Incontinence is a surprisingly common issue. According to the Continence Foundation Australia, it affects roughly 1 in 4 adult Australians. This translates to up to 10% of Australian men and a staggering 38% of Australian women experiencing some form of bladder control problem.

But let's talk specifically about men's health. As men age, it's quite common to experience changes in urinary function. While some leakage or urgency might seem like a minor inconvenience, bladder problems in men can often signal underlying prostate issues. That's why early detection and awareness are crucial.

Understanding the prostate's role

Prostate anatomy and function

The prostate is a small, walnut-sized gland that plays a crucial role in the male reproductive system. It is located just below the bladder and surrounds the urethra, which is the tube through which urine passes out of the body. The primary function of the prostate is to produce and secrete prostate fluid, one of the components of semen. This fluid is vital for nourishing and transporting sperm during ejaculation.

What is the causing urinary problems as men age?

As men age, the prostate tends to enlarge, a natural process known as benign prostatic hyperplasia (BPH). BPH is highly prevalent among older men, affecting approximately 10% of men in their 30s, 20% in their 40s, up to 60% of men in their 50s and 60s, and up to 90% of men in their 80s and 90s. While not cancerous, this enlargement can squeeze the urethra, the tube that carries urine from the bladder out of the body. This narrowing can lead to a variety of bladder problems, which we'll explore in the next section. 

Know the symptoms: Common bladder problems linked to prostate health

1. Difficulty urinating

An enlarged prostate can press against the bladder and the urethra, which can cause significant difficulties with urination. This can lead to several issues:

• Slow to start urination
• Weak urine stream, making it difficult to control the direction and potentially causing dribbling after urination
• Sensation that the bladder isn't fully emptied after urination

2. Frequent urination and urgency

The pressure on the bladder from an enlarged prostate can trigger a constant urge to urinate, even if you haven't stored much urine. This frequent urination (sometimes called urinary frequency) can be particularly bothersome at night, leading to multiple trips to the bathroom (nocturia). The urgency to urinate can also be quite strong, making it difficult to hold on until you reach the toilet.

3. Urinary retention  

In a more serious complication, a completely blocked urethra can lead to urinary retention, where you're unable to urinate at all. This is a medical emergency that requires immediate attention. If you experience complete urinary retention, don't hesitate to seek medical help right away.

4. Urinary Tract Infections (UTIs)

All these bladder issues can increase your risk of developing UTIs. A constantly full or partially emptied bladder creates a breeding ground for bacteria, making you more susceptible to infections. UTIs can cause burning pain during urination, blood in the urine, and a strong, persistent urge to urinate (which can be confused with urgency caused by BPH). Testing for UTI's can now be done in the comfort of your own home with the TouchBio UTI Testing Kits

Signs you should seek emergency medical attention

While some bladder problems can be managed through lifestyle changes or medication, there are certain symptoms that warrant immediate medical attention. See your doctor right away if you experience:

• Being unable to urinate - This is a sign of complete urinary retention and requires urgent medical intervention.

• Painful urination - While some discomfort can occur with BPH, severe or burning pain during urination could indicate an infection or other complications.

• Any blood in the urine at all - Blood in the urine is not a normal symptom and can signify various urological issues.

• Any unusual discharge from the penis - Any discharge, bloody or not, is a sign of potential infection and needs a doctor's evaluation.

• Continuous or severe urinary incontinence - While occasional leakage can occur with BPH, complete loss of bladder control requires medical attention

Or these signs, especially if it coincides with other urinary symptoms:

• Fever
• Lower back pain
• Pain in the groin

Diagnosing prostate-related bladder issues

Physical examination

A key component of diagnosing prostate-related bladder issues is the digital rectal exam (DRE). During this exam, the doctor inserts a lubricated, gloved finger into the rectum to feel the prostate gland. By assessing the size, shape, and consistency of the prostate, the doctor can identify any abnormalities, such as enlargement, nodules, or irregularities.

