There are some differences in how bladder problems in older men present that are distinct from what occurs in older women. Aging can significantly impact the bladder and the urethra.
It is important to understand these changes, know the risks and manage them to avoid unnecessary complications which can impact the quality of life in later years.
What is Normal and What is Not?
This review of medical publications, government agency articles and contemporary articles on bladder problems focuses primarily on older men and presents a preliminary read informational article to provide information on the types of bladder related problems in men, incontinence, Infection, and cancers associated with the bladder (kidney, bladder, prostate) along with key statistics and notable risk factors.
What are the Major Differences in Bladder Problems in Older Men and Women?
An infection by bacteria can occur in any part of the urinary system – kidneys, ureters, bladder, or ureter. Most urinary tract infections affect the bladder and the urethra
1. Age-related urinary tract problems are more common in men than in women where pregnancy, childbirth and the drop and fluctuating levels in hormonal estrogen levels at menopause tend to affect the urinary tract.
2. Men are less likely to develop a bladder infection (cystitis) than women mainly due to the following differences in anatomical features:
- Women have a shorter urethra than men, which means bacteria have a shorter distance to travel to reach and infect a woman’s bladder
- In women the opening to the urethra is closer to the rectum, where the bacteria that cause bladder infection live
3. Men can experience an enlarged prostate blocking the flow of urine. If left untreated, urine flow can get completely blocked, leading to further health issues, including kidney damage
4. Older men rarely develop UTIs. When it does develop, it is treated as a complicated UTI because it is more likely to spread to the kidneys and upper urinary tract.
What are Tell Tale Signs of Bladder Problems in Older Men?
Men experience many of the same tell-tale signs as women which were listed in a previous article – Bladder-problems in older women – A handy guide .
Conduct a quick review of the article. Do you experience any of the listed signs and symptoms as an older man? These could include having sudden and urgent need to go, sometimes with leakage of urine, trouble starting to pass urine, straining to urinate or experiencing pain when urinating among so may other signs.
These tell-tale signs are all evidence of some form of a urinary tract infection
On a cautionary note, it is strongly recommended to schedule a visit to your doctor or health care professional if you experience any of these symptoms because some of them may indicate serious health problems.
Pain in the lower abdomen or back, chills and fever, and nausea and vomiting are generally signs that the disease has spread to the kidneys. An infection that has spread here is a more serious problem that requires prompt attention.
Changes due to Aging in the Urinary Tract of Older Men
Age-related changes that occur in the urinary tract of older men are similar to changes noticed by older women except for one major difference – the prostate gland.
The urethra in men passes through the prostate gland. Non cancerous (benign) enlargement of the prostate gland (BPH) is more common as men get older. The enlarged gland may restrict the flow of urine and may cause symptoms of reduced urinary flow, straining, or may even block it completely It may or may not cause symptoms that inconvenience.
An enlarged prostate does not always cause urinary problems or mean that one will develop prostate cancer. Studies indicate that the size of a man’s prostate gland has little influence on the type of severity of his urination problems (Better Health, Government of Australia – Prostate gland and urinary problems)
Common Bladder Problems in Older Men As A Result of Aging
Bladder problems that commonly occur in older men can be grouped into three categories – Urinary tract infections, Lower urinary tract symptoms and Cancers in the urinary tract.
URINARY TRACT INFECTIONS (UTIs):
Infections can occur in the bladder, kidneys or urethra.
Bladder infection (Cystitis): The most common reason for obstruction of urine flow in men over 50 is an enlarged prostate. In older men the prostate gland can enlarge (without being cancerous) and block the flow of urine from the bladder. This can prevent the bladder from emptying completely which increases the likelihood that bacteria will grow and trigger an infection.
Infections of the bladder in older men are classified as Complicated bladder infections as they can lead to kidney infections (Harvard Health Publications, 2019).
Not all urinary symptoms are due to changes in the prostate. Interestingly, some men have enlarged prostrates and may experience few to no symptoms at all.
