Difficulties with passing urine are common as men age. One in 3 men over 50 years of age and nearly all men aged over 85 years experience some difficulty in urinating.
What bladder control problems can men have?
The way men urinate changes slowly as they get older, so at first men may not notice there is a problem. The usual changes include:
Difficulty or delay in starting to urinate. This is common with ageing, and with prostate problems. It can also be due to shyness when using a public toilet – this affects about 3 in every 10 men, who have no problems passing urine in private.
Stopping and starting in the middle of urinating.
After finishing, a bit more urine trickles out. After the flow stops and the man has adjusted his clothes, a few more drops can come out and can cause a wet patch on the trousers. This is due to urine pooling in the urethra (the tube the urine passes through). It can be prevented by making sure there is nothing pressing on the genital area, like tight clothing or zips. The drips can be helped by carrying out 2 or 3 pelvic floor muscle contractions after you have finished. This will help ensure that your urethra is emptied.
A feeling of not quite having emptied the bladder.
Men may experience the need to urinate more often than usual (called urinary frequency) or the sudden urge to urinate (called urinary urgency)
Get the following symptoms checked out straightaway:
burning discomfort or pain while passing urine
blood in the urine
pain or discomfort in the lower abdomen.
These could be due to infection or other cause needing treatment.
What causes bladder problems in men?
The two most common causes of bladder problems in men are ageing and enlargement of the prostate gland.
Ageing
As the bladder ages, the muscles within it become more likely to suddenly contract (squeeze), resulting in a feeling of urgency and having to rush to the toilet. Leakage of urine may occur before getting to the toilet.
With older age, the body tends to store fluid during the day and gets rid of it at night while lying flat. This results in extra urine production at night.
Enlargement of the prostate gland
The difficulties men experience with passing urine are often due to non-cancerous enlargement of the prostate gland. This condition is called benign prostatic hyperplasia (BPH) and is caused by a change in hormones. It is considered a normal part of ageing.
Prostate growth can also be the result of cancer. Prostate cancer, is much less common than BPH.
An overactive bladder may also occur if the bladder has to work harder to empty, for instance, if the outlet is narrowed by an enlarged prostate, or it may be worsened by the bladder not emptying completely.
Other causes include:
medical conditions such as urinary tract or bladder infection
surgery such as spinal surgery or prostate surgery
medications such as diuretics (water tablets).
What are the treatment options for bladder control problems?
Problems with bladder control can be annoying but, generally, if they are mild they will not affect your health and may be improved by following the self care measures below. Talk to your doctor if you are concerned about your symptoms. They will be able to let you know whether medication, surgery or prostate cancer testing is right for you.
Self care
Some men may be able to improve their bladder control by simple measures such as:
Reducing intake of coffee, tea, alcohol and other chemicals that irritate the bladder such as fizzy drinks, fruit juices and artificial sweeteners.
In men who have the problem where a bit more urine trickles out after they have finished urinating, the milking technique is helpful to prevent dribble.
Pelvic floor muscle exercises (called Kegel exercises) can strengthen the muscles that empty the bladder.
Bladder training can help the bladder to hold more urine without leaks.
The use of continence products to help you cope with urine leaks.
Medication may be an option, depending on the cause of your bladder control problems. If you have troublesome symptoms caused by an enlarged prostate (BPH), your doctor may prescribe one of the following medicines:
Medicine
Description
Alpha-blockers
They relax the muscles in the prostate so causing less blockage and allowing the bladder to empty more easily. Examples include doxazosin,tamsulosin andterazosin.
Finasteride
It blocks the effect of the male hormone testosterone on the prostate, causing it to shrink in size thereby reducing blockage and improving urine flow.
Anticholinergics
These medicines are used if your symptoms are due to an overactive bladder. They act on the bladder muscles. Examples include oxybutynin,solifenacin, andtolterodine..
Sometimes, both BPH and overactive bladder may be present, so two different medications can be used. If medicines are not helpful then you may be referred to a urologist (a doctor who specialises in urinary tract problems).
Surgery
Some people may require surgical treatment, depending on the cause of their bladder control problem. For BPH, surgery often involves removing excess prostate tissue to improve the flow of urine through the urethra. About 1 in 4 men with BPH will require this type of surgery.
Credits: Original content provided by Continence NZ, adapted for Health Navigator, Oct 2015. Reviewed By: Health Navigator Team
Bladder control problems & the prostate
The prostate is a gland found only in men. It is about the size of a walnut and is located below the neck of the bladder, surrounding the bladder outlet or urethra. Because the prostate gland is located close to the outlet of the bladder, it is common for problems with the male prostate gland to also affect urinary processes.
Urinary problems which start in middle age are often caused by the prostate gland getting larger as a man ages and partially blocking the flow of urine through the urethra as it leaves the bladder. This causes a condition called benign prostatic hyperplasia (BPH). Other causes of prostate-related urinary conditions include prostatitis (infection) or prostate cancer.
A man with a prostate problem may have any one, or a combination of these symptoms:
difficulty starting the flow of urine
slow urine stream once urination has started
the need to urinate more often than usual during the day (frequency)
having to wake during the night to urinate multiple times (nocturia)
dribbling either after urinating, or between visits to the toilet
feeling the urgent need to urinate (urgency)
sensation that emptying is not complete.
having to urinate again within a short time of having just urinated.
