How Does BPH affects Urination?

Prostate gland is a small walnut-sized male gland that plays a vital role in the reproduction process. The primary role of prostate gland is to secrete a fluid (also known as prostatic fluid) to protect and transport sperms from seminal vesicles into the urethra at the time of ejaculation. In addition, the gland also encloses the prostatic part of urethra; therefore any changes in the volume or size of prostate can significantly affect the process of urination.

How can BPH affect the normal urination process?

Benign prostatic hypertrophy refers to inorganic enlargement of glandular tissue that may impede urinary flow. It is imperative to mention that prostate gland experiences two major growth spurts; one at the time of puberty (under the influence of sex hormones); and other growth spurt in the middle-to old age. After the first growth spurt, the adult volume of prostate gland is almost 20 grams (which is normal); but the second growth spurt can lead to an additional gain of 20 grams in the glandular volume that may compromise the urinary functions in males.

Healthcare providers believe that some degree of urinary dysfunction is normal as part of the aging process and does not always reflect prostatic pathology or dysfunction. In addition, not all cases of prostate enlargement are serious.

Urinary problems and Aging

Urinary complaints are fairly common in elderly males. There are a number of organic and inorganic causes that may explain these symptoms. Based on the data reported in the peer reviewed The Journal of Urology (1), investigators suggested that prostatic enlargement is by far the most common cause of urinary complaints in elderly males (over the age of 60 years). The report also suggested that the prevalence of BPH is approximately 80% in males over the age of 80 years; as opposed to only 8% in males under 30 years of age.

Besides aging, certain other risk factors that are strongly linked to BPH in males are:

• African American males are typically known to develop symptomatic BPH at a much younger age as opposed to Asians and Caucasians.
• Chronic and poorly managed diabetes and hypertension is also known to aggravate the risk of developing BPH.
• Positive family history of BPH and sedentary lifestyle are some other known risk factors that are usually implicated in the setting of symptomatic BPH.

Other common causes of urinary dysfunction in elderly males are:

• Neurogenic bladder
• Uncontrolled or poorly managed diabetes mellitus
• Urinary tract infection
• Cancer of prostate
• Cancer of urinary bladder/ urethra
• Alzheimer’s disease/ dementia or other neurodegenerative conditions
• Spinal disorders (tumors and injuries)

How to differentiate Urinary complaints due to BPH from other causes?

Urinary complaints due to benign prostate hypertrophy/ hyperplasia are characteristic for:

• Increased frequency of urination (especially at night time) that may compromise the quality and duration of sleep
• Higher urgency for urination (urinary accidents are fairly common in individuals who couldn’t reach toilet in time)
• Poor urinary stream in the beginning
• Dribbling of urine even after the completion of urination
• Feeling of incomplete emptying of bladder.
• Feeling of re-visiting toilet just after a few minutes of urination.

These urinary symptoms does not always warrants a surgical treatment; however, if you feel that your quality of life is significantly altered because of these symptoms, you should see a healthcare professional. In addition, if you are experiencing following symptoms, you should see your doctor at earliest convenience:

• Inability to urinate
• Pain while urinating
• Appearance of fresh blood in urine
• Discharge of bloody/ pus like fluid from penis
• Incontinence of urine

How to manage Urinary complaints in elderly males due to BPH?

Urinary symptoms in elderly males can be managed via number of therapeutic as well as non-therapeutic interventions; for example:

1. Lifestyle modification and bladder re-training exercises:

This includes:

• Exercises to strengthen pelvic floor muscles: Performing regular exercises to strengthen pelvic floor muscles can aid in improving the bladder function significantly. You can also retrain the bladder to ease your urinary symptoms. For further advice, visit your doctor.
• Fluid Management: Minimizing the intake of caffeinated and alcoholic drinks especially before sleeping can also help in improving the quality of life in patients with mild BPH.

2. Medical management:

Certain pharmacological agents such as Tamsulosin, dutasteride, finasteride or Tadalafil can also improve urinary tract symptoms in males. Your healthcare professional may advice monotherapy (single-drug therapy) or combination therapy (more than one drug regimen); depending upon the response to therapy and severity of symptoms.

3. Surgical management:

In severe cases of urinary dysfunction, healthcare providers advise surgical intervention. Depending upon the overall health status, severity of symptoms and degree of prostatic enlargement; healthcare providers may choose from a variety of procedures such as:

• TURP (Transurethral resection of the prostate)
• TUMT (Transurethral microwave thermotherapy)
• TUIP (Transurethral incision of the prostate)
• TUNA (Transurethral needle ablation)
• Open or robot-assisted prostatectomy
• Prostate lift
• Embolization
• Laser therapy

Under ideal circumstances, it is advised by healthcare professionals to opt for periodic screening of prostate glands after 50 years of age to detect early changes in the glandular architecture for timely management.

References:

1. McVary, K. T., Roehrborn, C. G., Avins, A. L., Barry, M. J., Bruskewitz, R. C., Donnell, R. F., … & Wei, J. T. (2011). Update on AUA guideline on the management of benign prostatic hyperplasia. The Journal of urology, 185(5), 1793-1803.

2. Oelke, M., Giuliano, F., Mirone, V., Xu, L., Cox, D., & Viktrup, L. (2012). Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. European urology, 61(5), 917-925.

3. Roehrborn, C. G. (2011). Male lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Medical Clinics of North America, 95(1), 87-100.