Why are you having trouble urinating?
You notice that you’re feeling the urge to urinate more frequently. Yet, when you’re in the bathroom, you have trouble getting starting and your urine tends to stop and start in the middle of going. What’s causing this to happen? What steps do you need to take to fix?
Definition
Benign prostatic hyperplasia (BPH) is also known as prostate gland enlargement. It’s a common condition that men experience as they age. The prostate gland is located underneath the bladder. The urethra is the tube that allows you to get urine from your bladder through your penis and it passes through the middle of the prostate. So, as the prostate enlarges, it puts pressure on the urethra and can block urine flow. It’s not clear what causes the prostate to grow, but it’s thought to be related to changes in sex hormones as men grow older. BPH’s main risk factor is age, with about a third of men having moderate to severe symptoms by age 60 and half by age 80. Other risk factors include a family history of prostate problems, having diabetes or heart disease and being obese. Exercising can actually lower your chances of developing the disorder.
Symptoms of BPH vary in severity but tend to get worse over time. It’s important to note that the size of the prostate doesn’t determine the severity of symptoms. Some men even have stabilization or lessening of symptom severity. The most common symptoms are frequent/urgent need to urinate, increased frequency of urination at night, difficulty starting urination, weak urine stream, urine stream that stops and starts while going, dribbling at the end of urination, and inability to empty the bladder completely. Less common symptoms are urinary tract infection, inability to urinate or blood in the urine. Other conditions can produce the same symptoms, so you should be evaluated by a doctor to determine which one is causing yours. These conditions include urinary tract infection, inflammation of the prostate, narrowing of the urethra, scarring of the bladder due to a previous surgery, bladder/kidney stones, problems with the nerves that control the bladder, or cancer of the prostate/bladder. Many of these are also complications of BPH, such as urinary tract infections, bladder stones, bladder damage, kidney damage, and inability to urinate. If at any point, you’re unable to pass any urine, you should go to the nearest emergency room.
Treatment
There are a variety of treatments for benign prostatic hyperplasia. The best option depends on your prostate’s size, age, overall health, and the amount of discomfort you’re experiencing. If their symptoms are tolerable, some men take a wait and see approach. For mild to moderate symptoms, the most common intervention is medication. There are two main classes: alpha blockers and 5-alpha reductase inhibitors. Alpha blockers help to relax the muscles in the neck of the bladder and prostate. They work pretty quickly and include alfuzosin, doxazosin, tamsulosin, and silodosin. 5-alpha reductase inhibitors prevent hormonal changes that result in prostate growth. These can take up to six months to be effective and include finasteride and dutasteride. If neither is working on its own, your doctor might recommend taking one of each at the same time.
Another treatment option minimally invasive therapy. Your doctor will suggest this if you’re having moderate to severe symptoms, medication isn’t working, you have a urinary tract obstruction/bladder stones/blood in your urine/kidney problems, or you want a definitive treatment. One of the more common options is transurethral resection of the prostate (TURP). During this procedure, all but the outer part of your prostate is removed, which allows for stronger urine flow that can be seen shortly after the procedure. Transurethral incision of the prostate (TUIP) is when one or two small cuts are made into the prostate gland, making it easier for urine to pass. This method is often used for those who can’t have surgery due to other health issues. Transurethral microwave thermotherapy (TUMT) is when microwave energy from an electrode placed through the urethra to the prostate area destroys the inner part of the gland. Often it takes time to see results from this procedure and sometimes, it needs to be repeated. Transurethral needle ablation (TUNA) is when radio waves are passed through needles into the prostate via the urethra. These waves heat and destroy the prostate tissue that is blocking urine flow. You shouldn’t have any of these procedures if you have an untreated urinary tract infection, urethral stricture, history of prostate radiation therapy, history of urinary tract surgery, or a neurological disorder.
Laser therapy is a different option to consider. It uses a high-energy laser to get rid of overgrown prostate tissue. Its effectiveness is noticed quickly and it has fewer side effects than non-laser surgery. One type is ablative and it vaporizes obstructive tissue. The other type is enucleative and it removes the tissue that’s blocking urine flow.
An additional option is a prostatic urethral lift (PUL), which involves placing special tags to compress the sides of the prostate. Embolization is when the blood supply to or from the prostate is blocked. This procedure is still considered experimental since the long-term outcomes aren’t known yet. If you have a very large prostate, bladder damage, or other complicating factors, your doctor may recommend removing the prostate gland completely (prostatectomy).
Prevention
While you can’t prevent benign prostatic hyperplasia, you can reduce your discomfort and symptoms. It’s important to go to the bathroom when you first feel the urge to go. You should try to urinate on a schedule to retrain your bladder. Avoid caffeine and alcohol because they increase urine production and irritate the bladder, which will make your symptoms worse. To prevent needing to go to the bathroom in the middle of the night, don’t drink anything for an hour or two before going to bed. Don’t take decongestants or antihistamines without talking to your doctor since these can tighten the band of muscles around the urethra, making it harder to urinate. Try double voiding, which is when you urinate and then urinate again a few moments later, to make sure your bladder is empty. Keep your body warm since colder temperatures cause urine retention and elevate the urgency to urinate. Live a healthy lifestyle by eating nutritious foods and getting plenty of exercise since this will help prevent obesity.
Benign prostate hyperplasia is annoying to deal with. The good news there are many treatment options. If you have any questions or concerns about benign prostatic hyperplasia, please speak with your doctor. If you would like more information, please visit Urology Care Foundation’s benign prostatic hyperplasia page at https://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-(bph)