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The Link Between Overactive Bladder, Falls, and Fractures

  • urologyxy
  • Jun 10
  • 6 min read

Overactive Bladder (OAB) is a condition that causes sudden urges to urinate, frequent urination during the day, waking up at night to urinate (nocturia), and sometimes leakage (urge incontinence). OAB affects a large number of men—about 36% over the age of 40, according to European studies. The symptoms of OAB can worsen with age and significantly reduce quality of life by interfering with sleep, social activities, and daily routines.


Introduction


Many men are unaware that OAB is not just inconvenient—it can also be dangerous. Research shows that OAB increases the risk of falling, especially during nighttime bathroom trips, and can lead to fractures and other injuries. This connection is particularly important for older men, who may already have weaker bones or other health issues. Understanding and managing OAB isn’t just about comfort—it’s about preventing accidents and staying healthy and independent.


Understanding Overactive Bladder in Men


Overactive Bladder (OAB) in men usually involves a strong, sudden urge to urinate, going to the bathroom frequently, waking up at night to urinate (nocturia), and sometimes urine leakage. While not all men with OAB have the same symptoms, urgency and frequency are more commonly reported in men. OAB becomes more frequent with age and is often linked to changes in the bladder’s nerve signals or problems with the prostate.

In many cases, the bladder muscle (detrusor) contracts even when it shouldn’t, making men feel the need to urinate—even if the bladder isn’t full. This can be due to aging, prostate enlargement, past infections, or nerve-related changes in the brain or spine. Studies show that detrusor overactivity, a major contributor to OAB, is found in about 50% of men diagnosed with OAB. Left unmanaged, it can disrupt sleep, cause embarrassment, and limit physical and social activities.


The Link Between OAB and Falls


Overactive bladder (OAB) significantly increases the risk of falls in men, especially those over the age of 60. A comprehensive systematic review that included 43 studies—15 of which focused specifically on OAB patients—found that individuals with OAB are 1.3 to 2.3 times more likely to experience a fall compared to those without OAB. Approximately 19% to 56% of OAB patients reported at least one fall annually, with higher rates seen in older adults and those with multiple comorbidities.

The elevated fall risk is largely due to the hallmark symptom of urgency. Men with OAB often rush to the bathroom to avoid leakage, which increases the chance of tripping, slipping, or losing balance—especially in unfamiliar or cluttered environments. This risk intensifies at night due to nocturia, a common OAB symptom that forces individuals to wake and move in low-light conditions, contributing to nighttime falls. For older men with reduced mobility or visual impairments, these bathroom trips can be particularly hazardous.

Notably, even patients on antimuscarinic treatments for OAB showed persistently high fall risks, suggesting that symptom control alone may not eliminate the danger. The review concluded that while OAB is independently associated with falls and fractures, variability in study designs and patient populations makes it difficult to isolate OAB’s exact contribution from other risk factors such as age and frailty.

These findings emphasize the importance of a comprehensive fall-prevention approach in men with OAB—one that goes beyond medication to include home safety assessments and caregiver support.



Factors Increasing Fall and Fracture Risk


Beyond the direct effects of overactive bladder (OAB), several age-related and medical factors further increase the risk of falls and fractures in men. Age-related physiological changes—such as reduced muscle mass, diminished balance, and slower reflexes—significantly compromise stability. These changes make older men particularly vulnerable when responding to sudden urges to urinate, especially at night.

Medications used to manage OAB, particularly anticholinergics, may unintentionally worsen fall risk. Anticholinergics can cause side effects like dizziness, blurred vision, drowsiness, and confusion—each of which independently contributes to instability. While some studies suggest a slight reduction in fall risk with OAB treatment, others found that even treated patients experienced elevated risks, pointing to a persistent danger despite pharmacologic intervention.

Comorbid conditions common in older men, such as osteoporosis, further compound fracture risk after a fall. Vision impairments also play a significant role, especially in low-light environments during nocturia-related nighttime bathroom visits. The presence of these overlapping risk factors—age, medication side effects, and comorbidities—makes it difficult to isolate the exact impact of OAB on fall and fracture rates. However, the cumulative effect of these risks is clear, underlining the need for multifactorial fall prevention strategies in men with OAB.


Strategies to Reduce Risks 


To help male patients with overactive bladder (OAB) reduce fall-related risks, a combination of lifestyle, environmental, and medical strategies is essential.

Lifestyle modifications form the foundation of fall and symptom prevention. Fluid management—such as limiting intake before bedtime—can reduce nocturnal urgency and nighttime falls. Bladder training and scheduled voiding can improve control, while pelvic floor muscle exercises strengthen the muscles that help prevent leakage and urgency episodes.


Home safety improvements are also crucial. Simple modifications—like installing grab bars in the bathroom, ensuring adequate lighting, securing loose rugs, and decluttering walkways—can reduce environmental fall hazards. According to the CDC, falls are the leading cause of injury-related mortality in the U.S., and studies show that home safety assessments can significantly reduce fall risk, particularly when performed by healthcare professionals.


Exercise interventions, especially those combining strength, balance, and functional training, have been proven to reduce fall rates by up to 23% in older adults. While most data focuses on women, men can also benefit from similar regimens, ideally in a home-based setting to improve adherence. Programs like ExerciseUP—which combines bladder training, home hazard assessment, and balance exercises—show promising results in enhancing urinary control and reducing fall risk.


Finally, medical interventions must be carefully considered. While medications like beta-agonists may reduce OAB symptoms and improve mobility confidence, caution is advised with anticholinergics due to their association with cognitive decline and increased fall risk. Discussing medication side effects and exploring safer alternatives with healthcare providers is a key step in individualized fall prevention.


Conclusion 


Overactive Bladder (OAB) is more than a urinary inconvenience—it’s a serious risk factor for falls and fractures, particularly in older men. The urgency, nocturia, and side effects of certain medications can all contribute to instability, injuries, and loss of independence. A holistic approach combining lifestyle changes, home modifications, safe medication choices, and exercise is essential for reducing these risks. Managing OAB effectively can help men stay mobile, confident, and safe. For those managing incontinence, consider using QuickChange Wraps—a practical, hygienic solution that supports fall prevention by reducing rushed, unsafe trips to the bathroom. 

For those seeking support, we invite you to purchase a 10 Count Trial Pack here or request a professional-use sample pack for healthcare institutions here.


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