Complications of the Large Prostate Gland

 

The most common condition affecting millions of middle age American men is benign enlargement of the prostate gland.  This is called benign prostatic hyperplasia or BPH, which is a non-cancerous enlargement of the prostate. For reasons not entirely known, the prostate increases in size around age 50.  As the prostate gland grows, the gland compresses the urethra, which is the tube that transports urine from the bladder to the outside of the body.

Over time, the growth causes the urethra to become so compressed that it becomes difficult for men to empty the bladder.   The symptoms associated with enlarged prostate gland include frequency of urination, urgency of urination, dribbling after urination and even the complete inability to urinate or allowing only a small amount of urine to exit the bladder.

Bladder stones are formed when crystals inside the bladder collect together and harden to form a stone.  They often occur when the bladder is not fully emptying, so the urine that is left behind remains in the bladder for long time and coalesce and form stones.

Symptoms of bladder stones include frequent urination throughout the day, lower abdominal pain, a burning sensation when urinating, urine that appears cloudy or contains blood, and urgency of urination.

Urinary retention is the inability to fully empty your bladder. Acute urinary retention is a medical emergency, so it does require immediate medical attention.

There are two main types of urinary retention.  If there is an obstruction such as a bladder or kidney stone, then urine cannot properly be released, resulting in urine remaining in the bladder after urination. In this case, urinary retention can be life threatening, and you will require immediate medical intervention and the insertion of a catheter to relieve the blockage.

The most common cause of acute urinary retention is the enlarged prostate which compresses the urethra or the tube from the bladder that transports urine from the bladder to the outside of the body.

Non-obstructive urinary retention is caused by the weakening of the bladder muscles or nerve problems disrupting the communication between the bladder and the brain. Causes of non-obstructive urinary retention include stroke, pelvic injury or trauma, nerve diseases, impaired muscle or nerve function, and spinal cord injury that affects the nerves to the bladder.

Chronic urinary retention mainly affects men as a result of prostate enlargement. Although the condition is not life threatening, it can lead to permanent kidney damage. In chronic urinary retention, a man is unable to fully void their bladder, so urine stays within the bladder, increasing the risk of urinary tract infections.

Symptoms of chronic urinary retention include urinary frequency, urgency and hesitancy, nighttime urination, symptoms similar to a urinary tract infection, and lethargy and emotional irritability.

Urinary tract infections are often associated with urinary retention. Symptoms include cloudy or foul-smelling urine, blood in urine, difficulty urinating, pain while urinating, nausea, vomiting, shaking and chills, and fever.

Hematuria, or blood in urine, is frequently a benign condition, but there may be a risk of a more serious condition, too. For men with documented blood in the urine which is confirmed by a urine examination, you will will need some additional testing such as urine culture, a radiologic examination of the kidneys, and a cystoscopy or a look in the bladder with a lighted tube.

As the bladder retains urine, it continues to stretch. Excess stretching weakens the bladder muscles, making it impossible for the bladder to contract.  If this is left untreated, then permanent damage to the bladder muscle will occur and even if the obstruction is relieved the bladder muscle cannot contract and the man may be left with a permanent urinary catheter or may have to catherize himself several times a day.

Bottom Line: Every man over age 50 should see his doctor every year to check his prostate and to obtain a PSA blood test which is a screening test for prostate cancer.  Nearly every man can be treated with either medications or minimally invasive procedures that can often be done in the doctor’s office.

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