Get the following symptoms checked out straightaway:
burning, discomfort or pain while passing urine
blood-stained urine
pain or discomfort in lower abdomen.
These could be due to infection or other cause needing treatment.
How can prostate conditions lead to incontinence?
Partial blockage of the urethra by the prostate:
As the urethra narrows, the bladder has to contract more forcefully to push urine out the urethra.
Overtime, the increased effort required to empty the bladder makes the bladder muscles grow stronger and more sensitive. The bladder begins to contract even when it contains only a small amount of urine, creating the need to urinate more frequently and urgently. Sometimes urine leaks before you have time to get to the toilet (urge incontinence).
The narrowed urethra may also prevent the bladder from emptying completely when you urinate, which can cause a build up of urine and lead to leakage between trips to the toilet (overflow incontinence). This requires medical attention.
Nerve and muscle damage:
surgery for prostate problems can sometimes damage the muscles and nerves of the sphincter (the muscle that helps hold urine in the bladder) resulting in short- or long-term incontinence
the potential for damage depends on the extent of the surgery.
How is prostate-related incontinence treated?
Treatment options for prostate-related incontinence
Reassurance and observation
After medical tests and discussion with your doctor, you may feel that no treatment is required. Symptoms sometimes improve on their own or with simple changes in daily habits.
Medications
There are a number of prescription medications available, which may be helpful in some cases such as:
alpha blockers
These are a group of medicines that relax the muscles in the prostate so it causes less blockage and allows the bladder to empty more easily.
Examples are doxazosin, prazosin, tamusulosin and terazosin.
finasteride
This medication blocks the effect of the male hormone testosterone on the prostate, causing it to shrink in size thereby reducing blockage and improving urine flow.
Surgery
This involves removing whole or part of the enlarged prostate. The size of the prostate gland may influence the type of surgery required.
If you are concerned about any prostate or urinary symptoms talk to your doctor. There are also health professionals with special expertise in bladder control problems. Make sure you take part in making decisions about the diagnosis, treatment options, outcomes, risks, complications and costs.
The following tips are a few adjustments to your lifestyle that may improve your bladder control:
If rushing to the toilet and needing to go often are a problem, try reducing your coffee and tea intake. The caffeine in these drinks can irritate the bladder, making you go more urgently.
Assess how how much fluid (such as water, juice, coffee, tea, fizzy drinks) you drink in total each day. Usually a water-based drink every 2-hourly is enough. There is no ‘right amount’ to drink – frequently people think they should drink a lot more than they need. Reduce drinking in the evening if going to the toilet at night is a problem.
Try to break the habit of rushing to the toilet as soon as you arrive home; instead, go before you head home. Also, wait a few seconds until the urgency settles before moving to the toilet.
Pelvic floor muscle exercises
These exercise aim to strengthen the muscles that empty the bladder. It is best to speak to your doctor or nurse for advice on how to do pelvic floor muscles exercises – the following is a guide:
Stand, sit or lie down with your knees slightly apart. Relax.
Find your pelvic muscle. Imagine that you are trying to hold back urine or a bowel movement. Squeeze the muscles you would use to do that. DO NOT tighten your stomach or buttocks.
When you tighten the pelvic floor muscle, your penis will twitch and contract in towards your body.
Tighten the muscles for 5 to 10 seconds. Make sure you keep breathing normally. • Now relax the muscles for about 10 seconds.
Repeat 12–20 times, three to five times a day.
Keep doing the exercises. You should begin to see results after a few weeks. Like any other muscle in your body, your pelvic muscles will only stay strong as long as you exercise them regularly.
Bladder training involves changes to your toileting habits that may help improve your bladder control. The 2 main strategies are:
Keep a regular toilet schedule (this is called “timed voiding”), where you visit the toilet to urinate at set times and slowly increase the time between visits.
Learning to suppress the urge to urinate by doing strong pelvic muscle contractions and distracting yourself with something else, like counting backwards.
As a guide, a person who drinks 5 to 8 cups of liquid per day should be able to wait at least two hours between bathroom visits. If you’re going to the bathroom more often, are getting up more than once or twice during the night, or can’t delay the urge to empty your bladder for at least 30 minutes, bladder retraining may be helpful.
Information for healthcare providers on bladder control problems
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
The following signs and symptoms are cause for concern and require referral to a specialist for further investigation: (1)
Red flags for referral in people with incontinence
Males with urinary incontinence and any of the following factors should be referred to an appropriate specialist within 2 weeks:
Macroscopic haematuria without a concurrent urinary tract infection (UTI)
Unexplained microscopic haematuria if aged over 40 years
Recurrent or persistent UTI associated with haematuria if aged over 40 years
A pelvic mass arising from the urinary tract or pelvis, e.g. palpable mass
Suspected prostatic malignancy (in males)
Consideration for referral to a urologist should be given to patients with the following factors(with urgency of referral based on clinical judgement):
A bladder that is palpable on abdominal or bimanual examination after voiding and/or chronic urinary retention/voiding difficulties
Pelvic organ prolapse (in females)
Associated faecal incontinence
New or worsening incontinence in a person with a neurological disease
Symptoms of voiding difficulty
Recurrent UTI
Suspected or recurrent urogenital fistulae
Recurrent or continued incontinence following a previous continence surgery
Previous pelvic cancer surgery or radiation treatment
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
