MANAGING URINARY SYMPTOMS

A Guide for Patients

Often urinary symptoms such as passing urine too frequently, can be helped by simple lifestyle measures. Medications and surgical options vary for men and women and will be discussed separately.

 

ASSESSING THE CAUSE

Most urinary problems are easily treated, and usually relate to simple benign (non-cancerous) problems. However, always consider first is there an urgent need to see your GP. if you are passing blood in the urine, have bladder pain, are losing weight unexpectedly or have new bone pain, see your GP urgently.

If you have concerns like your risk of prostate cancer, particularly if out runs own your family, then again see your GP or specialist for examination and testing.

Next, think about the two functions of the bladder - is it a problem holding on to urine (storage) or a problem getting rid of it (voiding). Is it having go frequently, with urgency otherwise you might wet yourself, and getting up at night (an overactive bladder), or is it taking a long time to pass urine, a poor and interrupted flow, or not feeling like you've emptied, which is more likely to be due to a blockage of the bladder emptying. The symptoms can be mixed together, but thinking in this way will guide your options.

OVERACTIVE BLADDER

For an overactive bladder, avoid stimulant drinks especially caffeine, which makes the bladder much more sensitive and disturbs the body's natural fluid balance too by causing rapid urine production and dehydration (a diuretic). Fizzy drinks or acidic drinks such as pure fruit juices can also irritate the bladder. Alcohol may exacerbate the problem at the time. 

Trying to train the bladder to hold on longer can be useful so long as you're emptying out satisfactory, and trying to distract yourself (mind over matter) can indeed help. Performing a pelvic floor squeeze at the time of a bladder urge can stop the bladder contraction. This is called urge abatement, and is a way of allowing you to avoid running tot the toilet every time you feel the first need. The buttons below will take you to a leaflet on bladder training.

Medications can be used also to help when other measures aren't enough. Your doctor can prescribe a variety of tablets which reduce the urgent bladder contractions. It is usual to start with a tablet called an "anti-cholinergic" e.g. Tolterodine unless you can't take these or have a lot of side effects. Dry mouth and constipation are quite common with them. A second class of drug "beta 3 agonists" e.g. Mirabegron can work but often have less side effects, but are used as second choice due to their cost.

In more difficult cases, Botulinum Toxin (Botox) can be injected telescopically into the bladder by a Specialist, but this can have more significant side effects.

OUTFLOW PROBLEMS FOR WOMEN

Sometimes the water pipe (urethra) can be narrowed, and this can lead to emptying problems. This can be helped by a gentle dilatation, usually under anaesthetic if the flow and emptying are poor. If menopausal hormonal changes are associated, topical oestrogen creams may also be tried.


Sometimes though the issue is weakness of the pelvic floor muscles, leading to prolapse, where the bladder isn't well supported, and the urethra can in effect kink. Pelvic floor exercises, support pessaries, or gynaecological surgery can be useful in this situation.

OUTFLOW PROBLEMS FOR MEN:
PROSTATE AND OTHER

Occasionally, difficulty passing urine can be due to scarring in the water pipe (a stricture) which typically gives a very slow stream and sometimes spraying around. These won't be helped by medication, and need dilatation. 

More commonly though, the reason for a poor stream and incomplete emptying is the prostate enlarging, causing a narrowing where the urine exits from the bladder. The bladder may get thick and muscular in response to the blockage, and so its capacity can be reduced giving overactive bladder symptoms too. It is these symptoms, having to go in a hurry, and getting up at night, which can be more bothersome than the poor flow in itself.

If left unmanaged, the bladder can in fact suffer long term, with loss of stretch and capacity permanently. Occasionally in severe cases, the bladder can over distend to the point of the painful inability to pass urine (acute retention), or lose muscle strength entirely and irreversibly. So if your symptoms are becoming a nuisance its worth getting advice.

The usual first line of treatment is medication to relax the prostate (alpha-blockers e.g. tamsulosin). This will help about 2/3rds of men, but side effects such as dizziness or tiredness (by affecting blood pressure) and lack of semen coming out at orgasm (retrograde ejaculation) are common. Another type of tablet is a prostate shrinker (5 alpha reductase inhibitor e.g. finasteride). These work more slowly - at least 6 months for effect, and can reduce libido and erections in some men. 

If medications are ineffective or side effects undesirable, consider seeing a Specialist to discuss options including new minimally invasive techniques which have less side effects than standard operations. 

SURGICAL OPTIONS FOR PROSTATIC ENLARGEMENT

Traditional options have focused on removing the central part of the prostate to improve the stream. Whilst very effective, they can have common side effects such as bleeding, reduced ejaculation, occasionally impotence, and scarring. They are performed under full anaesthetic and require an in hospital stay of 1 to 2 nights. Transurethral resection of the prostate (TURP) is the most commonly performed variety of these options, but other laser types such as green light vaporisation and holmium laser enucleation (HoLEP) are performed in some centres. They have no great advantage over TURP.

More recently, new techniques include putting implants into the prostate under local gel anaesthetic to hold it open (Urolift), or using steam to shrink the prostate (Rezum). Mr Streeter introduced both of these technologies to East Kent. A further option being used locally is blocking off the blood supply to the prostate (embolisation). All of these are usually performed without the need to stay in hospital, and generally have a faster recovery and less side effects, especially less permanent sexual side effects. For more information on Urolift and Rezum, please click below.