Difficulty urinating? For men, it might be an enlarged prostate

Gabriel Fiscus, MD

Urology

Getting up several times a night to use the bathroom or having significant difficulty urinating is common for men as they age. For many, it can be a symptom of an enlarged prostate, called benign prostatic hyperplasia (BPH). Urologist Gabriel Fiscus, MD, explained more about this condition and what can be done to treat it.

What is the prostate?

All men have a prostate, a gland roughly the size of a walnut. The prostate’s primary function is to produce the fluid that nourishes and transports sperm. It is located directly beneath the bladder and in front of the rectum. The prostate surrounds part of the urethra, which is the tube that carries urine and sperm out of the penis. The urethra passes through the prostate, so if the prostate becomes enlarged, it can prevent urine from passing through the urethra.

“It is a very common condition as men age,” said Dr. Fiscus. “Roughly 60% of men 60 and older have some degree of BPH, and nearly 80% of men 80 and older.”

What are the signs and symptoms of BPH?

Some men with BPH can experience lower urinary tract symptoms, including:

• Needing to urinate often, especially at night
• Urgency to urinate
• Having trouble starting to urinate (this means you might have to wait or strain before urine will come out)
• Having a weak urine stream
• Leaking or dribbling urine
• Feeling as though your bladder is not empty even after you urinate

Rarely, some men may not be able to urinate at all and will require a catheter.

How is BPH diagnosed?

The following measures can be used to diagnose BPH:

• A survey to evaluate your symptoms
• A flow study to measure how slow the urinary stream is compared with normal urine flow
• A study to detect how much urine is left in the bladder after you finish urinating
• A cystoscopy to look into the bladder with a camera
• A rectal ultrasound to measure the size of your prostate

What are the treatment options for BPH? 

Dr. Fiscus said BPH is a very treatable condition. Some treatment options include:

• Lifestyle modifications such as limiting fluid intake after dinner time and limiting alcohol and caffeine
• Medications
  • Tamsulosin (Flomax) works by relaxing your prostate which reduce difficulty urinating 
  • Finasteride (Proscar) works by shrinking your prostate over several months
• Minimally invasive office-based procedures
  • Urolift – uses a tiny implant to hold open the blocked urethra
  • Rezum – uses steam to shrink the enlarged prostate
• Surgery to remove the prostate tissue that blocks the flow of urine
  • Transurethral resection of the prostate (TURP)
  • Robotic simple prostatectomy

Does BPH increase the risk of prostate cancer?

Dr. Fiscus said an enlarged prostate does not increase your risk of prostate cancer. “Prostate cancer often has no symptoms but is detected using a prostate-specific antigen (PSA) blood test. It’s recommended that men begin screening for prostate cancer at age 50,” he said.