Middle-aged and elderly men with urinary symptoms may not have a prostate problem, but a nutrient deficiency

When men middle-aged or elderly men have some difficulty with urination, their doctor’s attention will usually focus on their prostate ” the gland that encircles the pipe that takes urine from the bladder to the outside (the urethra). An enlarged prostate can impinge on the outflow of urine from the bladder and therefore cause symptoms such as frequency (needing to pass water frequently), nocturia (getting up at night pass urine), hesitancy (having difficult getting urination going) and post micturition dribbling (‘leaking’ after urination).

However, I find it’s not uncommon for men to have urinary symptoms that do not stem from the prostate. Sometimes, urinary symptoms are the result of dysfunction in the bladder. Here, the bladder (which is essentially a muscular bag) can be ‘overactive’, and this can cause a symptom known as urgency, which basically means there is strong desire to urinate and the need to get to a toilet quickly. It’s not uncommon for individuals with this symptom to get caught short, giving rise to something known as urge incontinence.

Women are usually the prime suspects for urge incontinence, because childbirth is believed to have the ability to change the muscles at the base of the pelvis (pelvic floor muscles) in a way which can reduce continence. However, according to some sources (for example, here), overactive bladder symptoms affect men and women equally, and this has certainly been my experience in practice.

By way of example, I saw a man last week with urinary symptoms, mainly of the “urgency” type. He had had his prostate investigated, and it had been concluded that while this was moderately enlarged, this might not actually explain his symptoms. Actually, in my opinion, his symptoms suggested an overactive bladder, which means his enlarged prostate may well be a red herring.

Over the years, I have discovered that an overactive bladder is very often related to a deficiency of the mineral magnesium. Magnesium is very important for normal muscular function, and a deficiency of it can cause muscles to be prone to spasm. So, this may cause the bladder to be overactive, but it can also cause symptoms in other muscles too including the skeletal muscles. Symptoms I look out for here are a tendency to cramp, tight muscles and ‘restless legs’ (a problem which tends to be most obvious when individuals are trying to get to sleep in bed at night). The man I saw last week was not a particular sufferer of cramp, but he had long-standing problems with muscular tension throughout his back, as well being prone to restless legs.

Part of the reason for me writing about this is that I noticed a study recently which attempted to look at the impact of an overactive bladder of quality of life [1]. The researchers who performed this study found that individuals suffering from an overactive bladder tended to suffer more from a range other conditions and symptoms including constipation, asthma, diabetes, high blood pressure, bladder or prostate cancer, neurological conditions and depression. What I found interesting is that several of these health issues (namely constipation, asthma, diabetes, raised blood pressure and neurological symptoms) have links with magnesium deficiency. What this study may be demonstrating, therefore, is that individuals with symptoms of an overactive bladder may have it as a result of magnesium deficiency, and that this underlying problem may manifest as other symptoms too.

I generally recommend that individuals with symptoms of an overactive bladder try upping their magnesium intake, and this is especially the case where there are other symptoms suggestive of magnesium deficiency. Nuts are a good source of magnesium, though for speedier results I find it helps to supplement too at a dose of about 300 mg per day.


1. Coyne KS, et al. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU International 2008;101(11):1388-1395

7 Responses to Middle-aged and elderly men with urinary symptoms may not have a prostate problem, but a nutrient deficiency

  1. David 31 July 2008 at 2:53 pm #

    Dr B, you say

    Over the years, I have discovered that an overactive bladder is very often related to a deficiency of the mineral magnesium.

    I assume the basis for this claim is your anecdotal experience, rather than any published scientific evidence. It certainly might be the case, but usually those with clinically significant magnesium deficiency have a multiplicity of related neuromuscular symptoms and often have associated hypokalemia and hypocalcemia which are more problematic.
    Might I ask how low were your patients’ Mg levels, and if you established their K and Ca levels?

  2. Paul Murray 1 August 2008 at 9:17 am #

    The article describes my problem of urgency and dribble, all but also having to get up at night occasionally to urinate.

    I visited a urologist who prescribed a bladder full and empty ultrasound tests. Before I returned to the uroligist for consultation, my problem was solved. The problem must be in my head, not my bladder! Ultrasound test did show bladder was not emptying completely. Hurray for Placebo effect!


  3. Hilda 1 August 2008 at 11:58 am #

    David. There is such a thing as subclinical deficiency. Magnesium is low in the modern diet as the soil is not rich in this mineral, plus the fact that people do not always go for foods rich in Mg such as grees and nuts. Most people eat quite a high Ca diet (in relation to Mg) and so may are low in Mg .

  4. roaminghermit 1 August 2008 at 2:47 pm #

    “published scientific evidence.”?????

    What drug company you work for…LOL

  5. Dallee 1 August 2008 at 8:11 pm #

    Dear Dr. Briffa,

    I had reason to look into my calcium / magnesium doses recently and here are some factoids I uncovered: it is generally recommended that calcium to magnesium proportions be 1 to 2; in some situations, the proportions should be 1 to 1 (many involve cramping); but, oddly, no-one discussing the proper proportions seems to discuss that following the US RDA’s would deliver a 3 units of calcium to 1 unit of magnesium.

    Started this investigation because I started taking calcium supplements on what seems to be the best recommendations for an effective dose of calcium supplements: 500 mg per meal at two meals a day (more than 500 results in no more absorption apparently; I failed to count in that I often snack on cheddar cheese, which has approximately 300 mg calcium per ounce). When I started on this dosage pattern, I suddenly got foot cramps — and so I embarked on my research reported above. Raising my magnesium to roughly 1 to 1 solved the problem.

    BUT the interesting thing is that my urine then went from dark to light even though I was not drinking significantly more water.

    Would you be able to provide any explanation or pointers? This phenomenon might play into the subject you address in your post (even though I’m female!).


  6. Tiggy 4 August 2008 at 10:57 pm #

    I’m often nearly ‘caught short’ and I’ve not even had children. I know I have a magnesium deficiency, but I forget to take my supplements. I hadn’t realised they were related. I tended to think I just got distracted while shopping! I’m always having to hand my goods to the staff and say, ‘I’ll be back in a minute’. They must think I’m mad.

  7. Edward 6 August 2008 at 3:56 pm #

    I came to the story because I’m always interested in anything to do with prostate symptoms and I also often get up in the night for a pee. But as my wife suffers from restless legs, I’m hoping she might benefit as well!

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