Kidney infection (Pyelonephritis): Once there is an Infection in the bladder, this can spread to the kidneys and cause severe problems if not treated in a timely manner. Recurring infections or infections which last a long time, may actually cause permanent damage to the kidneys.
Urethra infection (Urethritis): This is the least common of the UTIs. The Ureters are very rarely the site of infections.
LOWER URINARY TRACT SYMPTOMS (LUTS):
In older men, many symptoms, include trouble urinating, loss of bladder control, leaking urine, and frequent need to urinate. LUTS are caused by problems with pressure on the bladder. One of our previous articles – Incontinence in Seniors discusses this in greater detail.
URINARY TRACT RELATED CANCERS
Bladder cancer: This occurs in the lining of the bladder. It’s most common symptom is blood in urine and it occurs more frequently in smokers (Kendal 2018)
Kidney Cancer: While the exact cause of a person’s kidney cancer may not be known, certain risk factors are strongly linked to the disease, including smoking tobacco and obesity. (American Cancer Society 2020)
Prostate Cancer: This is a disease defined by the abnormal growth of cells. These abnormal cells can proliferate uncontrolled, and, if left untreated, form tumors which may metastasize or spread to other parts of the body.
The most common cancer among men (after skin cancer) is prostrate cancer, but it can often be successfully treated (American Cancer Society 2020).
Key Statistics of Bladder Problems in Older Men
URINARY TRACT INFECTIONS
- Older men have a higher risk of having a UTI especially after the age of 50
- UTIs are 25% less common than in women
- In the United States, 70-80% of complicated UTIs are linked to catheter usage, accounting for over 1 million cases per year (Flores-Mireles et al 2015)
LOWER URINARY TRACT SYMPTOMS – BLADDER CONTROL
- Urinary Incontinence is 50% less common in men than in women.
- Men are at a higher risk of getting bladder cancer. The chance that women will develop bladder cancer during their lifetime is 1 in 89 for women, while the chance that a man will develop this type of cancer during their life is about 1 in 27. (American Cancer Society, 2020)
- Cigarette smoking causes about 50% of all bladder cancers
- Occurs mainly in older people – about 90% of people with bladder cancer are over age 55, while the average age at the time of diagnosis is 73.
- The chance of getting bladder cancer is much higher among older men. This is probably because of the higher incident of smoking in men, and workplace occupational hazards related to exposure to toxic chemicals in the line of work of many of them.
- According to the American Cancer Society 2020, most people with kidney cancer are older. The average age of people when they are diagnosed is 64 with most people being diagnosed between the ages of 65 and 74.
- It is about 50% more common in men than in women
- Kidney cancer is among the 10 most common cancers in both men and women. Overall, the lifetime risk for developing kidney cancer in men is higher than in women – about 1 in 46 (2.02%). The lifetime risk for women is about 1 in 82 (1.02%).
Bladder Problems in Older Men – What Are My Risk Factors?
Different diseases or bladder problems have different risk factors. Some can be changed eg smoking while others like age or family history cannot be changed.
But having a risk factor or even several risk factors does NOT mean that you will necessarily have a bladder problem or disease. Also, some people who have a bladder disease may have few or no known risk factors (American Cancer Society 2020).
