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The Male Urinary Problem That Won't Just Go Away

Sometime in your 40s or 50s you might notice that you wake up a lot more at night to go to the bathroom. It's something that happens to men when their prostate enlarges. And according to experts, it's not a problem that goes away on its own.

"The prostate continues to grow throughout a man's life," says Stephen Summers, MD, a urologist at University of Utah Health. "You may start having problems in your 40s. It's largely genetic."

Benign prostatic hyperplasia (BPH) is the medical term for it, when the prostate gland grows inward and pinches the urethra, obstructing the urinary system. What is the main cause of BPH? There's no one cause, but Summers says you're more likely to have the problem if your father or brothers do.

Other contributing factors include obesity; high blood sugar; and high intake of caffeine and alcohol, both of which irritate the bladder.

BPH is Common Among Men

Urinary health in men is an issue worth attention. About 50% of men have significant BPH symptoms by age 50, and it increases with each decade of life. Summers says some men even experience symptoms in their 30s.

Symptoms include:

  • A slow stream of urine
  • Starting and stopping while urinating
  • Inability to empty your bladder completely
  • Bladder irritation or discomfort
  • Feeling an urgency to urinate
  • Waking up multiple times at night to urinate
  • Urinary incontinence (an inability to control your bladder)

Urinary health is something some men find difficult to talk about. "A lot of patients have that concern—that this is something private. And, I certainly understand that," Summers says. "But it's something very regular that we see all the time."

BPH Treatment Options

Treatment with medications can give you a 25 to 30% reduction in prostate volume, but they're slow to work, and some are associated with erectile dysfunction (ED). On the flip side, one of the most common surgical procedures, Urolift, offers immediate relief, and it's done in office.

“It's kind of like you're in a mine shaft, and it's collapsing, so you're putting up struts to support it,” Summers says.

A typical range of BPH treatment options includes:

  • Lifestyle changes: Weight and blood sugar management, reducing alcohol and caffeine intake, and urinating at regular intervals.
  • Flomax or Tamsulosin: Alpha blockers that relax smooth muscle (first line therapy).
  • Dutastaride or Finasteride: Blocks the effects of testosterone to limit prostate growth (second line therapy).
  • Cialis: Phosphodiesterase inhibitors approved to treat both ED and BPH (third line therapy).
  • Urolift surgery: Small implant that holds back prostate tissue.
  • Rezum procedure: Steam or water vapor targeted to kill prostate cells.

There are also multiple BPH surgery types that you can speak to your doctor about and see whether you’re a candidate.

"Most patients would prefer to trial medications before moving onto surgery," says Summers. "But there are some that say, 'You know, I don't want to take a pill the rest of my life. I'd rather move right on to surgery.'"

BPH's Relation to Prostate Cancer

According to Summers, BPH is not a precursor to prostate cancer, though his patients often worry about that.

"Prostate cancer may have no symptoms at all," Summers says. "But we do screening for prostate cancer during any workup for BPH."

Part of that cancer screening is checking prostate specific antigen (PSA) levels. Of note, both prostate cancer and BPH can cause an elevated PSA.

When to Go to The Doctor for Urinary Health

Summers advises to seek treatment when symptoms arise. When you work harder to push urine out, you're putting pressure on your bladder. This may lead to bladder abnormalities or other issues.

"It's better to intervene earlier,” he says. “What happens if you delay too long, is your bladder undergoes irreversible changes. We've all seen patients that end up in renal failure because they've neglected their urinary symptoms. That's one reason to stay on top of this."