I am 55 with frequent urge to urinate. How to manage?

Question

Hi doctor,

I am 55 and have been having frequent urges to urinate even at night. My urine test and ultrasound were normal, and my doctor said it is probably an overactive bladder. I have started on Solifenacin 5 mg. How long does it take before symptoms improve?

Also, are there side effects like dry mouth or constipation that I should expect? I am trying to reduce tea and coffee, but still feel the urge every two to three hours. Are there any pelvic floor exercises or bladder training methods that actually help in controlling this? Does this problem get worse with age, or can it be completely resolved?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

With your medications, you may start noticing improvement in one to two weeks, with full effect seen by four weeks. Common side effects include dry mouth, constipation, and blurred vision. Drink plenty of water and increase fiber intake.

Pelvic floor (Kegel) exercises and bladder training, like proper voiding timings, are very effective and recommended. This condition can be managed well, but may not completely resolve; it can vary with age and requires ongoing management.

It looks like it is Idiopathic detrusor overactivity in your case. Apart from that, the other possible causes include:

Age-related changes in bladder muscle and nerve function.
Neurological factors (though not indicated here).
Excessive intake of bladder irritants (caffeine, alcohol, artificial sweeteners).
Post-menopausal estrogen deficiency affecting the urethral or bladder tissue.
Hidden comorbidities (for example, undetected urinary tract infections (UTI), interstitial cystitis).

I advise you to do the following investigations:

Urine dipstick & culture (already done - normal).
Post-void residual volume (bladder scan).
Urodynamic studies (if first-line treatment fails).
Cystoscopy (if hematuria or refractory symptoms).

In your case, the best differential diagnosis is:

Urinary tract infection (ruled out).
Interstitial cystitis or bladder pain syndrome.
Bladder stone or tumor (ruled out by ultrasound).
Diabetes mellitus or insipidus.
Neurological disorders (multiple sclerosis(MS), Parkinson's, stroke).
Pelvic organ prolapse.
Nocturnal polyuria (excessive nighttime urine production).

From all this, I would say your probable diagnosis is idiopathic overactive bladder (OAB) - dry type (without incontinence). Continue with the medication and exercises. Follow up after five days.

I hope my answer is clear to you, and if you need any details at any time, I am here and at your service.

Thank you.