Prostate problems are very common among men. They start appearing as early as 40 years of age, and the risk only increases as a man gets older. An enlarged prostate is usually the culprit behind urinary incontinence in older men, however, once discovered, the condition is easily treatable with simple medical and surgical interventions.
The medical term used to describe the enlarging prostate in older men is “benign prostatic hyperplasia (BPH)”, and almost half of all men will have this condition as they pass their fifth decade. According to an important study done in the '80s, BPH is found in eight percent of men who are in their forties, 50 percent of those who are in their fifties, and more than 80 percent of those who are in their nineties.
What symptoms indicate benign prostatic hyperplasia?
Patients most commonly visit their urologist when they start noticing symptoms implying bladder outlet obstruction, which may include any of the following:
- Straining when urinating
- Urinary retention
- Feeling that your bladder didn’t empty completely after urinating
- Weak urine stream
- Waking up to urinate ("nocturia")
- Sudden urges to go
- Pain when urinating
If you’re over 50, the doctor will almost immediately suspect prostate enlargement as the reason behind your symptoms, and a digital rectal exam would confirm this diagnosis. If symptoms are left untreated for some time, they will eventually lead to urinary incontinence. Several types of urinary incontinence are known to doctors, and the type most likely to be associated with prostate problems is called "urge Incontinence".
How is the prostate related to a man’s urinary function?
First of all, to know how an enlarged prostate causes urinary problems, you need to know the delicate location of the prostate gland in the male body and some of its characteristics. The gland is normally the size of an average strawberry and weighs somewhere around 20 grams. It is situated just beneath the urinary bladder and encircles the first part of the urethra (the muscular tube that delivers urine from the bladder to outside the body), called the membranous urethra.
Since the urethra passes inside the prostate, an enlarged prostate can compress it and cause a block in the urine flow, known as bladder outlet obstruction, leading to the symptoms listed above.
How does BPH cause incontinence?
Normally, we are programmed to start feeling the need to urinate when the bladder is half full. This gives us time to find a proper place to relieve ourselves. Once you’re in the bathroom, you can relax the urinary sphincter, and let all the urine out. In overactive bladder syndrome, the muscle of the bladder (called the detrusor muscle) contracts suddenly, and uncontrollably, in socially inconvenient situations, trying to push against the closed urinary sphincter. In many situations, the forceful contraction will lead to urine leakage before reaching the bathroom, better known as urge incontinence.
Several theories have been used to explain how all of this happens. When the urinary bladder is chronically obstructed, the muscle of the bladder can increase in size since it’s being forced to squeeze harder to pass urine through the closed urethra. This is much like what happens to other muscles in our body, which become larger after weight training. In both cases, the muscles need more oxygen to survive as they grow larger.
The obstruction also causes a chronic stretching of the bladder wall, compressing the blood vessels within it, and preventing enough oxygen from reaching the already highly demanding detrusor muscle, leading to damage. Other reasons, such as the disruption of nerve receptors and bladder muscle composition have also been suggested as possible culprits in this condition.
What can be done about this?
To treat overactive bladder syndrome and the associated incontinence, you have to treat the obstruction.
- Usually, doctors start treatment by prescribing alpha-blockers, which relax the muscles in the prostate and bladder neck and urethra, allowing the urine to pass more easily, and preventing further damage to the bladder.
- If medical therapy fails, doctors can offer a procedure called “Transurethral Resection of the Prostate (TURP)”, in which the urologist enters with a scope through the penis, and cuts the excess prostatic tissue.
Treating the obstruction caused by the enlarged prostate means that the bladder won’t have to push as hard during urination, and the bladder muscle would relax and symptoms of overactivity might fade away with time. Drugs that reduce the contraction of the bladder are also available and can be prescribed if the problem doesn’t resolve after treating the enlarged prostate.