Urinary problems are not a result of aging, but of prostate enlargement as men age.
As a maturing man who is approaching 50 years old, I personally have had time to truly empathize with many of my patients. Most men confuse the onset of urinary symptoms and worsening lower urinary tract symptoms as the normal aging process.
The good news is that what many men consider a part of aging can be reversed. For example, it is not part of the normal aging process for men to get up during sleep and need to urinate. Having a hard time starting the stream (hesitancy), a weak stream, and feeling like the bladder isn’t empty are also not part of the normal aging process.
WHAT IS NORMAL
The urinary process starts from the kidneys, the pump that makes the urine, filtering the blood and releasing urine, which is composed of water and electrolytes and waste products from the body.
The urine passes from the kidneys to the bladder by small tubes called ureters. The bladder has the main function of storing the urine until we are ready to eliminate it.
When a person wants to urinate, the bladder will squeeze and the urinary muscles will relax. If the urinary tract outlet, which we call the bladder outlet, is normal, the urine will start right away and the flow will be quick; the bladder will empty, and the flow will stop quickly as the bladder empties.
WHAT HAPPENS WITH AGING
Men can develop trouble emptying the bladder for many reasons, but the majority of the time the problem is the prostate. The prostate is a donut-shaped organ that connects the bladder with the urethra. Its opening is called the prostatic urethra and is the main cause of blockage for the aging male. As the prostate enlarges (also known as BPH or Benign Prostate Hyperplasia), it can become larger on the outside, which does not affect urination that much, but more importantly can grow on the inside, which causes blockage and forces the bladder to squeeze and work harder to pass urine.
THE BLOCKAGE (OBSTRUCTIVE SYMPTOMS)
The first signs of problems for men are often obstructive symptoms. The symptoms include a hard time starting urinary flow, the stream being slower than it used to be, and a feeling of not being completely empty after finishing to urinate. This usually starts slowly and it can take years before it becomes a problem. For me, I first started to notice the slowing of the stream when occasionally I awakened in the middle of the night. As time went by, this became more obvious, and when I first urinated in the morning, the stream was at its slowest compared to other times of the day.
THE BLADDER RESPONSE (IRRITATIVE SYMPTOMS)
The bladder usually can compensate by working harder and increasing its pressure so the urinary flow is maintained. While this is a good thing to maintain a normal urinary life, the bladder works harder and the muscle gets thicker and it becomes overactive. Men then develop the urge to urinate much sooner than they should, since the bladder is irritated and wants to empty before it has reached its normal size. This urgency leads to frequency of urination, having to urinate more frequently than one did before. When this happens at night, we develop nocturia, the need to urinate more at night, which becomes a problem since we are unable to sleep as well as we should. Also see, “7 Symptoms of Enlarged Prostate (BPH).”
THE GOOD, THE BAD, AND THE UGLY
The Good News
The good news is that the process of urinary dysfunction is not really normal or a sign of aging, but the effects of aging which lead to an enlarged prostate. As I am nearing 50 and seeing my primary care doctor for a referral for a colonoscopy, which I thought was more than enough for now, I also plan to visit my colleague Dr. Opell, but not in the usual way.
The Bad News
This is not really bad news, but it is important for men as they get older to make sure that any urinary symptoms are not due to prostate cancer, which can also cause a blockage. This will require an examination and blood work for a PSA.
People are born with one bladder and if we let urinary problems progress, this can lead to a poorly functioning bladder, the worst case being that the bladder does not function anymore. Letting the bladder reach higher pressure than it should can lead to problems with the kidneys draining. This can also lead to swelling of the kidneys, which was relatively common many years ago when men were not evaluated for urinary problems as frequently as they are now, but now is rarely seen.
THE GREAT NEWS
Urologists have many ways they can improve urinary function in men. Supplements or medications can often help and usually are a lifelong necessity. As the prostate enlarges, most men will still have further symptoms; however, Urologists also have multiple procedures that can be performed to reverse the effects of an enlarged prostate and leave men with normal urinary function as they get older.