Enlarged prostate and overactive bladder play alternating roles

DEAR DR. ROACH »

I am 77 years old and have a quite enlarged prostate, according to my doctor. Often, an hour or so after I drink a cup of coffee, I’ll feel like I have to urinate. If I’m in the middle of doing something trivial and try to put it off, it will become more and more urgent to the point where I will start to leak. Once I start to leak, I have a very hard time stopping it. But here is the strange part: If I get to moving a lot, like hiking or riding a bike, the urge goes away, and I might last two or more hours without relieving myself.

When I wake up at night and feel like I must urinate, I usually pass only a half cup of urine.

If I’m doing a bike ride, I might go three hours before I feel like I need to urinate and then I will pass a cup or two of urine. Some days my underpants are completely dry at the end of the day, and sometimes they are a bit wet. — F.B.

DEAR READER » I think you may have more than one problem. Certainly the enlarged prostate is a major part of the problem and needs to be treated. But I think you may also have an overactive bladder, and that the combination of these two is causing your two sets of symptoms.

The main concern I have is that if your bladder “gives up” on a hike or bike ride, the kidneys could be damaged by high pressure in the bladder. I hope your doctor has been keeping an eye on your kidney function through blood and urine tests.

I think you need to discuss treatment right away with your regular doctor or a urologist.

They may wish to do some further testing, such as an ultrasound test of the kidneys and bladder, or a test of voiding to see whether the problem is more in the prostate or in the bladder. A trial of medication to help reduce the prostate size could be life-changing for you.