Diagnostic tests

Several diagnostic tests can aid in confirming prostate issues affecting bladder function:

• Urine tests - Urinalysis can detect signs of infection or inflammation in the urinary tract. Urine flow studies can also assess the rate and pattern of urine flow, providing insights into bladder function.

• Blood tests - Prostate-specific antigen (PSA) testing measures the level of PSA, a protein produced by the prostate gland, in the bloodstream. Elevated PSA levels may indicate prostate enlargement, inflammation, infection, or cancer. While PSA testing is not diagnostic on its own, it can help guide further evaluation.
• Imaging tests - Imaging studies such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be used to visualise the prostate gland and surrounding structures. These tests can provide detailed images of the prostate's size, shape, and any abnormalities, helping to confirm a diagnosis and assess the extent of the condition.

Treatment options

Managing prostate-related bladder issues involves a combination of lifestyle modifications, medications, surgical interventions, and alternative therapies. The best approach will depend on the severity of your symptoms and the underlying cause. 

Lifestyle modifications

Sometimes, simple changes to your daily routine can significantly improve bladder function. Here are some tips:

• Reduce fluid intake before bed
• Limit alcohol and caffeine
• Reduce processed food and carbohydrates in your diet
• Engage in regular exercises or physical activities
• Practice doing pelvic floor and bladder retraining exercises once a day

Several medications can help manage BPH and its associated symptoms, such as:

• Alpha-blockers - These medications relax the muscles in the prostate and bladder neck, allowing for easier urine flow.
• 5-alpha-reductase inhibitors - These medications shrink the prostate gland over time, reducing pressure on the urethra.

For severe cases of BPH or when other treatments are ineffective, surgical interventions may be necessary. Options include:

• Transurethral resection of the prostate (TURP) - This is a minimally invasive procedure where excess prostate tissue is removed to relieve urinary obstruction.
• Laser surgery - Various laser techniques can be used to vaporise or remove excess prostate tissue, offering an alternative to traditional surgery with potentially fewer side effects.

Some individuals may explore alternative therapies to manage prostate-related bladder issues. These may include:

1. Saw palmetto

Saw palmetto is a type of palm native to the southeastern United States.The fruit of the saw palmetto plant has been used in traditional medicine for centuries, primarily for urinary symptoms associated with an enlarged prostate gland in men.
In a research study on the effects of saw palmetto fruit extract intake on improving urination issues in Japanese men, the results indicated that the consumption of the supplement for a period of 12 weeks relieved subjective symptoms related to urination.

Many supplements designed to support prostate health, such as Australian NaturalCare's Prostate Care Complete, combine saw palmetto with other beneficial ingredients like Crateva. Crateva is traditionally used on Ayurvedic medicine reputed to enhance the tone of the bladder, helping it to contract and relax more efficiently.

2. Beta-sitosterol

Beta-sitosterol is a plant sterol found in many fruits, vegetables, nuts, and seeds. It's also available as a dietary supplement. Beta-sitosterol has been studied for its ability to alleviate symptoms associated with BPH, including difficulty urinating, weak urine flow, and frequent urination. Some research suggests that beta-sitosterol may help improve urinary flow rate and decrease residual urine volume in the bladder, leading to more effective bladder emptying.

There are various other herbal supplements and vitamins marketed for prostate health, but it's essential to consult with a healthcare provider before starting any new treatment to ensure safety and efficacy.

Conclusion

The prostate plays a crucial role in urinary function and reproductive health, and any issues affecting its function can have a significant impact on daily life. Fortunately, there are various treatments and alternative therapies available to manage prostate-related bladder issues effectively.

While medications, surgical interventions, and alternative therapies can be valuable options for managing bladder health, simple lifestyle changes can also make a significant difference. These changes may include:

• Maintaining a healthy diet
• Staying physically active 
• Practising good bladder habits like avoiding holding urine for long periods, and practising pelvic floor exercises
• Regular prostate check-ups

Regardless of the approach taken, it's crucial to always consult with a medical professional before starting any new treatment regimen or making significant lifestyle changes.

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