Prostate and urethral problems can affect the smooth flow of urine in men. This leaflet will give you a brief explanation of the different prostate and urethral conditions and how the urine system can be affected.
How common are prostate problems?
Prostate problems are very common, especially in men over 50 (approx 1 in 3), as the prostate tends to get bigger with age.
What conditions can cause prostate problems?
There are a number of different conditions that can affect the prostate gland, including:
Benign prostatic hypertrophy
Benign prostatic hypertrophy (BPH) is non-cancerous enlargement of the prostate gland, which can cause reduced urinary flow, hesitancy when starting to pass urine, frequent urination and needing to pass urine during the night.
There are various treatments for the symptoms of BPH, including drugs such as alfuzosin/doxazosin (alpha-blockers), dutasteride/finasteride (5-alpha reductase inhibitors), oxybutinin/tolterodine/fesoterodine/darifenacin/solifenacin/trospium (antimuscarinics), mirabegron (for overactive bladder) and desmopressin (for frequent night-time urination)
Acute prostatitis is usually caused by an infection, which can be severe, and requires antibiotic treatment. Symptoms include:
- Painful, frequent urination with urgency.
- Pain of the genitals, rectum and/or perineum (the area between the scrotum and anus) .
- Difficulty passing urine.
- Lower back pain.
- Pain on ejaculation.
- Fevers, aches and feeling unwell.
Chronic prostatitis is long-standing inflammation of the prostate gland. The exact cause is not known but it may be due to inflammation or infection. It can cause:
- Pain or discomfort in the genital area.
- Problems passing urine - eg, hesitancy, poor flow.
- Problems with erection, ejaculation, libido.
- Associated stress, depression and anxiety.
- Symptoms that are usually present for three months or longer.
Prostate cancer can cause the same symptoms as many non-cancerous prostate conditions, such as frequent urination, hesitancy, poor flow, needing to pass urine overnight, and dribbling at the end of passing urine. The symptoms are common in older men with enlarged non-cancerous prostate glands, and do not usually start in early prostate cancer, but can be a sign of obstruction in a more advanced cancer. Most men with these urinary symptoms will not have prostate cancer.
Other symptoms can include:
- Back or other bony pain.
- Erection problems.
- Blood in the urine (haematuria).
- Weight loss.
Again, these are usually symptoms of more advanced prostate cancer. Unfortunately, prostate cancer often only causes symptoms when it has become more advanced, but in a lot of cases it is a very slow-growing disease and there are many effective treatments for it. See the separate leaflet on Prostate Cancer for further information.
To assess all the above conditions, a prostate examination maybe required - this involves a doctor or nurse inserting a gloved finger into the rectum to assess if the prostate gland is enlarged or tender. It can be a little uncomfortable but does not take long and can give the doctor or nurse important information to aid diagnosis and treatment.
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Types of urethral problems in men
The urethra - the tube that urine flows out of from your bladder - can sometimes become narrowed. See the separate leaflet called Urethral Stricture for more details.
Urinary tract infection
One of the most common causes of urethral pain is urinary tract infection. It is usually accompanied by other symptoms such as a frequent and urgent need to pass urine.
This is inflammation of the urethra. It's usually due to an infection which has been acquired sexually, most commonly gonococcus. Again, other symptoms often accompany urethral pain, such as a discharge from the penis or pain passing urine.
See the separate leaflet called Urethritis and Urethral Discharge in Men for more details.
The most common type of injury to the urethra is by the insertion of a tube to drain the bladder (a catheter). You may require this procedure if you develop urinary retention, usually as a result of swelling of the prostate gland.
Bleeding from the urethra
Urethral bleeding may have a number of different causes.
- Infection is a common cause - either in connection with a urinary tract infection or associated with urethritis. It often presents as blood in the urine (haematuria) rather than blood oozing from the urethra.
- Trauma - injury from a catheter can cause bleeding as well as pain.
- Cancer - urethral cancer is very rare in men. Cancer of the bladder or kidney is more common. You may notice bleeding from the urethra, or blood in the urine. Treatment of urethral cancer is usually surgical. It may be necessary to remove the penis entirely, although in some cases it can be preserved.
Further reading and references
Guidelines on Prostate Cancer; European Association of Urologists (2018)
Lee YJ, Kim SW; Current management of urethral stricture. Korean J Urol. 2013 Sep54(9):561-9. doi: 10.4111/kju.2013.54.9.561. Epub 2013 Sep 10.
LUTS in men; NICE CKS, March 2019 (UK access only)
CKS Urethritis - male; NICE CKS, April 2022 (UK access only)
EAU: Guidelines Management of Non-Neurogenic Male Lower Urinary Tract symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO); European Association of Urology, 2018 - last updated 2021