The prostate is a gland found only in men.  It is about walnut-size, below the neck of the bladder, surrounding the bladder outlet (urethra).  Its job is to secrete a milky fluid which becomes part of the semen and nourishes the sperm.

As men age, the prostate gland enlarges.  This may take many years.  For the majority of men this does not create any difficulties but for some this enlargement can cause urinary symptoms such as –

• A slow and/or interrupted stream
• A difficulty starting to pass urine
• Need to pass urine more often
• A feeling of incomplete emptying and, in some cases,
• Loss of urinary control (incontinence).

Incontinence can also occur as a result of other medical conditions.  It can cause a lot of suffering and embarrassment.  If you have changes in your urinary symptoms, or concerns about your prostate gland, contact your doctor or a continence advisor for advice.

Common prostate conditions

1 Prostatitis is inflammation of the prostate gland and may be associated with urinary tract infection.  It more commonly younger men.

2 Benign Prostatic Hyperplasia (BPH) is progressive prostate enlargement, usually commencing in middle age.  About 25% of men will need surgery for this problem.  (BPH does not lead to cancer.)

3 Prostate Cancer mat be found at first without any symptoms.  For men, it is the most common cancer, and increases with age.  However it is one of the most responsive to treatment.

Symptoms

A man with a prostate problem may have any one – or a combination – of these symptoms:

• Difficulty initiating the flow of urine
• Slow urine stream once urination has stated
• Need to pass urine more often than usual during the day (frequency), or overnight (nocturia)
• Dribbling either after passing urine of between visits to the toilet.
• Returning to urinate within a short time after initial urination
• Feeling of urgency to urinate
• Burning, discomfort or even pain while passing urine
• Urine may be blood-stained
• Sensation that emptying is not complete.

Some of these symptoms may occur for reasons other than prostate problems, for example, some medications prescribed for other conditions may cause retention (storing up) of urine.  Your doctor can help you identify the actual cause of your problem.

Bladder problems and the prostate

Why can incontinence be associated with prostate conditions?

Obstruction of the urethra (tube taking urine from bladder to the outside of the body): a blockage may occur by the prostate getting larger.  This may prevent the bladder from emptying completely.  This storing up of urine may become severe enough to lead to “overflow incontinence”, a situation demanding immediate medical attention.

Irritability of the bladder may develop.  This is caused by the increased effort of the bladder to try to overcome obstruction.  An irritable bladder can contract involuntarily, resulting in episodes of “urge incontinence”.  After treatment of outflow obstruction with surgery, any underlying bladder irritability may, at least initially, mean an increase in “urge incontinence” until the bladder returns to normal.

Surgery for prostate problems can sometimes cause muscle and nerve damage to the sphincter, which is the muscle that helps hold urine in the bladder.  Incontinence may result – it may be short – or long-term, and may depend on the degree or extent of surgery undertaken.

Treatment

There are several options that might help incontinence associated with prostate disease.  Make sure you take part in making decisions about the diagnosis, treatment options, outcomes, risks, complications and costs.

1 Reassurance and observation

After medical tests and discussion with your doctor you may feel that no treatment is required.  Symptoms sometimes improve with time or with simple changes to daily habits.

2 Medication

The are a number of prescription drugs available – ask your doctor about these.

3 Surgery 

Surgery involves the removal of the whole or part of the enlarged prostate.  The size of the prostate gland may influence the type of surgery required.

4 Bladder training

A program of bladder training aims to improve bladder control, increase the amount of urine the bladder can hold without the urgency or leakage of urine and reduce urgency and frequency in those with bladder irritability.

5 Pelvic floor muscle exercises

These exercises strengthen the muscles that control the function of the bladder and the bowel.  Familiarise yourself with the exercises prior to surgery and commence them as soon as it is comfortable to do so.

6 Incontinence products

A wide range of incontinence aids is available to help cope with urine loss.

Diabetes warning: If you are always feeling thirst and having to urinate all the time, talk to your doctor.  It is important that you are checked to ensure that diabetes is not the problem.