Urine is produced by the kidneys, passes down to the bladder in the pelvic area behind the pubic bones, where it is stored. When the bladder feels full, at an appropriate time and place, a person can empty it completely.Bladder symptoms are common affecting about 40% of men over the age of 45 and increasing with further ageing.


Urinary Symptoms

FLOW SYMPTOMS:
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‍Slow to get started
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The first step in starting the flow is to relax the muscles under the bladder in the pelvic floor. Delay in starting is common with ageing, and with prostate problems, but it can also be due to shyness if voiding in a public toilet. This affects about 30% of men, who have no problems passing urine in private.Stream is weak. It may also stop and start and as the bladder empties the flow can slow down to just a trickle. This is called 'terminal dribble".•  

After-discharge of urine
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After the flow stops and the man has adjusted his clothes, a few more drops can come out and can cause an embarrassing wet patch on the trousers. This is due to urine pooling in the water pipe (urethra). It can be prevented by making sure there is nothing pressing on the urethra, like tight clothing or zips. The drips can be helped out by milking the water pipe using the fingers pressing from behind the scrotum bag and stripping any retained fluid out. Shaking the end of the penis also can help.
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Feeling of incomplete bladder emptying
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This symptom sometimes indicates the presence of residual urine, but is not always accurate at predicting this.

‍STORAGE SYMPTOMS OR OVERACTIVE BLADDER SYMPTOMS (OAB):
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Increased frequency of bladder emptying
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This refers to passing urine more often than usual in the daytime, and if there is also a need to get up at night, this is termed nocturia. Increased volumes of urine can be the cause. Drinking large volumes of fluid especially tea, coffee, chocolate drinks, or alcohol in the evenings, will mean a person has to empty the bladder more often. Cold weather makes the bladder more irritable. Diuretic medications like frusemide, prescribed for blood pressure or heart failure, can cause increased frequency. These tablets are best taken in the morning to allow time to get rid of the extra water in the body. Increased frequency can also arise simply because of an effect of ageing on the kidneys and bladder. An overactive bladder can be the cause.

Urgency alone or with urge incontinence
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This means the urgent desire to empty the bladder, which if not responded to promptly, might lead to leakage of urine before reaching the toilet. It can be very embarrassing. Often it is caused by an overactive or irritable bladder. This can happen with ageing, but also if the bladder outlet is restricted by the prostate. Nerve problems to the bladder can also cause it.
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Stress incontinence
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This refers to leakage on coughing, straining or any exertion, and is uncommon in men. It can occur if nerve damage has occurred due to spinal injury, or if the urethral muscles are damaged after a prostate operation. You should discuss this with your doctor and the urologist.
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Blood in the urine
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If you notice blood always see your doctor. There may be an important reason for it and you need to have it investigated promptly.

‍The Prostate Gland
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‍This is a male gland which produces a fluid to nourish the sperm. It sits at the base of the bladder, surrounding the urethra or water passage. It gradually enlarges as a man gets older and can then restrict the flow, partly because of its bulk, and partly because of an increase in specialised smooth muscle. When this muscle contracts it can further restrict the flow along the urethra. Other causes of reduction of the flow are ageing, and stricture or narrowing in the urethra lower down.
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Treatment
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‍If any of the symptoms listed in this brochure are bothersome to you, then you should see the doctor, or specialist continence advisor, who can arrange tests and treatment if appropriate.

After various tests, explanations and reassurance may be all that is needed to reduce the 'bother' being experienced.

Medication with tablets to relax the smooth muscle in the urethra or prostate, can be used for the symptoms when troublesome. Other tablets to reduce the bulk of the prostate gland have been tried but are not commonly used in New Zealand.

If not successful then an operation to re-bore the prostate may be advised. The success in improving symptoms, is around 80-90%.For leakage you should see your doctor or continence advisor nurse or physiotherapist. You do not have to put up with leaking.

Usually the overactive bladder symptoms can be treated by special bladder training programs, by pelvic floor muscle exercises, and by tablets to reduce the bladder irritability. You may need to be referred to a urologist for further advice.

How to seek help
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Visit the web-site www.continence.org.nz
Continence helpline 0800 650 659

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