Problems Peeing are Normal as Men Age, but Shouldn’t be Ignored

The symptoms of an enlarged prostate/BPH that can drive men crazy
Do you have trouble starting to urinate (pee)? Does it dribble and flow weakly?  Feeling the need to pee RIGHT NOW? Are you waking up several times during the night to go to the bathroom? Does it feel like you can’t fully empty your bladder? What’s the cause of all these potty woes? As men age, the prostate gets larger, pushing on the bladder and urethra causing more frequent urination.

Just what is the prostate?
Sitting below the bladder and surrounding the urethra, the prostate is the reproductive gland that produces fluid for carrying sperm. In a man’s lifetime, the prostate doubles in size in early puberty. Then, around age 25, it starts to grow again and continues growing throughout most of a man’s life. An enlarged prostate or benign prostatic hyperplasia (BPH), is a common problem for men starting in their 60s, and it is more likely for men in their 70s and 80s to have some symptoms of BPH.

It’s important to talk with your primary care provider if you’re experiencing symptoms
While BPH is common, diagnosing it in its earlier stages can lower the risk of complications later like bladder stones and infections from not fully emptying the bladder. BPH is not a risk factor for prostate cancer. If you’re experiencing symptoms of BPH, talk to your primary care provider so they can assess your condition, and in some cases, start a first line of treatment. Your primary care provider (PCP) may refer you to a urologist for additional testing and/or treatment. The testing may include checking for infection, an ultrasound of the bladder and physical exam.

In the meanwhile, try some lifestyle changes to help relieve some symptoms:

• Sitting to pee relaxes the pelvic floor and leg muscles and makes it easier to empty the bladder
• Drinking fewer liquids before bed can help

A range of treatments for BPH: herbal supplements to medication to procedures
Valley’s urologists will discuss options to help manage urinary symptoms and the discomfort that comes with them. Many patients like to try a naturopathic approach first—the herbal supplement saw palmetto gives relief to some.

If saw palmetto isn’t effective, then a prescription for alpha blockers (e.g. FlowMax) is worth trying. “We usually start with this medication as it is well-tolerated with few side effects,” says Daniel Simon, MD, a urologist at Valley’s Urology Clinic. “Over time however, some find that the medications don’t work as well or they prefer not to take life-long medications. The medications just control the symptoms, they don’t correct the prostate enlargement itself which, as far as we know, is age-related and genetic.” Then it’s time to talk about interventional options with your urologist. They will use tests to help find the option best for your BPH based on your prostate size and other anatomy.

In-office treatment options
Cooled Thermotherapy (transurethral microwave thermotherapy) and UroLift. These treatments can reduce the size of prostate tissue around the urethra to help improve urine flow. These procedures have the lowest risk and have the fewest side effects.

Outpatient options (same-day surgery)
GreenLight laser therapy and Button plasma vaporization. Using tiny cameras and endoscopic scopes to direct the laser or electrode, these treatments will “melt” the prostate tissue around the urethra. Because these treatments have a lower risk of bleeding, they are considered lower risk than typical surgical procedures.

Prostate surgery
Transurethral resection of the prostate (TURP). TURP is recommended for patients where other options are not possible due to prostate size, anatomy issues, or other medical conditions. In this minimally-invasive surgical procedure, the urologist will remove prostate tissue surrounding the urethra and bladder to reduce the pressure. In rare cases of very enlarged prostates, patients will have a simple prostatectomy (removal of a larger amount of prostate tissue) using robotic surgery, but this isn’t recommended for most patients. Removing the prostate can sometimes cause urinary incontinence and erectile dysfunction.

Urology Clinic’s physicians offer minimally invasive treatment options for both male and female patients and are specialists in endoscopic, laparoscopic and da Vinci® robotic surgery.

Attreya Dash, MD

Susan Dong, MD

Daniel Simon, MD

Urology Clinic
Medical Arts Center
4033 Talbot Rd S Ste 500
Renton, WA, 98055
Phone: 425.656.5365
valleymed.org/urology