BPH causes the prostate to enlarge. This growth can cause narrowing of the prostatic urethra, which makes the process of urination more difficult. All the while, the bladder must work harder to overcome the resistance from the obstruction in the urethra. If left untreated, the bladder’s muscular lining will thicken, causing it to weaken and become less efficient at draining – in some cases irrevocably. 

It’s usually at this juncture that symptoms become severe. Men suffer from incomplete emptying, even after using the restroom, and always have the feeling of being “full.” Their frequent trips to the restroom at night cause sleep cycle interruptions. With the bladder stretched, sneezing, laughing or coughing can cause leakage, or in more extreme cases the bladder may leak because it’s simply too full.

If they haven’t found a urologist by this point, usually we find them … recovering in the hospital from acute urinary retention. In this setting, the most immediate relief comes in the form of catheterization, either from an indwelling or intermittent catheter. Usually, the patient’s bladder health and overall physiology dictate whether a de-obstructive procedure to remove prostate tissue will provide more permanent relief.

For a smaller percentage of men, particularly those who have aversions to the risk of surgery, or more commonly, health complications that prevent a surgical de-obstructive procedure, catheterization is the only solution. Yet chronic catheterization comes with several important drawbacks, including:

  1.    Losing the ability to void naturally
  2.    Heightened infection risk
  3.    Compromises to quality of life

In the next post on this topic, we’ll delve into these three issues in more detail, as we take a closer look at urinary catheters. Part 3 of this series will also cover the amazing story of a patient who was brought back from the brink after years of struggling with chronic catheterization for BPH symptoms. But first, let me add a few closing thoughts on the theme of BPH-induced incontinence.

I can’t stress enough how important it is to get regular screenings for bladder and prostate health. Checkups like these should be likened to that of mammograms or stress tests. Furthermore, males experiencing the symptoms above should seek medical guidance from a urologist as early as possible, preferably well before incontinence becomes a focal point of symptoms.

Read Part 2 of this series here.

 
Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.
Dr. Richard Roach attended the University of Wisconsin-Madison Medical School and completed his residency at the University of Wisconsin-Madison Hospital and Clinics. After graduation, Dr. Roach moved to Minocqua, Wisconsin and joined the Marshfield Clinic, where he practiced for the next 26 years. In 2013, he moved to Florida and is currently a partner in Advanced Urology Institute. He is certified by the American Board of Urology. His specialties include plasma vaporization for BPH, treatment of female stress incontinence and penile prosthesis for ED. He is also an expert in laser & laparoscopic surgery.