Understanding Urinary Problems and Symptoms

This feature appeared in the Health Matters column in the Grimsby Telegraph in April 2011

Welcome from Donna Read, Hospital Director at St Hugh’s

St Hugh’s is  Grimsby’s very own private, independent hospital, providing a wide range of surgical operations carried out by a team of very well qualified local surgeons. We pride ourselves on our MRSA free environment.  Every month, the Health Matters column features a different treatment or procedure offered at the hospital. This month’s health feature is Understanding Urinary Problems and Symptoms, written by our consultant urologist Mr Jorge Clavijo.

Understanding Urinary Problems and Symptoms

Urinary symptoms are one of the most frequent problems in the over 50s. They are particularly bothersome in males. By far, most are related to prostate enlargement. The prostate is doughnut shaped and the size of a golf ball. It lies at the base of the bladder and the urethra (water-pipe) exits the bladder through the central hole. It produces sperm fluid. When it grows inwards, it narrows the water pipe thereby increasing the resistance to urine outflow. The flow becomes weaker, interrupted, and the bladder does not empty completely. The bladder wall must generate more pressure to pass urine, so the muscle in the bladder wall thickens, this in turn reduces the capacity of the bladder to stretch out and store urine, resulting in particularly disturbing frequency and urgency to void.

When these symptoms are present, they must be assessed adequately. This includes testing the urine to rule out infection and completing a standardized voiding diary and symptom score (IPSS). The prostate is examined during the rectal examination for size, shape, consistency and smoothness. Additionally, blood tests, a flow rate and post void bladder scan measurements can be used to decide on management.

The best management of these symptoms will depend on multiple factors, including their severity, associated health problems, other medications, age, and expectations. Off-the-shelf solutions are ill suited, and treatment has to be tailored to each patient and revised periodically. In most cases, lifestyle changes, including timing of fluid, intake will be beneficial. Medications include alpha-blockers that tend to improve flow (tamsulosin, alfuzosin) and 5 alpha-reductase-inhibitors that tend to prevent further prostate growth and complications (dutasteride, finasteride). However, the most effective management is surgical, and an endoscopic prostate resection remains by large the gold standard treatment of symptoms due to an obstructive enlarged prostate. Other minimally invasive surgical treatments are also available for men unfit for a resection. As with anything in health, any treatment may have side effects.

The elephant in the room. By now many of you may be waiting for me to talk about prostate cancer. Prostate cancer is the most frequent solid cancer and the second leading cause of cancer deaths (in males). PSA is a simple and inexpensive blood test that measures the risk of prostate cancer. Even though it is the most reliable of available tumour markers (1 in 3 men with abnormal PSA for his age has prostate cancer) it can be elevated for non-cancer reasons. Expert advice is needed in these circumstances.

In females urinary incontinence presents as related to increased abdominal pressure activities such as coughing, lifting weights, laughing or doing physical exercise, or to urgency (the immediate need to empty the bladder). Both conditions benefit to a certain extent by lifestyle changes. Medications are also available and are usually needed permanently. Alternatively or if the above are not effective, scar-less, day case surgical interventions provide continence in more than 90% of ladies.

Urinary symptoms are common; they impair quality of life and can be an early manifestation of a serious underlying condition.

Help is at hand at St Hugh’s Hospital, Grimsby.

Tel: 01472 251100