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webGP -Difficulty passing urine

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Learn more about difficulty passing urine: introduction

Benign prostate enlargement (BPE) is the medical term to describe an enlarged prostate, a condition that can affect how you pass urine.

BPE is common in men aged over 50. It is not a cancer and it isn't usually a serious threat to health.

This page covers:

Symptoms

Causes

Diagnosis

Treatment

Complications

Symptoms of benign prostate enlargement

The prostate is a small gland, located in the pelvis, between the penis and bladder.

If the prostate becomes enlarged, it can place pressure on the bladder and urethra (the tube through which urine passes).

This can affect how you pee and may cause:  

  • difficulty starting to pee
  • a frequent need to pee
  • difficulty fully emptying your bladder

In some men, the symptoms are mild and don't need treatment. In others, they can be very troublesome.

Read more about the symptoms of benign prostate enlargement.

Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This isn't the case.

The risk of prostate cancer is no greater for men with an enlarged prostate than it is for men without an enlarged prostate.

Causes of benign prostate enlargement

The cause of prostate enlargement is unknown, but it is believed to be linked to hormonal changes as a man gets older.

The balance of hormones in your body changes as you get older and this may cause your prostate gland to grow.

Diagnosing benign prostate enlargement

You might have several different tests to find out if you have an
enlarged prostate.

Your GP may do some of these tests, like a urine test, but others might need to be carried out at a hospital.

Some tests may be needed to rule out other conditions that cause similar symptoms to BPE such as prostate cancer.

Read more about diagnosing benign prostate enlargement.

Treating benign prostate enlargement

Treatment for an enlarged prostate will depend on the severity of your symptoms.

If you have mild symptoms, you won't usually need immediate treatment but you'll have regular prostate check-ups.

You'll probably also be advised to make lifestyle changes, such as:

  • drinking less alcohol, caffeine and fizzy drinks
  • limiting intake of artificial sweeteners
  • exercising regularly
  • drinking less in the evening

Medication to reduce the size of the prostate and relax your bladder may be recommended to treat moderate to severe symptoms of BPE.

Surgery is usually only recommended for moderate to severe symptoms of BPE that have failed to respond to medication.

Read more about treating benign prostate enlargement.

Complications of prostate enlargement

Benign prostate enlargement can sometimes lead to complications such as:

Acute urinary retention (AUR) is the sudden inability to pass any urine.

Symptoms of AUR include:

  • suddenly not being able to pee at all 
  • severe lower abdominal pain
  • swelling of the bladder that you can feel with your hands

Go immediately to your nearest accident and emergency (A&E) department if you experience the symptoms of AUR.


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Learn more about difficulty passing urine: symptoms

Symptoms of an enlarged prostate include:

  • finding it difficult to start peeing
  • straining to pee
  • having a weak flow of urine
  • "stop-start" peeing
  • needing to pee urgently and/or frequently
  • needing to get up frequently in the night to pee
  • accidentally leaking urine (urinary incontinence)

Leaking urine can happen when you feel a sudden need to pee and can't stop some pee leaking out before you get to a toilet. This is called urge incontinence.

Leaking urine can also happen when you strain, for example when you cough, sneeze or lift a heavy object. This is stress incontinence.

The most common form of leaking is when a small amount of urine dribbles into your underwear after peeing.

Read more information about incontinence.

When to seek medical advice

See your GP if you have any of the symptoms on this page.

Even if the symptoms are mild, they could be caused by a condition that needs to be investigated.

Any blood in the urine must be investigated by your GP to rule out other more serious conditions.


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Learn more about difficulty passing urine: diagnosis

To find out whether your prostate gland is enlarged, you'll need to have a few tests.

Some tests will be carried out by your GP and, if needed, others will be carried out by a specialist in urinary problems (a urologist).

GP examination and tests

Your GP will ask about your symptoms and your concerns, and their impact on your quality of life.

You may be asked to complete:

  • A urinary frequency-volume chart
    This will give a record of how much water you normally drink, how much urine you pass, and how often you empty your bladder on a daily basis, as well as any leakage you have. Download a chart (PDF, 115kb) from the Bladder Matters website. 
  • IPSS questionnaire
    The IPSS (International Prostate Symptom Score) questionnaire allows your doctor to better understand how serious your symptoms are. Download a version of the questionnaire (PDF, 180kb) from the Royal United Hospital Bath NHS Trust.

Your GP should perform a physical examination. They may examine
your stomach and genital areas.

They may also feel your prostate gland through the wall of the back passage (rectum). This is called a digital rectal examination (DRE).

Your GP may order a blood test to check that your kidneys are
working properly.

They may advise you to have a prostate-specific antigen (PSA) blood test to rule out prostate cancer.

You may be offered a urine test, for example to test for glucose (sugar) or blood. This is to see if you have diabetes or an infection.

Referral to a urologist

Your GP may refer you to a urologist or other appropriate specialist if:

  • previous treatments have not helped your urinary problems
  • a urinary infection does not go away or comes back regularly
  • you cannot fully empty your bladder 
  • you have kidney problems
  • you have stress incontinence: when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh

You should also see a specialist if your GP is concerned that your symptoms could be caused by cancer, although for most men cancer is not the cause.

