What's the state of your prostate?

Prostate enlargement is a normal part of getting older for men but it can come with inconvenient and sometimes embarrassing 'plumbing' issues. You don't have to put up with it. Mr John Donohue, Consultant Urologist at Nuffield Health Tunbridge Wells Hospital, explains the options.

It’s a simple test of whether your bladder is working as it should: playing a round of golf without needing to pee. It should be something you take in your stride, but for many men as they get older, going a full 18 holes without having to dash behind a tree is simply impossible.

There is one prime suspect behind men’s growing need to pee as they get past the age of 40: the prostate - the gland that sits below the bladder. You hear a lot about it, because it has a big impact on men’s health as they reach middle age. Commonly, a general need to urinate more frequently is a part of this.

The centre of the prostate slowly enlarges in all men from about the age of 40 (known as Benign Prostatic Hypertrophy), and this puts pressure on the uretha. This can reduce the flow in the same way that stepping on a hose pipe reduces the speed at which the water comes out of the nozzle. But whether your flow is getting slower or you can still pee at full force, you may still feel the need to go more regularly.

Working hard on the inside

With a restricted uretha, the bladder has to work harder to empty itself. Sometimes it simply gives up before it has fully emptied. As your bladder still has urine in it, it takes less time to fill up again, causing you to go to the toilet more regularly. Failing to empty properly can also cause stones to form in the bladder, which can make it irritated and overactive. Secondly, the bladder may seem like a pouch, but it is in fact a muscle. If you exercise, you know that the harder you work a muscle, the more it grows. The bladder is no exception. This can be true whether your flow is slowing or if it is still going strong. In the latter case, your bladder may be compensating for a restricted uretha by working harder to void itself. In both scenarios, your bladder can become thicker and develop pouches. This can again make it irritable and overactive, increasing the frequency with which you feel the need to pee.

Fortunately, there are lots of potential solutions that can reduce your need to go to the toilet so frequently and improve your quality of life.

Get checked

First, you need the right tests and scans to make sure you know exactly what is going on. You should have blood tests to check your kidney function and the concentration of Prostate Specific Antigen (PSA), a urine flow test and an ultrasound of your bladder. These tests will help to eliminate or detect other possible reasons for your bladder issues.

Your options

Once an enlarged prostate has been established as the cause of your symptoms, it's important to figure out if treatment is the right option for you. The key question underlining this decision is: how much does it affect you? If you do want to scale back your need for regular comfort breaks, simple lifestyle changes may be all that is needed; reducing caffeine and alcohol intake is often a good start. A GP or a nutritional therapist can recommend more options.

If dietary changes don’t work, there are a number of prescription drugs that work in slightly different ways to either shrink the prostate or calm the bladder. These drugs can significantly improve symptoms and are generally well tolerated by patients for many years.

The final option is surgery to core out the enlarged portion of the prostate, either by cutting away small sections with a prostate resection (TURP) or with prostate laser treatment. A TURP usually involves a general anaesthetic and an overnight stay in hospital. And the good news is that neither procedure will effect your ability to have an erection.

So next time you're at the 12th hole and dashing for the bushes, remember, you do have other options.

Visit John Donohue's website for detailed information about prostate conditions and treatments.

Last updated Tuesday 10 November 2020

First published on Monday 16 November 2015