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The Male Urinary Problem That Won't Just Go Away

Aug 17, 2021

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, like University of Utah Health urologist Stephen Summers, MD, it's not a problem that goes away on its own.

"The prostate continues to grow throughout a man's life," says Summers. "You may start having problems in your 40s. It's largely genetic."

About 50 percent of men have significant BPH symptoms by age 50. - Stephen Summers, MD

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 percent 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. Those 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; and/or
  • 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," says Summers "But it's something very regular that we see all the time."

There are a Wide Variety of BPH Treatment Options

Treatment with medications can give you a 25 to 30 percent 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. - Stephen Summers, MD

A typical range of BPH treatment options includes:

  • Lifestyle changes—weight and blood sugar management; reducing alcohol and caffeine intake; 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, so the focus at U of U Health is on shared decision-making, after determining what options you're a candidate for.

"Most patients would prefer to trial medications before moving on to surgery," says Summers. "But there are some that say, 'You know, I, 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

Summers says 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.

What to Expect When You Go to The Doctor for BPH Treatment?

At your U of U Health appointment, you'll be asked to fill out a symptom questionnaire. Summers says he reviews your health history; completes a physical, including a prostate exam; and he may ultrasound your prostate. A cystoscopy is sometimes also done to look through the urethra.

"That helps us make sure that it's a prostate enlargement causing the blockage and not, say, a scar along the urethra or a stone that's sitting in there or other issue."

Summers says he always screens for a urinary tract infection and treats that first, to see if symptoms subside.

When Should You Go to The Doctor for Urinary Health?

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. What happens if you delay too long, is your bladder undergoes irreversible changes," says Summers. "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."