RE: clinical question about urinary urgency

[Guest guest]

Is he like this during the day too?Sent from my iPhone

I have a male patient in his 70's who doesn't have BPH symptoms except for nocturia x 1. What is has is that he leaks urine once he starts to head to the restroom; he says he can hold his urine for a long time if he knows he has to, but once he gets close, he can't.

UA neg; culture pending.Thoughts?Thanks,SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax:

www.SharonMD.com

[Guest guest]

Risk factors for overactive bladder:Certain neurological disordersDiabetesEnlarged prostate in menBladder cancerUrinary tract infection Urinary tract inflammationBladder stonesBladder tumorsExcess caffeine or alcohol consumption Certain medications

I would evaluate for BPH with a DRE and a PSA then try Vesicare or similar

anticholinergic. Kegel type excercises might help. If he didn't get better I'd consider a Urology consultation for urodynamics and possibly a cystoscopy.

Ben

[Guest guest]

Bladder spasm, urge incontinence. Much more common in women, but it's what Detrol, etc helps with.

 

Is he like this during the day too?Sent from my iPhone

 

I have a male patient in his 70's who doesn't have BPH symptoms except for nocturia x 1.  What is has is that he leaks urine once he starts to head to the restroom; he says he can hold his urine for a long time if he knows he has to, but once he gets close, he can't.

UA neg; culture pending.

Thoughts?

Thanks,

SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

-- Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care 'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee.  If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

I also once was taught that irritative symptoms like urgency and

dysuria or more alarming than straight obstructive symptoms, as far as an

underlying malignancy being involved. I don’t know if that is

evidence based observation or just one urologist’s observation though.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Lynette Iles

Sent: Tuesday, February 01, 2011 7:19 PM

To:

Subject: Re: clinical question about urinary

urgency

Bladder spasm, urge incontinence. Much

more common in women, but it's what Detrol, etc helps with.

Is he like this during the day too?

Sent from my iPhone

On Feb 1, 2011, at 2:59 PM, Sharon McCoy

wrote:

I have a male patient in his 70's who doesn't have

BPH symptoms except for nocturia x 1. What is has is that he leaks urine

once he starts to head to the restroom; he says he can hold his urine for a

long time if he knows he has to, but once he gets close, he can't.

UA neg; culture pending.

Thoughts?

Thanks,

Sharon

Sharon McCoy MD

Renaissance Family Medicine

10 McClintock Court; Irvine, CA 92617

PH: (949)387-5504 Fax: (949)281-2197 Toll free

phone/fax:

www.SharonMD.com

--

Lynette I Iles MD

301 South Iowa

Ste 2

Washington IA 52353

Flexible Family Care

'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and

is only for the named addressee. If you have received this email in

error, please notify the sender immediately and delete it from your computer.

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[Guest guest]

Thanks for the help. But do you think it is urgency or irritability or what?  (Maybe I misled with my subject line.)  I thought urgency was coming more from the bladder nerves than from the brain which this seems to be.  But then I used to see almost no elderly men, so maybe this is common?

Sharon 

[Guest guest]

Thanks for the help. But do you think it is urgency or irritability or what?  (Maybe I misled with my subject line.)  I thought urgency was coming more from the bladder nerves than from the brain which this seems to be.  But then I used to see almost no elderly men, so maybe this is common?

Sharon 

[Guest guest]

Thanks for the help. But do you think it is urgency or irritability or what?  (Maybe I misled with my subject line.)  I thought urgency was coming more from the bladder nerves than from the brain which this seems to be.  But then I used to see almost no elderly men, so maybe this is common?

Sharon 

[Guest guest]

P.S. not that 70 is elderly.sh

[Guest guest]

P.S. not that 70 is elderly.sh

[Guest guest]

P.S. not that 70 is elderly.sh

[Guest guest]

Sharon,

Just a Pyschological thought on all of this.... Our 10 year old son for YEARS since about 3 or 4.... The moment he sits down, pours a bowel of Cereal and pours in the milk, his eyes get wide and he RUNS and I mean RUNS for the Bathroom needing to Pee and once in awhile even both.... and with all the cats it's Please Watch my Food 'cause I've got to Pee kind of a thing... If this is not Pavlovian Conditioning then I'll be a monkey's uncle.... EVERY TIME, I swear... It is now just one of those family jokes and we all just know it is going to happen, and sure enough, there he goes!!!!

So when you said this patient is FINE if and until they get close to a chance to get to the bathroom, and then all bets are off and they are off to races... This is the first thing that went thru my mind.... Classical Conditioning is a very strong and not easy to see or tease out thing all the time be it with PTSD like hypervigilance response to a smell or thought or place... or Food and Pee or Bathroom and Pee.... I know that I can hold it a good while when out driving on a highway, but sometimes that last mile or two as the driver watching the odometer and mile markers can seem like an eternity.... as my own conditioning and Expectations start to kick in....

