Case study: James who has bladder outlet obstruction

In this step we meet ‘James’ who is the fourth and final of our four case studies of people with different types of bladder dysfunction. James has bladder outlet obstruction (BOO). Find out about how this affects his life.

James is 74 years old and considers himself to be fit. He eats a healthy diet and loves to drink coffee which he feels gives him the energy to keep going throughout his busy working day.

He is still working and has quite a high pressure job. To help counteract this he enjoys going for long walks with his friends at the weekend to unwind after a tiring week.

He has noticed for a couple of months that he is needing to urinate very frequently, sometimes hourly. Occasionally he can feel a really desperate need to pass urine, but has to wait a while to start. Sometimes his flow stops and starts a few times and other times his urine just seems to trickle out.

James has found that when he gets the urge to pass urine he cannot delay it and has even passed a little bit of urine once or twice before he can get to the toilet.

A couple of times he has passed a dribble of urine after he thinks he has finished and this has stained his trousers. This has happened at work and is a source of great anxiety for him. His bladder wakes him up at least three times every night.

The negative impact this has had on his life is huge:

• James sleeps poorly because he has to get up to use the toilet at least twice each night

  Often he lies awake for hours worrying that it might be cancer and he has delayed seeking help because he fears the worst

• He’s finding it hard to concentrate at work because he’s tired and because his bladder is insistent
• He’s constantly checking his trousers for staining and keeps spare trousers in his office
• He has stopped walking because his friends have teased him about constantly being ‘caught short’

Your task

Consider James’ condition and answer the following questions:

• Why do you think this man has bladder outlet obstruction? What are the symptoms?
• Is there any aspect of his lifestyle that might be making things worse?