As men get older, most of them will develop an enlarged prostate, a condition known as Benign Prostatic Hyperplasia or BPH. “Benign” means that it is not cancerous, and “hyperplasia” means excess growth. BPH is so common that a 50-year-old man has more than a 50% chance of developing symptoms; this increases to over 90% in men older than 80 years. BPH is not normally a life threatening condition but symptoms can impact significantly on your quality of life. If severe and left untreated for a prolonged period of time, it could cause very serious problems with the function of the bladder, and, less commonly, the kidneys.
For those with BPH, the enlarged prostate squeezes the urethra (the tube where urine exits the bladder) tighter than normal, like a clamp around a hose, and begins to block the flow of urine from the bladder. When this occurs, the bladder becomes thicker and stronger, and must work harder to push the urine past the obstruction. The urethra may eventually become so narrow that the bladder is unable to empty completely, allowing urine to remain in the bladder. At this stage the bladder will fill up again that much sooner, causing more frequent urination. When this problems worsens, it is sometimes known as “prostatism” or lower urinary tract symptoms “LUTS”. Someone suffering from this problem will notice:
- a weak, hesitant urine stream
- a need to strain when urinating
- a sense that the bladder is not empty
- dribbling or leaking after urination
- an inability to completely empty the bladder
- frequent urination, including several times during the night
Occasionally, an enlarged prostate may bleed a little bit into the urine. This is known as “hematuria” and is usually painless. It happens because small, fragile blood vessels on the surface of the prostate stretch and rupture, usually due to the pressure caused when urinating or having a bowel movement. Sometimes a blood vessel may break as the result of heaving lifting or crouching. In most cases the amount of blood is so small that it can only be seen under a microscope. It is rare for anyone to lose a significant amount of blood from a small vessel on the prostate gland.
Enlarged prostates are not the only condition that may causes blood to be present in the urine. Other more serious conditions such as bladder or kidney cancer commonly cause bleeding. Any man who sees blood in his urine should see his doctor immediately and ask to be referred to a urologist to rule out more serious possibilities before assuming that “it’s nothing” or “it’s just my prostate”.
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