This page gives a short overview of this topic. For more information see the links at the bottom of this page.

Many men experience troublesome urinary symptoms as they grow older. This can occur in as many as one quarter of men over 40. These symptoms can include:

• weak urine stream
• difficulty starting urination
• straining to urinate
• stopping and starting while urinating
• dribbling at the end of urination
• a sense that the bladder is not empty at the end of urination
• urinating frequently at night
• an urgent need to urinate, sometimes with leakage of urine

There are many causes of urinary symptoms including prostatitis and bladder infections.  However the most common is benign prostate enlargement caused by a condition called benign prostate hypertrophy (BPH).  After the age of 40, the central part of the prostate can grow larger relative to the rest of the gland. The prostate surrounds the urethra which is the tube carrying urine to the outside.  The enlarged gland squeezes the urethra, partially blocking urine flow. This causes the lower urinary tract symptoms or LUTS symptoms mentioned above.

Prostate cancer is much less common than BPH and usually grows in a different (outer) part of the gland. However, when it is advanced enough, prostate cancer can also partially block the flow of urine causing lower urinary tract symptoms.

There are a range of treatments for urinary symptoms, depending on just how bothersome they are.

For mild symptoms, you can do several things to help such as limiting beverages in the evening, limiting caffeine or alcohol, practicing pelvic floor muscle exercises and exercising.

For more moderate symptoms, there are medicines which relax the muscles around the bladder neck and others that shrink the prostate gland. Minimally invasive surgical treatments, microwave therapy, needle ablation and high intensity focused ultrasound can be used to overcome the symptoms if medicines and simple measures do not provide adequate relief.

For men who have more bothersome symptoms, surgery called trans-urethral resection of the prostate (TURP) or laser therapy are available. They have the greatest impact when symptoms are particularly bothersome and there is significant obstruction by the prostate gland

All of these treatments have different pros and cons and not all may be suitable for you. Your doctor will assess your situation and discuss the options with you. Tests may include a digital rectal examination, PSA test or a urine test to rule out infection and other conditions. It is helpful for you to complete a symptom questionnaire. This helps you and your doctor decide which symptomsyou are experiencing and how troublesome they are. Your doctor may then start treatment. If more invasive therapy is necessary, you may be referred to a urologist for further assessment and investigations..

More information is available at these sites:

American Urological Association Link:

http://www.auanet.org/timssnet/products/guidelines/patient_guides/bph_guide_2003.pdf#

search=%22AUA%20urinary%20symptom%20guide%22

Mayo Clinic Link:

http://www.mayoclinic.com/health/enlarged-prostate-bph/BP99999/PAGE=BP00004

Andrology Australia Link:

http://www.andrologyaustralia.org/pageContent.asp?pageCode=URINARYSYMPTOMS

Urological Society of Australia and New Zealand

http://www.urosoc.org.au/consumer_health/index.jsp?a=1126154460

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