To help find out what might be causing your symptoms and decide how best to manage them, you should be offered additional tests to measure:

  • how fast your urine flows
  • how much urine is left in the bladder after you have peed

You may also be offered other tests, depending on your symptoms or the treatment you and your doctor are considering.


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Learn more about difficulty passing urine: treatment

The treatment for an enlarged prostate gland will depend on the severity of your symptoms.

The main treatments are:

Lifestyle changes

Medication

Catheters

Surgery

Read a summary of the pros and cons of the different treatment options for benign prostate enlargement.

Lifestyle changes

You might be able to relieve the symptoms by making some simple
changes to your lifestyle, such as:

Drinking fewer fizzy drinks and less alcohol, caffeine and artificial sweeteners
Fizzy drinks and drinks that contain alcohol, caffeine (like tea, coffee or cola) and artificial sweeteners can irritate the bladder and make urinary
symptoms worse. 

Drinking less in the evening
Try to reduce the amount you drink in the evening and avoid drinking anything for two hours before you go to bed. This might help you avoid getting up in the night. Make sure you're still drinking enough fluid earlier in the day.

Remembering to empty your bladder
Remember to go to the toilet before long journeys or when you know you won't be able to reach a toilet easily.

Double voiding
This involves waiting a few moments after you've finished passing urine before trying to go again. It can help you to empty your bladder properly. But take care not to strain or push.

Checking your medicines
Check with your doctor whether any medicines you take, such as antidepressants or decongestants, may be making your urinary symptoms worse.

Eating more fruit and fibre
This will help you avoid constipation, which can put pressure on the bladder and worsen symptoms of an enlarged prostate.

Using pads or a sheath
Absorbent pads and pants can be worn inside your underwear, or may replace your underwear altogether. These will soak up any leaks.

Urinary sheaths can also help with dribbling. They look like condoms with a tube coming out of the end. The tube connects to a bag that you can strap to your leg under your clothing. 

Bladder training
Bladder training is an exercise programme that aims to help you go for longer without peeing and hold more pee in your bladder. You'll be given a target, such as waiting at least two hours between each time you pee.

It's a good idea to use a bladder training chart (PDF, 115kb), which allows you to record each time you pass urine and the volume of urine passed – you'll need a plastic jug to measure this. Your doctor should give you a chart to take home.

You'll also be taught a number of exercises, such as breathing, relaxation and muscle exercises, to help take your mind off the need to urinate.

Over time your target time will be increased, and at the end of the programme you should find you're able to go for longer without peeing.

Ask your doctor or specialist nurse for more information about any of these lifestyle changes. 

Medicines

If lifestyle changes don't help or aren't suitable for you, you may be offered medicine.

Alpha blockers relax the muscle in the prostate gland and at the base of the bladder, making it easier to pass urine. Commonly used alpha blockers are tamsulosin and alfuzosin.

Anticholinergics relax the bladder muscle if it's overactive.

5-alpha reductase inhibitors shrink the prostate gland if it's enlarged. Finasteride and dutasteride are the two 5-alpha reductase inhibitors available.

Diuretics speed up urine production. If taken during the day, it reduces the amount of urine produced overnight.

Desmopressins slow down urine production so less urine is produced at night.

Your doctor shouldn't offer you homeopathy, herbal treatments or acupuncture to treat urinary symptoms.

This is because there isn't enough reliable evidence about how well they work or how safe they are.

Herbal treatments may also cause side effects or interact with other medicines.

Catheters

If you continually have trouble peeing, a condition called chronic urine retention, you may need a catheter to drain your bladder.

A catheter is a soft tube that carries urine to the outside of the body from the bladder. It can pass through your urethra, or through a small hole made in the abdomen above your pubic bone.

You may be recommended a removable catheter or a catheter that stays in your bladder for a longer period of time. 

Surgery

Most men with urinary symptoms don't need to have surgery, but it may be an option if other treatments haven't worked.

Transurethral resection of the prostate (TURP)
TURP involves removing part of the prostate gland, generally using a tube that passes through the urethra. It's suitable for men who have an enlarged prostate.

Open prostatectomy
An open prostatectomy involves removing the prostate gland through a cut in your body. This procedure is suitable for men who have an enlarged prostate over a certain size.

Cystoplasty
Cystoplasty is a procedure to increase the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall. This intervention may help men whose bladder muscle contracts before it's full.

Botulinum toxin
This procedure involves injections of botulinum toxin into the walls of the bladder. This intervention may help men whose bladder muscle contracts before the bladder fills.

Implanted sacral nerve root stimulation
A small electrical device is implanted under the skin and sends bursts of electrical signals to the bladder and urine system for better control. This is suitable for men whose bladder muscle contracts before the bladder fills.

Urinary diversion
Urinary diversion involves linking the tubes connecting the kidneys to the bladder directly to the outside of the body, so the urine can be collected without flowing into the bladder.

This method is suitable for men whose symptoms can't be managed by self-management and medicine, and who can't have – or don't want – cystoplasty or sacral nerve root stimulation.

Content Supplied by NHS Choices