You are not alone if you have experienced an urgent need to urinate—really urgent. Like nearly wrecking the car to cross the road to a gas station bathroom. Your wife thinks you have lost your mind. But it is not your mind that’s putting pressure on you. It may be your prostate gland.
The prostate is a walnut-sized gland that wraps around the urethra—the tube that runs from your bladder through your penis carrying urine out your body. The prostate continues to grow all your life and may become a problem around 60 or later. As it grows it squeezes the urethra, making urination difficult. This may be BPH, benign prostatic hyperplasia. If it is BPH, it will not turn into cancer. But prostate cancer has the same symptoms. That’s why it’s important to see your doctor.
You are more likely to have BPH if the following conditions describe you:
- You are 60, 70, or 80
- Your brother or father had BPH
- You have diabetes, heart disease and use beta blockers
- You are obese (exercise can lower your risk)
BPH has been plaguing men since ancient Egyptian times, so don’t feel bad if it’s affecting you. It can sometimes start as early as 40’s, with a weak urinary stream and some dribbling after urinating.
Besides putting the squeeze on your urethra, the enlarged prostate also creates a domino effect in your bladder. The bladder wall becomes thicker and irritated. It begins to contract, even when containing only small amounts of urine. Thus, the urgent need to urinate. But on the other hand, the bladder muscle weakens, causing difficulty emptying your bladder. Not fair, is it?
Symptoms
Besides the urgent need to urinate, other symptoms of BPH include:
- Needing to urinate at night more than you used to
- Slow stream or difficulty starting urination
- Weak stream
- Dribbling at the end of urination
- Inability to completely empty the bladder
Less common symptoms include:
- Urinary tract infection
- Complete inability to urinate
- Blood in the urine
BPH isn’t the only condition with these symptoms, so it’s important to see your doctor and get a diagnosis. Delaying treatment can cause permanent bladder damage.
But before that happens, worst case scenario, this may happen:
- You suddenly can’t urinate at all. Catheter time, meaning you need a tube inserted through your penis into your bladder to drain urine.
- Urinary tract infection. Not good. Could lead to surgery.
- Bladder stones, which can cause infection, bladder irritation, blood in the urine, and can stop urine flow.
- Bladder damage or a stretched bladder; think of a balloon with the air let out. It’s flaccid and floppy.
- Kidney damage, when bladder infection reaches the kidneys.
Diagnosis
Now, the good news is that there are many ways to diagnose and treat BPH. When your doctor diagnoses it, he or she is not looking only for BPH. The task is to identify what you have and to rule out what you don’t have. Common diagnostic tests include those on the following list. You probably won’t have all of them. Tests toward the end of the list are for complex cases.
- Digital rectal exam to check the size of the prostate
- Urine test to rule out infections
- Blood test to indicate kidney problems
- Prostate-specific antigen blood test, the PSA test. PSA increases with enlarged prostate or also if you have had recent surgery, an infection, or prostate cancer.
- Urinary flow test; used over time to see progress or lack of.
- Postvoid residual volume test to see if you can empty your bladder.
- 24-hour voiding diary to see if more than 1/3 of your daily output is at night.
- Transrectal ultrasound to measure your prostate.
- Prostate biopsy to diagnose or rule out cancer.
- Urodynamic and pressure flow study to measure bladder muscle strength.
- Cystoscopy to provide a view of the interior of your urethra and bladder.
Treatments
Treatments for BPH are even more numerous than diagnostic tests. They range from nothing at all to medication to surgery. All of these decisions for treatments are made by you and your doctor. Generally, docs give you a number of options which are right for you, and you choose.
If your symptoms are mild and you can live with them, you might choose simply to monitor them with your doctor.
Medication
If you need more aggressive treatment, you have several options for medicine, depending on your symptoms.
- Alpha blockers to relax muscles in the bladder and prostate. Quick acting if your prostate is small. Possible side effects: dizziness, retrograde ejaculation (see Dr Dick’s answer to “Why Do I Have Trouble Ejaculating When Having Sex?”)
- 5-alpha reductase inhibitors to shrink your prostate. Might take six months to be effective. Side effects: retrograde ejaculation.
- Combination of alpha blockers and 5-alpha reductase inhibitor.
- Cialis, usually used for erectile dysfunction, but can also treat prostate enlargement. Bonus side effect: You might get your sex life back.
- Anticholinergic medications which help the bladder calm down and not contract as frequently
Minimally invasive surgery
If you have tried medication, with little or no benefit, you might consider minimally invasive treatment or surgical treatment. There are also a huge number of people taking pills for their prostate, and if you want to stop taking these pills a procedure on the prostate can often release the squeeze and fix your symptoms.
All of the following treatments depend upon the state of your BPH, the severity of your symptoms, your age and current health, your medical history, and history of medications. They can all cause side effects. After going through testing, you and your doctor can make informed decisions about surgical therapy.
Many of the surgical therapies produce positive results. Many involve inserting a scope or electrode into the urethra and removing varying amounts of the prostate gland.
- A tried and true method for symptom reliever is TURP, transurethral resection of the prostate. It uses a lighted scope to remove all but the outer part of the prostate.
- The newest procedure available and the least invasive is the prostatic urethral lift. If you have lower urinary tract symptoms (needing to urinate a lot at night, weak stream, etc.) or you worry about how a treatment will impact erectile dysfunction and ejaculatory problems, you might have a PUL, prostatic urethral lift. PUL’s effect on ED and ejaculatory problems is lower than TURP’s. This procedure compresses the sides of the prostate, increasing urine flow. It is quick and with relatively few side effects.
- If the amount of your enlargement is small, you might be a candidate for TUMT, transurethral microwave thermotherapy. The surgeon uses an electrode to remove the inner portion of the prostate. Re-treatment is often necessary and results vary.
- Men who take blood-thinning medications might have laser therapy. It destroys overgrown tissue. Modern medicine offers two sub-categories of laser surgery. You can choose whether to have the tissue vaporized—honest to God—(PVP or HoLAP) or be completely done with it and have the whole prostate removed (HoLEP).
Surgery
If your prostate is very enlarged, you have bladder damage, or other complications you might have surgery where the surgeon removes the prostate, leaving the shell behind. It’s called robot-assisted suprapubic prostatectomy. Through many small incisions in your lower abdomen, the surgeon removes the tissue. This is the most invasive of the treatments, but has the best overall results and is reserved for overachievers with really massive prostate glands.
Always follow your doctor’s directions for post-surgical care. It could last for a few days to a few weeks.
Take matters into your own hands
Manage your BPH, regardless of whether you take medication or have surgery for it. Make these simple changes in how you live.
- Don’t drink much in the evening and don’t drink anything for one to two hours before you go to sleep. Limit caffeine and alcohol.
- Stop smoking.
- Lose weight if you’re overweight.
- Exercise and stay active.
- Eat wisely: men who eat diets high in zinc, butter, and margarine are linked to a higher risk of BPH. Men who eat lots of fruit are linked to lower risk of BPH.
- Know the effect of decongestants and antihistamines. They tighten muscles around the urethra.
- Stay warm. Cold temperature increases urine retention and urgency.
- Go at the first sign you need to. Remember that retaining urine stretches the bladder.
- Urinate regularly throughout the day. Link it to activities you do every day.
- Double void: Urinate and then, shortly after, urinate again.
BPH is an annoyance, but it is manageable. It’s more manageable the earlier you get treatment. Don’t be that guy who waits too long to go, then waits too long to get treatment. It will be a huge relief to find out the name of the problem and how to treat it (and that you really don’t need adult diapers).