The patient’s health history and current medical evidences point out to a hidden urinary disease. However, he denies having any discomfort except for more frequent urination. Due to the fact that the patient does not experiences any pain when urinating, and has no signs of infections or other diseases, it can be concluded that he has an overactive bladder. An overactive bladder is a symptom complex which is accompanied by urgency, nocturia – frequent urination at night – with or without urinary incontinence and frequent urination. It occurs in the absence of proven urinary tract infection or other obvious pathology of the lower urinary tract.
Differential diagnosis should first include a benign neoplasm of the prostate – the fact that the patient’s prostate is enlarged and firm points to the possibility of the prostate adenoma in the making. Langan (2019) states that “benign prostatic hyperplasia is a common condition in aging men that is frequently associated with troublesome lower urinary tract symptoms” (p. 223). Secondly, it could be a case of the second type diabetes – it can cause frequent urination without any concomitant discomfort. For example, Northwood et al.’s (2021) study results “underscore the need for routine screening for UI in older home-care clients during diabetes consultations” (p. 10). Finally, there is the primary bladder neck obstruction which also manifests in frequent urinations. According to Sussman et al. (2019), “PBNO may present with a variety of symptoms including storage symptoms such as frequency, urgency, urgency incontinence, and nocturia” (p. 53). Thus, the patient would require a more specific examination to exclude these diseases’ influence.
The overactive bladder treatment begins with non-medication methods such as behavioral correction and changes in drinking regime. Behavioral therapy in the treatment of OAB is aimed at creating a new model of urination, or restoring the previous one, in which the process of urination becomes controllable again. To reduce the frequency of urination, the patient must also limit intake of the caffeine-containing liquids such as coffee and tea. These drinks not only have a weak diuretic effect, but also increase the frequency of urination, thus, their intake should be limited to 1-2 cups per day. Medication therapy includes drugs of the anticholinergic group that block muscarinic receptors of the smooth muscles of the bladder. Lastly, a botulinum toxin injection is the most effective treatment for overactive bladder when the medication is ineffective.
References
Langan, R. C. (2019). Benign prostatic hyperplasia.Primary Care: Clinics in Office Practice, 46(2), 223–232. Web.
Northwood, M., Ploeg, J., Markle-Reid, M., & Sherifali, D. (2021). The complexity of living with diabetes and urinary incontinence for older adults with multiple chronic Conditions Receiving home Care Services: An interpretive description study.Global Qualitative Nursing Research, 8, 233339362199345. Web.
Sussman, R. D., Drain, A., & Brucker, B. M. (2019). Primary Bladder Neck Obstruction. Reviews in urology, 21(2-3), 53–62.