What Urination Tells You About Your Prostate

Name the gland in your body that is important for male fertility when you are young but messes up urination as you age. The inimitable prostate. An organ critical for the continuation of the species but a urinary rabble rouser as its owner ages.

It’s a Wrap

Wrapping itself firmly around the urethra (urine tube) at the base of the bladder like a donut, the prostate is the one sex gland that uniformly grows in size as we age. We wish it were another organ down there that increased in size with age, but no it’s the prostate. And this benign enlargement (called BPH) is the source of a host of urinary symptoms that men notice as they age. Roughly 50% of men will notice urination changes by age 60. This is in stark contrast to prostate cancer, which is much less common (1/9 men) than BPH and typically causes no symptoms. It’s also unlike prostatitis, or prostate infections, which tend to cause severe, sudden symptoms that resolve with treatment.

Slow Flow

As the prostate enlarges, the hole in the middle of it gets smaller, which decreases the size and increases the resistance of the urethra to the passage of urine. Typically, this results in a slower urinary stream to the point where you can’t write your name in the snow anymore. Along with this comes straining to urinate, where you bear down more to keep things going. Finally, the feeling of incomplete emptying leading to double voiding (urinating once and then waiting to urinate again 20-30 seconds later) is quite common. This constellation of symptoms is termed “obstructive” urination and can be very concerning to many men.

Fast Pass

Alternatively, men with prostatic enlargement can have issues with both feeling the need to urinate (urgency) a lot more than before and also actually urinating a lot more often (frequency) than they used to. Adding fuel to the fire, these “irritative” symptoms can extend into the night and cause men to wake up just to urinate (nocturia), often with disappointingly low volumes when they do. These symptoms typically reflect the bladder’s response to the tight passage that urine must be pushed through when it contracts to initiate urination.

Gladder Bladder

Luckily, the symptoms of an enlarged prostate are treatable. The best studied are pills that either shrink the prostate (5-alpha reductase inhibitors) or open the doughnut hole in the prostate (alpha blockers). Minimally invasive surgical procedures including Rezum and Urolift are also used when medications fail. Finally, a tried and true, century-old, keyhole surgical procedure through the urethra can open up the channel and restore the race-horse stream of younger years. So, how you urinate can tell you a lot about your prostate. And, there’s no doubt that a gladder bladder makes a cheerier chap.