Male urinary problems

Urinary problems are common in men, particularly in those over 40 years of age. In fact, about a quarter of all men will develop urinary problems sometime during their life. The problems can range from minor discomforts to serious health issues, such as a slower or less forceful flow of the urine or dribbling at the end of urination, to pain during urination or being unable to fully empty the bladder. Often, the problems increase with age.

What exactly causes urinary problems in men is not always clear, but we know that age is a contributing factor. As the body gets older, organ systems can become less efficient. For example, the chance of men developing prostate problems increases with age, leading to urinary issues. The sphincter muscles around the urethra may become weaker, or the bladder wall may lose its elasticity, losing the ability to expand and contract. These are a few causes of urinary problems in men. The good news is that most problems are harmless.

In this article, we look at common urinary problems in men, what causes them and how to treat them. Fortunately, many urinary problems can be treated fairly easily or managed effectively.

Male anatomy explained in a few words

Before we discus male urinary incontinence and other urinary problems in detail, let’s take a closer look at how the urinary system works from an anatomical perspective. We’ll limit ourselves to the most important parts of the body's urinary tract system: the prostate, the bladder, the urethra and the pelvic floor muscles.

Prostate, bladder, urethra and pelvic floor muscles

The prostate is a male sex organ. It is a small gland that produces a fluid that mixes with sperm from the testicles to make semen. During ejaculation the prostate contracts forcefully, pressing the semen out into the urethra.

The prostate is about the size of a chestnut and somewhat conical in shape. It is located underneath the bladder and surrounds the upper part of the urethra. Through the prostate run the vas deferens, the tubes that carry sperm from the testicles.

The pelvic floor muscles are located on the bottom of the pelvis. They close the pelvic floor to stop leakage of urine and faeces. The urethra and the anus all pass through the pelvic floor muscles. The pelvic floor muscles in men support the bladder and bowel. They are kept under slight tension, tightening the opening of the urethra, to prevent leaks. When you pass urine or open your bowels the pelvic floor muscles should relax and then tighten afterwards.

Common male urinary problems

Although urinary problems, in themselves, are not life threatening, they can have a huge impact on quality of life. In one third of all men, they go away on their own. If the problems persist, we recommend seeing a doctor.

The following are some of the most common male urinary problems:

1. Difficulty passing urine despite an intense urge to urinate.
2. Urinary hesitancy (difficulty initiating the stream).
3. Increased need to urinate.
4. Urinating often, especially at night.
5. Dribbling at the end of urination.
6. An interrupted urinary stream or weak urinary stream.
7. Taking a long time to pass urine or passing small amounts of urine.
8. Being unable to fully empty the bladder.
9. Involuntary discharge of urine (incontinence).
10. A burning sensation or pain during urination.
11. Cloudy urine.

If you have any of the following urinary symptoms, we advise you to see your doctor immediately.

1. Worsening of urinary symptoms.
2. Blood in the urine.
3. Pain during urination.
4. Urinary problems in combination with pain in the abdomen and/or lower back.
5. Urinary problems with fever.
6. Inability to urinate, also in a familiar environment.

What are common causes of male urinary problems?

Urinary problems in men can be caused by a variety of factors. Prostate cancer is often the thing that comes to mind for most men. In reality, however, urinary symptoms are rarely symptoms of prostate cancer.

Urinary issues can be related to:

1. Ageing. As men get older, there are various things that happen to their bodies, including their prostate, bladder and the nerves that control these organs. For some men this can cause urinary problems.

1. An enlarged prostate. It is normal for the prostate gland to get bigger as men get older. The enlarged prostate can press against the bladder and the urethra, slowing down or blocking urine flow.

1. The pelvic floor muscles. With age, the pelvic floor muscles may become weak or overactive. When the pelvic floor muscles weaken, this may affect your ability to control your bladder because the sphincters (circular closing muscles) around the urethra don’t close. When the pelvic floor muscles are too tight, this can cause pressure in the bladder, leading to feelings of urgency.

1. Urinary tract infection (UTI). Common symptoms of an UTI include passing small amounts of urine, abdominal pain, and cloudy or bloody urine.

1. Medicine use. Certain medicines, such as antidepressants, antipsychotics and furosemide, a medicine used to treat high blood pressure and heart failure, are known to cause increased urination.

1. Surgery performed via the urethra. This may cause narrowing of the urethra, restricting urine flow.

1. An STD. Painful urination can be a symptom of certain sexually transmitted diseases.

1. Cancer. Sometimes, a urinary problem is caused by a prostate cancer tumour that is pressing on the urethra or bladder.

How to treat male urinary problems

Many urinary problems in men can be treated or managed effectively. Of course, the treatment depends on the type of problem, its severity and the underlying cause. Your GP can do tests to determine the best course of treatment for you and, if necessary, refer you to a urologist.

Medication, therapy or surgery?

If the tests show that your issues are caused by an enlarged prostate, you may be prescribed medication to shrink your prostate gland to relieve pressure on the urethra. In some cases, it may be necessary to have prostate surgery. Physiotherapy in the form of pelvic floor muscle training can help to improve urinary problems caused by weak or overactive pelvic floor muscles. Infections of the urinary tract or prostate gland are usually treated with antibiotics. Most STDs can also be treated with antibiotics or an ointment.

Bladder or prostate cancer

In rare cases, urinary problems can be symptoms of prostate cancer or bladder cancer. Treatment will depend on the stage of the cancer, the type of tumour, and the patient’s overall health.

Treatment options include internal or external radiation, a surgical procedure to remove a bladder tumour through the urethra (transurethral bladder tumour resection), or a surgical procedure to remove the entire bladder (cystectomy) or prostate (prostatectomy). It's not possible to cure advanced prostate or bladder cancer. However, patients may benefit from palliative care. Palliative care focuses primarily on symptom control and quality of life preservation.