Urinary Symptoms

As men get older, they often develop urinary symptoms due to prostate enlargement (or BPH). 

Lower urinary tract symptoms (LUTS) may include 
• difficulty starting a urinary flow 
• slow urinary stream with interrupted flow 
• incomplete bladder emptying, or 
• frequent urination, a sensation of urgency and nocturia (needing to wake to pass urine during the night)
• urinary incontinence  

What is Benign Prostatic Hyperplasia? 
The prostate sits just below the urinary bladder. Usually the size of a small fig, it grows as men get older. This can restrict the flow of urine through the urethra (the tube that passes down through the centre of the prostate) and cause urinary obstruction.  
Symptoms due to prostate enlargement may develop from the 50’s. Prostate cancer can also cause urinary symptoms, but are not usually a symptom of prostate cancer. 

A Prostate assessment will include: 
• Prostate Cancer risk assessment (PSA, prostate examination and possibly MRI Prostate)
• a symptom score (IPSS) to assess severity of symptoms,
• Urine test (MSU)
• urinary tract ultrasound – to measure whether you are emptying your bladder, and make sure there are no complications of obstruction such as bladder stones or back pressure to your kidneys 

Treatment Options 

Nothing – if your symptoms are mild or moderate and do not bother you (and your Prostate cancer risk is low), you probably don’t need treatment!

Bladder retraining – if your bladder is overactive, bladder retraining and/or medication may help. This can reduce your urinary frequency, sensation of urgency and urinary incontinence and can increase your functional bladder capacity. 

Medication – can improve your urinary flow by relaxing the muscles in the bladder neck and prostate and helping you to pass urine more easily, Some tablets can help shrink the prostate. Medication is usually the first line treatment for men with mild to moderate symptoms, but you need to keep taking the medication to get the benefit. 

Prostate surgery – a TURP or “rebore” is the gold standard for treatment for men with severe, bothersome symptoms or when medical treatment has not worked. Surgery is also needed for men with complications of obstruction, such as infection, bladder stones or kidney problems due to back-pressure from the prostate. Some men will need urgent surgery if they develop a complete blockage (acute retention).