Older men with bladder issues at risk of falling

16 july 2009– Elderly men with moderate or severe bladder problems are at increased risk of suffering a fall, new research suggests.

Understanding the links bladder problems and falls in men is "a salient public health issue," Dr. J. Kellogg Parsons, at the University of California, San Diego Medical Center, and co-authors note in the medical journal BJU International.

The high prevalence of lower urinary tract symptoms, or LUTS, in older men "underscores the relevance of this problem, particularly in an era of rapidly increasing male longevity," they point out.

Among 5872 men aged 65 and older, Parsons and colleagues determined that 54% had mild LUTS, 39% had moderate LUTS, and 7% had severe bladder symptoms.

Over the course of 1 year, 25% of men reported falling at least once and 12% reported two or more falls.

Men with moderate or severe bladder problems, the investigators found, were far more likely to fall than men with mild bladder woes, after adjusting for factors that might influence the results, like history of falls, dizziness, relevant medications, and physical limitations.

The urinary symptoms most strongly associated with falls were urinary "urgency," difficulty initiating urination, and having to urinate frequently at night.

Parsons' team speculates that urgency might prompt impulsive, risk-generating motions toward the toilet.

Men with difficulty urinating may try to find relief with the so-called Valsalva maneuver -- where a person exhales forcefully while closing off the top of the throat, not allowing the air out. This maneuver may increase the risk of fainting.

Frequent nighttime urination, they suggest, could disrupt normal sleep patterns, induce sleep deprivation, and cause men to repeatedly navigate darkened environments.

"Because of the serious consequences of falls," Parsons and colleagues say, doctors should consider asking older men about bladder problems.

SOURCE: BJU International, July 2009.