- Elderly age
- A past occurrence of UTI
- Trouble emptying the bladder
- You have an abnormality of the urinary tract (National Institute of Diabetes & Digestive and Kidney Disease 2017) – only your doctor can identify this for you
- There is an obstruction in the urinary tract such as a kidney stone
- Not being circumcised
- You have diabetes or problems with your body’s immune syste
- You recently used a catheter. A catheter is a tube placed in the urethra and bladder to help empty the bladder. The catheter can be an entry point for bacteria into the bladder
- A close member has urge urinary incontinence. You have a higher risk of developing the condition
- Your risk of incontinence is increased if you have a neurological disease or diabetes (Mayo Clinic 2018)
- Race – occurs more commonly in Whites than African Americans and Hispanic Americans (American Cancer Society 2020)
- Workplace exposure to chemicals and gases
- Drinking water containing arsenic (Cancer Treatment Centers of Americas 2020)
- Low fluid consumption – not drinking enough increases the risk that chemicals are left in the bladder longer
- Bladder defects from birth
- Personal history of bladder cancer
- High blood pressure
- Family history of kidney cancer
- Workplace exposures to certain chemicals
- Gender – about twice as common in men as in women possibly because men are more likely to be smokers and more likely to be exposed to cancer causing chemicals at work.
- Race – African Americans have a slightly higher rate than whites. Reasons are unknown
- Use of certain medicines – Some studies suggest that the use of acetaminophen – a common analgesic may be linked to an increased risk (Karami et al 2016)
- Presence of an advanced kidney diseaseA host of genetic and hereditary factors that your doctor can discuss in greater detail with you.
Several factors have been identified from various scientific research. These are
- Age – Rare in men younger than 40, but likelihood increase rapidly after age 50. About 60% of pr
- ostate cancer are found in men older than 65
- Family history
- Race – more common in African American men and in Caribbean men of African descent than in men of other races and when it does develop, men tend to be younger and less common in non-Hispanic whites than in Asian American and Hispanic/Latino men.ACS
- Geography – most common in North America, northwest Europe, Australia and Caribbean Islands. The reasons for it being less common in Asia, Africa, Central America and South America are unknown (American Cancer Society 2020)
- Inherited gene changes (mutations)
The American Cancer Society also reports on factors identified in several ongoing research which produce unclear effects on the risk of prostate cancer. These include the following:
The exact role is unclear, but here are the findings.
Men who eat a lot of red meat or high-fat foods (especially dairy products) appear to have a slightly higher chance of getting prostate cancer. Men who do so also generally tend to eat fewer fruits and vegetables and doctors are currently unsure which of these factors is actually responsible for raising the risk.
Other studies suggest that men who consume a lot of calcium through food or supplements may have a higher risk of developing prostate cancer.
Dairy foods are generally high in calcium and may also increase risk
Being obese does not appear to increase the overall risk of getting prostate cancer in older men.
Some studies suggest that obese men may be at higher risk for contracting more advanced stages prostate cancer and eventually dying, although these findings are inconclusive
Other studies suggest that obese men may have a lower risk of getting a slower growing form of the disease, but a higher risk of getting more aggressive and faster growing prostate cancer. The reasons for this are not clear
Most studies have not found a link between smoking and getting prostate cancer
There is some evidence that firefighters can be exposed to chemicals that may increase their risk of prostate cancer
A few studies suggest that men who have had a vasectomy have a slightly increased risk for prostate cancer
Reducing the Risk of Developing UTIs – Behavioral Changes
Preventative measures help reduce the occurrence of many bladder problems. The measures proposed by medics may appear restrictive but following them will promote a healthier lifestyle
- Hydration- Remain hydrated by drinking at least 6 -8 eight ounce glasses of water a day.
- Don’t smoke. If you are a smoker, it is time to quit! Why? Non smokers have a lower risk of developing bladder and kidney cancer.
- Limit consumption of alcohol and caffeinated drinks or beverages. The key word is limit and not necessarily cut out.
- Maintain a healthy high fiber diet – fruits, vegetables and whole grains – to prevent constipation.
- Exercise regularly to maintain a healthy weight.
- Practice good toileting habits – Do not hold your urine when you feel pressure to go to the bathroom, and when you do go, do not rush. Regular voiding regularly every 3-6 hours will help keep your bladder healthy (The Simon Foundation for Continence 2018)
- Avoid bladder irritants. Avoid or eliminate any foods that irritate your bladder. Some of these may include spicy and acidic foods, caffeine, alcohol and carbonated beverages (The Simon Foundation for Continence, 2018)
Bladder Problems in Older Men – Treatment
A thorough analysis by your doctor or health care professional is required before they can recommend appropriate treatment.
