bladder problems in men

by Diane K. Newman, RNC, MSN, CRNP, FAAN

The prostate gland is often involved in a variety of bladder disorders that occur in men. A walnut-size structure, the prostate surrounds the male urethra like a doughnut. Its purpose is to secrete fluid to carry sperm during ejaculation. Both age and the hormonal changes associated with age can cause the gland to become larger. By the age of 60, most men have an enlarged prostate. Prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer are the most common prostate problems in aging men.

Defined as inflammation (swelling) of the prostate gland due to a bacterial infection or a backup of secretions within the gland, prostatitis may occur in association with sexual activity. Symptoms of prostatitis include a minimal, watery discharge from the head of the penis (which is sometimes compared to a runny nose), frequent urination, discomfort when urinating, and urinary urgency. Bacteria are the most frequent causes of infection within the prostate gland and the urethra. Antibiotics, avoidance of caffeine, frequent ejaculations, smoking, and increased fluid intake are some of the recommended treatments for typical prostatitis. For persistent symptoms that may involve pelvic pain (pain in the in the scrotum, penis or rectum), bladder training and pelvic muscle exercises may offer relief.

The prostate gland of a young man is usually the size of a walnut. By the time he reaches his mid-forties, a man's prostate may begin to enlarge on the inside and cause a condition called benign prostatic hyperplasia (BPH). As the prostate grows, it gradually compresses the urethra and may actually partially obstruct (kinks) its central tube. As this happens, the bladder muscle must work harder to expel urine during voiding. Over time, the overworked bladder muscle gradually loses the ability to contract or contracts with increasing difficulty. This is known as bladder muscle decompensation, and if the enlarged prostate is left untreated, it can lead to detrusor muscle instability. Early symptoms of this condition include:

Frequent and urgent urination
Nocturia or getting up at night to urinate
Hesitancy or a delay in starting a urine stream
Weak or interrupted urine stream
A feeling that the bladder is not being emptied completely

Until recently, the most common treatment for BPH was transurethral [trans-yer-REETH-rul] resection of the prostate. This is a type of surgery sometimes called a TUR or TURP by doctors but patients tend to think of this surgery as a "roto-rooter job". During the past few years, new, less-invasive treatments have become the standards, including medications that relax the smooth muscle of the prostate, minimally-invasive laser surgery and thermal therapy. Common medications used to treat BPH include Flomax, Hytrin, Proscar and Cardura.

One of the most common cancers in men, especially African-Americans, is prostate cancer. A fairly reliable blood test for prostate cancer that was developed during the nineties is responsible for increased reporting of prostate cancers. The PSA (Prostate Specific Antigen) test allows comprehensive screening of older men for this cancer. In fact, the American Cancer Society recommends both an annual PSA test and a digital rectal exam (DRE) in men over 40.

Cancer of the prostate causes the gland to enlarge on the outside, rather than the inside as in BPH. Symptoms of this enlargement occur very late in the disease and are not reliable for early detection and diagnosis. A digital rectal examination is the best way to diagnose the cancer early. During this exam, the doctor feels the surface of the prostate gland and can detect any firm, hard nodules that signal an early cancer. When the cancer becomes more advanced, men may experience such symptoms as a weak or interrupted stream of urine, inability to urinate, hesitancy, hematuria (blood in the urine), pain or burning on urination, and continuing pain in lower back, pelvis or upper thighs.

The most popular treatment for prostate cancer is radical prostatectomy surgery or surgical removal of the prostate gland. Radiation, hormone therapy, cryosurgery, and seed implants may also be used to shrink or remove the cancer. Seed implants (also called brachytherapy) are radioactive capsules inserted into the prostate to radiate the cancer.

During the first two to three months after prostate surgery, some men (from five to fifteen percent) experience urinary incontinence due to damage of the sphincter muscles in the urethra. This type of incontinence is often temporary but may become a long-term condition that causes men much anxiety or may even disrupt their lives in significant ways.

Post-prostatectomy urinary incontinence may come as a shock to some men who feel they were not warned about this possible complication from the surgery. Many such men are further frustrated because the urologist who performed the surgery may not be interested in helping the patient overcome this side effect. Men need to know that effective treatments are available including behavioral treatments, medications, urethral injections, or an artificial sphincter. They need to demand information from their doctors about urinary incontinence and about all treatments that may be available for their particular situation. Other complications of prostate cancer treatments include impotence. Men may need to use treatments such as drug therapy (Viagra, Levitra and Cialis) or penile injections.

There are books on both urinary incontinence and impotence that will discuss these conditions in more detail. They are The Urinary Incontinence Sourcebook and Managing and Treating Urinary Incontinence by Diane Newman, CRNP, and The Impotence Sourcebook by Dr Chris Steidle.

Last updated September 2004

See also: Managing the Wetting, Managing Male Incontinence

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