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24 November, 2009

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Prostate gland and urinary problems

The prostate gland is a male reproductive organ. Many men experience urinary changes as they age, which may be caused by inflammation or enlargement of the prostate gland. An enlarged prostate gland, however, does not always cause urinary problems. Troublesome urinary symptoms are rarely symptoms of prostate cancer.

The prostate gland is about the size of a walnut and is found at the base of the bladder. A thin tube that allows the passage of urine out of the penis (urethra) runs through the prostate gland. Fluid produced by this gland helps to nourish and support sperm, which come from the seminal vesicles via the ejaculatory ducts into the urethra.

How the prostate gland develops
The prostate undergoes two main growth spurts. The first is fuelled by sex hormones made by the testicles during puberty. This prompts the gland to reach an average weight of 20g. The second growth spurt begins when men are in their 30s.

Urinary changes are common as men age
Many men experience urinary symptoms as they age, which may be caused by inflammation of the prostate gland (prostatitis). In the older male, symptoms may be the result of a blockage in the tubes due to a benign (non-cancerous) enlargement of the prostate gland (benign prostatic hyperplasia). The most common symptom is difficulty emptying your bladder.

Urinary symptoms may become sufficiently difficult that they require treatment.

Common urinary symptoms associated with ageing
Not all urinary symptoms are due to changes to the prostate. Also, some men have enlarged prostates and yet experience few, if any, symptoms. Urinary symptoms commonly experienced include:

The need to urinate frequently during the night
Urinating more often during the day
Urinary urgency – the urge to urinate can be so strong and sudden that the toilet may not be reached in time
The urine stream is slow to start
Urine dribbling some time after finishing urination
A sensation that the bladder isn’t fully emptied after urination
Lack of force to the urine flow, which makes directing the stream difficult
The sensation of needing to go again soon after urinating.

Although these symptoms often do not need treatment, you should see your doctor if they are particularly difficult as they can be successfully treated.

Symptoms that should be followed up
See your doctor if you have the following symptoms:

Inability to urinate
Painful urination
Any blood in the urine at all
Any discharge from the penis
Continuous or severe urinary incontinence (you can’t hold your urine).

Inflammation of the prostate
Bacteria sometimes cause prostatitis (inflammation of the prostate). More commonly, however, the underlying cause is uncertain. If the following symptoms are present, you should consult your doctor promptly:

Fever
Low back pain
Pain in the groin
Urgent and frequent urination.

Treatment with antibiotics is essential for acute bacterial prostatitis. Admission to hospital is often necessary and, as with chronic (ongoing) prostatitis, specific antibacterial drugs are required for a long time.

Enlargement of the prostate
Benign prostatic hyperplasia (BPH) causes enlargement of the prostate, which may cause troublesome symptoms. BPH is more common as men get older.

The prostate gland goes around the urethra, so men may have problems urinating if the enlarged gland restricts the flow of urine. If the flow stops completely, a catheter is required to empty the bladder. It is rare for this form of acute urinary retention to cause kidney damage.

An enlarged prostate doesn’t always cause urinary problems. Studies indicate that the size of a man’s prostate gland has little influence on the type or severity of his urination problems. BPH is just one possible cause of urinary symptoms.

Other causes of urinary symptoms include changes to the muscle that are part of the urinary system, which may cause bladder contractions or stop the bladder from contracting.

Diagnosis
If you are troubled by urination problems, you should see a doctor – no matter what your age. If your doctor agrees that your symptoms need further evaluation and treatment, you may need to undergo a few tests. These may include:

Physical examination – including rectal examination to check the size and shape of the prostate gland.
A urine check – to ensure the prostate is not infected.
A flow rate check – to estimate the speed with which you pass urine.
An ultrasound examination – to assess if the bladder is emptying completely and to examine the appearances of your kidneys.
Urodynamics – may be indicated in selected instances.

Self-help strategies
If your urination problems are simple and don’t bother you very much, management strategies include:

Review your fluid intake. Perhaps it can be reduced. However, if you have a condition such as kidney stones, you may have to pass more than two litres of urine a day to minimise the risk of more stones forming. If you are uncertain, discuss this topic with your doctor.
Minimise drinks such as coffee, caffeinated soft drinks and alcohol, especially before bedtime and particularly if getting up at night to pass urine is disturbing your sleep.
Try ‘urethral stripping’ or ‘milking’ your urethra empty after you finish urinating if dribbling is a problem. You do this by running your finger from behind your scrotum to the tip of your penis to help press the last dribbles out. If you wait a little while after passing urine before replacing your penis in your underpants, it may also lessen the likelihood of dribbling.
Learn pelvic floor and bladder retraining exercises; they may help to ease some urinary symptoms. See your doctor for advice.

Medications can help
Your doctor may advise medications to help ease your urinary problems, including:

Drugs to reduce the tone of the muscles of the urethra and prostate to minimise any constriction to urine flow caused when these muscles contract.
Medications to reduce the size of the prostate gland. These drugs work by blocking the action of male hormones produced by the prostate gland.
Drugs to relax the bladder, making unwanted contractions less likely and thus reducing the symptoms of urgency and frequency of urination.
The over-the-counter preparation saw palmetto (Serenoa repens) is sometimes recommended. This may help some men, especially if frequent urination at night is a problem. However, studies on the effectiveness of saw palmetto are inconclusive and may vary with different formulas.

Treatment
If your urinary problems are caused by infection or enlargement of the prostate gland, treatment options include:

For prostatitis – a prolonged course of antibacterial drugs. Because infection is difficult to eradicate, they will need to be taken for many weeks.
For obstruction caused by an enlarged prostate – medications to improve urine flow and other symptoms. Surgical procedures suggested might include transurethral resection of the prostate (TURP), transurethral incision (TUIP) and – for very large glands – open (enucleative) prostatectomy. This last procedure involves removing the enlarged prostatic tissue around the urethra and leaving the remaining prostate behind. The type of surgery required depends on the size of the prostate and the condition of the urethra.
To reduce urinary symptoms – a number of other procedures have been devised and promoted to reduce urinary symptoms. Laser resection with vaporisation has the best track record and has gained a place in the management of this condition.

Where to get help

Your doctor
Nurse on Call Tel. 1300 606 024 – for expert health information and advice (24 hours, 7 days)
Urologist
Kidney Health Australia Tel. 1800 682 531

Things to remember

The prostate gland is a male reproductive organ that contributes fluids to nourish sperm cells in the ejaculate.
Many men experience urinary changes as they age. In many cases, these changes do not need specific treatment.
When urinary changes cause problems, they can be treated successfully by lifestyle changes, medication, surgery or both.
For problems such as blood in the urine, pain on urination, inability to urinate or uncontrollable urine flow, you should see your doctor promptly.

You might also be interested in:
Cystitis explained.
Incontinence - prevention tips.
Incontinence - tips for carers.
Incontinence and continence problems.
Men's health.
Non-specific urethritis - signs and symptoms.

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