So before you do too many drug or other more invassive based therapies, IMHO I would take a second look at all of this with good questions and perhaps have the patient note and report extra accurately exactly what is the process and chain of events... If I was a betting man, I would put good money on old Pavlov here.... I just know it in my gut. And after living with it personal for a half dozen years or more I know it much more intimately than most.... I'd love to hear the final outcome of this one... Psych or Medical Model????

To: Sent: Wed, February 2, 2011 1:13:08 PMSubject: Re: clinical question about urinary urgency

P.S. not that 70 is elderly.

sh

[Guest guest]

Sharon,Sounds like OAB/urge incontinence, but of course he should be evaluated appropriately for the differential. I use the NMP22 (http://www.matritech.com/bladderchek.php) as a quick screen for bladder cancer now instead of just cytology. If it turns out to be OAB, the anticholinergics help but so does bladder retraining. I've used this successfully in many women and a few men. Either eliminates the need for Rx or significantly reduces their dosage requirements, and thus, their side effects. http://www.nationalincontinence.com/s/BladderRetrainingthis link is a reasonable review of

how its done. I have the patient complete a bladder diary first and then bring it to me for review and we then go over instructions on how to do the training. Sometimes, I will start them on Ditropan XL in low dose for the first month if they have severe symptoms, otherwise, not. I also teach them PROPER kegels. Doing a kegel helps to relax the bladder temporarily.I've had training in pelvic floor dysfunction/biofeedback and in my opinion, most folks don't benefit from the EMG/biofeedback portion unless they need that for some form of objective motivation.CarlaFrom: Sharon

McCoy To: < >Sent: Tue, February 1, 2011 3:59:22 PMSubject: clinical question about urinary urgency

I have a male patient in his 70's who doesn't have BPH symptoms except for nocturia x 1. What is has is that he leaks urine once he starts to head to the restroom; he says he can hold his urine for a long time if he knows he has to, but once he gets close, he can't.

UA neg; culture pending.Thoughts?Thanks,SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax:

www.SharonMD.com

[Guest guest]

Sharon,Sounds like OAB/urge incontinence, but of course he should be evaluated appropriately for the differential. I use the NMP22 (http://www.matritech.com/bladderchek.php) as a quick screen for bladder cancer now instead of just cytology. If it turns out to be OAB, the anticholinergics help but so does bladder retraining. I've used this successfully in many women and a few men. Either eliminates the need for Rx or significantly reduces their dosage requirements, and thus, their side effects. http://www.nationalincontinence.com/s/BladderRetrainingthis link is a reasonable review of

how its done. I have the patient complete a bladder diary first and then bring it to me for review and we then go over instructions on how to do the training. Sometimes, I will start them on Ditropan XL in low dose for the first month if they have severe symptoms, otherwise, not. I also teach them PROPER kegels. Doing a kegel helps to relax the bladder temporarily.I've had training in pelvic floor dysfunction/biofeedback and in my opinion, most folks don't benefit from the EMG/biofeedback portion unless they need that for some form of objective motivation.CarlaFrom: Sharon

McCoy To: < >Sent: Tue, February 1, 2011 3:59:22 PMSubject: clinical question about urinary urgency

I have a male patient in his 70's who doesn't have BPH symptoms except for nocturia x 1. What is has is that he leaks urine once he starts to head to the restroom; he says he can hold his urine for a long time if he knows he has to, but once he gets close, he can't.

UA neg; culture pending.Thoughts?Thanks,SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax:

www.SharonMD.com

[Guest guest]

Sharon,Sounds like OAB/urge incontinence, but of course he should be evaluated appropriately for the differential. I use the NMP22 (http://www.matritech.com/bladderchek.php) as a quick screen for bladder cancer now instead of just cytology. If it turns out to be OAB, the anticholinergics help but so does bladder retraining. I've used this successfully in many women and a few men. Either eliminates the need for Rx or significantly reduces their dosage requirements, and thus, their side effects. http://www.nationalincontinence.com/s/BladderRetrainingthis link is a reasonable review of

how its done. I have the patient complete a bladder diary first and then bring it to me for review and we then go over instructions on how to do the training. Sometimes, I will start them on Ditropan XL in low dose for the first month if they have severe symptoms, otherwise, not. I also teach them PROPER kegels. Doing a kegel helps to relax the bladder temporarily.I've had training in pelvic floor dysfunction/biofeedback and in my opinion, most folks don't benefit from the EMG/biofeedback portion unless they need that for some form of objective motivation.CarlaFrom: Sharon

McCoy To: < >Sent: Tue, February 1, 2011 3:59:22 PMSubject: clinical question about urinary urgency

I have a male patient in his 70's who doesn't have BPH symptoms except for nocturia x 1. What is has is that he leaks urine once he starts to head to the restroom; he says he can hold his urine for a long time if he knows he has to, but once he gets close, he can't.