Although most UTIs are generally not serious, some can lead to serious problems especially when they affect the kidneys. Recurrent or long-lasting kidney infections can cause permanent damage or become life threatening.
Bladder problems may generally be treated with medication, exercises, behavioral changes described in the preventative measures section above, surgery, or a combination of these treatments.
Because most urinary tract infections are caused by bacteria, antibiotics are the usual treatment for UTIs and the type and recommended dosage will be prescribed by your doctor. The full dose of antibiotics must be taken to prevent the risk of antibiotic resistance by the bacteria.
Bladder, kidney or prostate cancer treatment require medical expertise and will depend on the level of invasiveness.
Bladder related problems of one kind or the other are a common problem in older women and men and should not be a cause of shame. Certain risks are peculiar to older men. Understanding some tell-tale signs can be helpful in getting speedy diagnosis and treatment before more serious consequences may develop.
Have you experienced additional unique symptoms? Leave your comments in the Comment box below to let me know, and I will respond back.
1. National Institute on Aging (2017) Bladder Health for Older Adults .https://www.nia.nih.gov/health/bladder-health-older-adults
2. Bladder Cancer Risk Factors. Cancer Treatment Centers of America (2020)https://www.cancercenter.com/cancer-types/bladder-cancer/risk-factors
3. Bladder Control Problems (Urinary Incontinence) (2017) https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems
4. The Simon Foundation for Continence (n.d) Bladder Health and Aging https://simonfoundation.org/resources/education-materials/
5. Matthews SJ, Lancaster JW. Am J Geriatr Pharmacother. 2011 Oct;9(5):286-309.Urinary tract infections in the elderly population.https://www.ncbi.nlm.nih.gov/pubmed/21840265
6. Flores-Mireles, Ana et al (2015) Urinary tract infections: epidemiology, mechanisms of infection and treatment options https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457377/
7. U.S. Department of Health & Human Services – Office of Population Affairs (2020) Urinary Tract Infection (UTI) https://www.hhs.gov/opa/reproductive-health/fact-sheets/urinary-tract-infections/index.html
8. Urinary Tract Infections – World Health Organization https://www.who.int/gpsc/information_centre/cauda-uti_eccmid.pdf
9. Prostate gland and urinary problems (2018) Better Health, Government of Australia
10. American Cancer Society. Key Statistics About Kidney Cancer – 2020 https://www.cancer.org/cancer/kidney-cancer/about/key-statistics.html
11. American Cancer Society. Key Statistics About Bladder Cancer – 2020 https://www.cancer.org/cancer/bladder-cancer/about/key-statistics.html
12. Bladder Cancer Risk Factors. Cancer Treatment Centers of America (2020) https://www.cancercenter.com/cancer-types/bladder-cancer/risk-factors
13. Harvard Health Publications (2020) Urinary Tract Infection in Men https://www.health.harvard.edu/a-to-z/urinary-tract-infection-in-men-a-to-z
14. Harvard Health Publications (2019) Try these techniques to relieve common urinary symptoms without medication https://www.health.harvard.edu/mens-health/try-these-techniques-to-relieve-common-urinary-symptoms-without-medication
15. Karami et al (2016) Analgesic use and risk of renal cell carcinoma: A case-control, cohort and meta-analytic assessment. Int J Cancer 139: 584-592
16. Canadian Cancer Society (2019) Am I at risk of prostate cancer? https://www.prostatecancer.ca/Prostate-Cancer/About-Prostate-Cancer/Risk-Factors
17. Siddiqui M et al. Vasectomy and risk of aggressive prostate cancer: A 24-year follow-up study. J Clin Oncol. 2014;32:3033-3038
18. Mayo Clinic (2018) Urinary Incontinence – Overview https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808?p=1