Urinary problems in middle-aged men can be frustrating and embarrassing, and are often caused by an enlarged prostate. However, they may also be indicative of something more serious such as prostate cancer. Our two experts explain why vigilance is important and share their self-help tips.
Wisdom, understanding, perspective. Getting older can offer many unexpected benefits for men - an enlarged prostate is most definitely not one of them.
Located underneath the bladder, this unassuming little gland may only be the size of a walnut, yet it plays a big role in a man's sexual and urinary health, producing seminal fluid and, as he gets older, impacting urinary functionality.
Obstructing the flow
Enlargement of the prostate, also known as benign prostatic hypertrophy (BPH), begins in puberty. Once a man reaches 50 it can gradually become so large that it obstructs the flow of urine out of the bladder.
To compensate, the bladder becomes more muscular and sensitive, or 'overactive', leading to issues including poor flow of urine; frequent but incomplete bladder emptying; the need to urinate more often (which can be particularly frustrating during the night); leakage of urine in between; and even incontinence and bladder discomfort.
"Because the bladder isn't fully emptied, men with an enlarged prostate are more prone to urinary tract infections," explains GP Dr Clare Morrison. "These can cause lower abdominal pain, frequent passing of urine, and sometimes a fever and blood in the urine. In elderly men, infections can also cause confusion and shaking."
Men also suffer from kidney stones, which can cause severe pain anywhere from the loin to the groin, and sometimes blood in the urine. Similarly, an inflamed prostate (prostatitis) causes pain in the penis, testicles, anus and lower abdomen, combined with a frequent urge to pass urine.
Urinary problems and prostate cancer
Prostate cancer is the most common form of cancer in men in the UK and claims the lives of 11,000 men each year - one every 45 minutes.
Charity Prostate Cancer UK estimates that 400,000 men are currently living with and after the condition and 47,000 new cases are diagnosed each year. One in eight men will potentially develop prostate cancer during their lifetime.
Unlike other cancers, prostate cancer often doesn't present any specific warning symptoms. Symptoms can be similar to those of BPH, meaning that vigilance and a proactive attitude to personal health are especially important, as John Robertson, a specialist nurse at charity Prostate Cancer UK, explains.
"Men should be aware of any changes in their urinary flow,” he says. “Things to look out for are a weak flow of urine or the need to urinate more frequently, especially at night, a sudden urge to urinate, difficulty starting to pass urine and the feeling that the bladder hasn't emptied properly."
However, Robertson emphasises these are quite common changes that can occur in men due to non-cancerous conditions such as an enlarged prostate. In other words, the only way you can really diagnose prostate cancer is by ruling out other causes.
"Don't just assume that changes in bladder function are merely a consequence of getting older and ignore it," he says. "Make an appointment with your GP so they can assess what may be causing the changes.
"If men are concerned and are reluctant, or having problems making an appointment, to see their GP, they can get in contact with Prostate Cancer UK, which offers a specialist nursing helpline."
"It's important to report persistent urinary problems to your GP," she adds. "There is a blood test, known as 'PSA', which is fairly reliable at detecting prostate cancer, and the GP can easily do this. They may also examine the prostate by doing a rectal examination."
However, it's important to recognise that two out of three men who have raised PSA turn out not to have prostate cancer, but will need to be investigated.
"You should also be sure to seek advice if you pass blood in the urine," adds Dr Morrison. "It may be an infection, but it could also be cancer of the bladder or kidney, and should always be checked out. There are effective treatments for urinary problems, so be reassured that it is well worth seeking medical help."
Self-help tips for older men
So, men of a certain age, if you are experiencing urinary issues, the message to take away is: If in doubt, get it checked out. If the cause is an enlarged prostate, here are some invaluable self-help tips.
Keep drinking (water)
Don’t be tempted to drink fewer fluids in order to avoid having to go to the bathroom too often. It's important to drink plenty, spread out throughout the day, to reduce the risk of infection.
On the other hand, if you have problems emptying your bladder, it's not a good idea to suddenly drink a lot all at once, as this could lead to the severe pain of urinary 'retention', where the bladder becomes distended and won't empty at all.
Take your time
If the bladder empties slowly, it's important not to feel rushed or stressed. Sometimes it also helps to turn a tap on in the bathroom, as this prompts a natural instinct to empty the bladder (it works!).
Passing urine while sitting instead of standing (or vice versa) can help empty the bladder. It's also worth 'double voiding', ie go to the loo again a short while after the first attempt, to see if more urine will come out. A heat pad or hot water bottle on the lower abdomen may also help.
Avoid caffeine and alcohol
If you have to get up several times at night to use the bathroom, avoid caffeine and alcohol in the evening. If it happens anyway then make sure there are no trip hazards on the way to the bathroom!
Exercise and watch your weight
Try to get enough exercise and maintain a healthy weight, as obesity can aggravate prostate enlargement.