What is the prostate?

The prostate is a gland found only in men. It is about walnut size and is located below the neck of the bladder surrounding the bladder outlet or urethra. Its job is to secrete a milky fluid that becomes part of the semen and nourishes the sperm.

The prostate gland undergoes changes with increasing age. In some men these changes may be associated with urinary symptoms such as a slow and/or interrupted stream, difficulty starting to pass urine, need to pass urine more frequently, a feeling of incomplete emptying, and, in some cases, loss of urinary control - that is incontinence.

Incontinence, which can also occur as a result of other medical conditions, can cause a lot of suffering and embarrassment. If you have any changes in your urinary symptoms, or concerns about your prostate gland, contact your doctor for advice.

What conditions can affect the prostate?

Common prostate conditions include:

• prostatitis: an infection of the prostate gland that may be associated with urinary tract infection. It more commonly affects younger men
• benign prostatic hyperplasia (BPH): a progressive enlargement of the prostate which usually starts in middle age. About 25% of men will need surgery for this problem. It does not lead to cancer
• prostate cancer: a relatively common cancer that is more common with increase in age. There may be no symptoms at first. It can often be treated effectively.

How can prostate problems affect the bladder?

A man with a prostate problem may have any one, or a combination of these symptoms:

• difficulty initiating the flow of urine
• slow urine stream once urination has started
• the need to pass urine more often than usual during the day (frequency) and overnight (nocturia)
• dribbling either after passing urine, or between visits to the toilet
• returning to urinate within a short time after initial urination
• feeling of urgency to urinate
• burning, discomfort or even pain while passing urine
• blood-stained urine
• sensation that emptying is not complete.

How may prostate conditions lead to incontinence?

• obstruction of the urethra by the prostate may prevent complete bladder emptying when you urinate. The retention may become severe enough to lead to overflow incontinence. This requires medical attention
• the increased effort of the bladder to overcome outflow resistance may also lead to irritable bladder muscles which may contract involuntarily causing urge incontinence. This may be worse for some time after surgical treatment for outflow obstruction, until the bladder returns to normal.
• surgery for prostate problems can sometimes damage the muscles and nerves of the sphincter, the muscle that helps hold urine in the bladder, resulting in short- or long-term incontinence. The potential for damage depends on the extent of the surgery.

How is prostate-related incontinence treated?

The main treatment options are:

• reassurance and observation: after medical tests and discussion with your doctor, you may feel that no treatment is required. Symptoms sometimes improve spontaneously with time, or with simple changes in daily habits
• medications: there are a number of prescription drugs available, which may be effective in some cases
• surgery: this involves removing whole or part of the enlarged prostate. The size of the prostate gland may influence the type of surgery required.

Other options may include:

• bladder training: this aims to improve bladder control, increase the amount of urine the bladder can hold without urgency or leakage of urine, and reduce urgency and frequency in those with bladder irritability
• pelvic floor exercises: these strengthen the muscles to help control the function of the bladder and bowel. Familiarise yourself with the exercises prior to surgery and start them as soon as it is comfortable to do so. (refer everybody title Pelvic floor muscle training for men)
• incontinence aids: these include a wide range of products to help cope with any urine loss. Contact your local continence advisor for advice on appropriate products.

If you are concerned about any prostate or urinary symptoms talk to your doctor. There are also health professionals with special expertise in bladder control problems. Make sure you take part in making decisions about the diagnosis, treatment options, outcomes, risks, complications and costs.

Click here for information on prostate screening.

Original material provided by the New Zealand Continence Association. Edited by everybody, August 2005.