UA neg; culture pending.Thoughts?Thanks,SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax:

www.SharonMD.com

[Guest guest]

Thanks Carla and everyone who answered.  Love this group!Sharon

[Guest guest]

Thanks for the laugh,

‘pours a bowel of cereal’

From:

[mailto: ] On Behalf Of

Bleiweiss

Sent: Wednesday, February 02, 2011 11:41 AM

To:

Subject: Re: clinical question about urinary

urgency

Sharon,

Just a Pyschological thought on all of this.... Our 10 year old son for YEARS

since about 3 or 4.... The moment he sits down, pours a bowel of Cereal and

pours in the milk, his eyes get wide and he RUNS and I mean RUNS for the

Bathroom needing to Pee and once in awhile even both.... and with all the cats

it's Please Watch my Food 'cause I've got to Pee kind of a thing... If this is

not Pavlovian Conditioning then I'll be a monkey's uncle.... EVERY TIME, I

swear... It is now just one of those family jokes and we all just know it is

going to happen, and sure enough, there he goes!!!!

So when you said this patient is FINE if and until they get close to a chance

to get to the bathroom, and then all bets are off and they are off to races...

This is the first thing that went thru my mind.... Classical Conditioning is a

very strong and not easy to see or tease out thing all the time be it with PTSD

like hypervigilance response to a smell or thought or place... or Food and Pee

or Bathroom and Pee.... I know that I can hold it a good while when out driving

on a highway, but sometimes that last mile or two as the driver watching the

odometer and mile markers can seem like an eternity.... as my own conditioning

and Expectations start to kick in....

So before you do too many drug or other more invassive based therapies, IMHO I

would take a second look at all of this with good questions and perhaps have

the patient note and report extra accurately exactly what is the process and chain

of events... If I was a betting man, I would put good money on old Pavlov

here.... I just know it in my gut. And after living with it personal for a half

dozen years or more I know it much more intimately than most.... I'd love to

hear the final outcome of this one... Psych or Medical Model????

From: Sharon McCoy

To:

Sent: Wed, February 2, 2011 1:13:08 PM

Subject: Re: clinical question about urinary

urgency

P.S. not that 70 is elderly.

sh

[Guest guest]

You're quite welcome... That's just live in our home....

To: Sent: Thu, February 3, 2011 10:47:48 PMSubject: RE: clinical question about urinary urgency

Thanks for the laugh,

‘pours a bowel of cereal’

From: [mailto: ] On Behalf Of BleiweissSent: Wednesday, February 02, 2011 11:41 AMTo: Subject: Re: clinical question about urinary urgency

Sharon,

Just a Pyschological thought on all of this.... Our 10 year old son for YEARS since about 3 or 4.... The moment he sits down, pours a bowel of Cereal and pours in the milk, his eyes get wide and he RUNS and I mean RUNS for the Bathroom needing to Pee and once in awhile even both.... and with all the cats it's Please Watch my Food 'cause I've got to Pee kind of a thing... If this is not Pavlovian Conditioning then I'll be a monkey's uncle.... EVERY TIME, I swear... It is now just one of those family jokes and we all just know it is going to happen, and sure enough, there he goes!!!!

So when you said this patient is FINE if and until they get close to a chance to get to the bathroom, and then all bets are off and they are off to races... This is the first thing that went thru my mind.... Classical Conditioning is a very strong and not easy to see or tease out thing all the time be it with PTSD like hypervigilance response to a smell or thought or place... or Food and Pee or Bathroom and Pee.... I know that I can hold it a good while when out driving on a highway, but sometimes that last mile or two as the driver watching the odometer and mile markers can seem like an eternity.... as my own conditioning and Expectations start to kick in....

So before you do too many drug or other more invassive based therapies, IMHO I would take a second look at all of this with good questions and perhaps have the patient note and report extra accurately exactly what is the process and chain of events... If I was a betting man, I would put good money on old Pavlov here.... I just know it in my gut. And after living with it personal for a half dozen years or more I know it much more intimately than most.... I'd love to hear the final outcome of this one... Psych or Medical Model????

To: Sent: Wed, February 2, 2011 1:13:08 PMSubject: Re: clinical question about urinary urgency

P.S. not that 70 is elderly.

sh

[Guest guest]

Sorry, Elaine, just saw this as I was reviewing.Yes, has the incontinence pretty much every time he prepares to head to the bathroom.Culture was negative.Sharon