It’s one of the most annoying health issues for men: urinary problems that wake them up to go to the bathroom several times each night, or that otherwise make urination difficult or uncomfortable. And it’s one of the most common reasons men come to see me.
Causes of frequent urination
The cause is almost always an enlarged prostate, a completely benign growth of the prostate gland. This growth will never turn into cancer. But that doesn’t mean it can’t make for trouble.
The prostate, normally about the size of a walnut, lies between the bladder and the urethra. As new tissue grows — a natural phenomenon in men as they age — it blocks some of the flow of urine through the urethra.
More than half of men develop symptoms of an enlarged prostate by age 60; by the time they reach age 85, it’s more like 90 percent.
In addition to the need to urinate more frequently, the symptoms can include:
- Weak urine flow
- Difficulty starting to urinate
- Feeling of bladder fullness
- Some dribbling of urine
Symptoms can turn serious
Actually, the problems from an enlarged prostate can be more than just deeply annoying; they can become serious medical issues, including:
- More frequent bladder infections
- Bladder stones
- Kidney damage
- An inability to urinate, which is a very serious emergency
Even someone with mild symptoms should see a physician, preferably a urologist. At the UCI Health Center for Urological Care, we do a complete workup that includes a physical exam, an assessment of urinary stream and a bladder ultrasound for kidney function.
Enlarged prostate treatments
Once we determine that the problem is an enlarged prostate, we have many ways to treat it:
- No treatment. One of the first and most common avenues is not to treat it at all. Symptoms vary widely from one patient to the next. If a man has only mild symptoms, perhaps getting up once a night to urinate, a conservative approach might be best.
- Lifestyle and dietary changes. We might suggest dietary modifications, such as reducing or eliminating coffee, tea and alcohol, as well as advising patients to stop or reduce smoking. All of these are bladder irritants. Restricting fluid intake in the late afternoon and evening can prevent the need for waking up to urinate.
- Medications to free urine flow. If and when the time comes where a patient needs intervention to bring relief, the first step is usually alpha blockers, oral medications that relax the muscles around the prostate and bladder neck, allowing freer urine flow. They’re the least expensive option and they work for most patients. The relief is generally felt within a couple of days. But this drug can cause what’s called retrograde ejaculation--ejaculate that goes into the bladder rather than exiting the penis.
- Medications to shrink the prostate. Another medication, 5-alpha reductase inhibitor, actually shrinks the prostate but requires a longer time to take effect and has potentially problematic sexual side effects. I rarely prescribe it. A medication for erectile dysfunction, tadalafil, is a much better option. It also works by relaxing muscles. Combination therapies are available as well.
- Surgery. When medications aren’t the answer, there are surgical solutions. One of the safest and most promising of these is a recently developed procedure called the prostatic lift, in which prostate tissue is moved away from the urethra, with a few sutures to hold it in place. It’s a minimally invasive, outpatient procedure that can be done with local anesthesia and preserves sexual function.
The most recent studies show promising results; researchers examined patients four years after having a lift, and it was still working well for them. If you’re not a candidate for this procedure, there are other therapies and surgeries, including robotic excision of the prostate in more advanced cases.
Men shouldn’t brush off problems with urination as something minor or something that comes with age and thus can’t be avoided.
They should be checked to make sure nothing serious is going on, and if the problem is enlarged prostate, we have many ways to help them. They don’t have to suffer through the discomfort, and for the sake of their health, they shouldn’t.
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