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Difficulty With Urination Could be From THIS

Difficulty with urination may be due to bladder and kidney problems but in elderly men, it is a sign of prostate problems. Although the prostate is a small organ, its growth is accelerated as men age. Because it is located along the urinary pathway, it affects the passage of urine. This article discusses the causes of urinary difficulties especially the three prostate problems that are known to block the flow of urine and cause the painful, stinging sensation that some experience while urinating.
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Some people, especially elderly men, find it difficult to urinate as they age. Although this condition can also be observed in young people, the occurrence is less common in this age group.

Difficulty with urination, also known as dysuria, is often painful and it is as sign of urethral obstruction.

Depending on how severe the condition is, it can be tolerable in some men while other men may experience complete inability to urinate.

Other feelings associated with difficulty with urination include burning and stinging sensations when trying to pass urine. In addition, little or no urine may be released even when the bladder is still full. Therefore, those who have difficulty urinating also have frequent urges to urinate.

Furthermore, due to the incessant urge to pass urine during the night (known as nocturia or nycturia), this condition may also cause sleep problems.

Although difficulty with urination occurs in both sexes, the causes and presentations are often different in men and women. For example, the causes of difficult urination in women are usually from urinary tract infections and STDs while prostate problems are the primary causative factors in men.

Why Do I Have Difficulty Urinating?

Most cases of difficult urination occur due to urinary retention. This is where it becomes difficult to empty the bladder, typically caused by something blocking the urethra tube. Men are more commonly affected by this than women because as many men age, their prostates gradually grow, preventing the bladder from emptying as effectively. Women can suffer from urinary retention as well, particularly during pregnancy, but it is not as common.

Causes of difficulty urinating include obstructions in the urinary tract, such as enlarged prostate, bladder stones, infections, nerve problems, constipation, weak bladder muscles, and medications.

In severe cases, difficulty urinating can be life-threatening. If you physically cannot urinate, visit an emergency room as soon as possible to get the issue resolved.

Far more common is chronic difficulty urinating, where it is harder, but not impossible, to empty the bladder completely. Symptoms of this problem are difficulty starting to urinate, weak urine flow, needing to use the restroom frequently, waking up at night to use the restroom, or feeling like you need to go after you've finished urinating (when not caused by a bladder infection).

Individuals who cannot fully empty their bladders can have side effects including urinary tract infections, bladder damage, and even chronic kidney disease.

How Does the Urinary Tract Work?

The urinary tract is the body's way of removing waste and extra fluid from the body. A healthy person has a urinary tract that functions properly and in the correct order. Your urinary tract consists of the following parts:

The kidneys are located below the rib cage on either side of the spine. Your kidneys filter about 120 to 150 quarter of blood, which results in about 1 or two quarts of urine per day.

The ureters are thin tubes of muscle that carry liquid from the kidneys to the bladder. You have one ureter per kidney.

The bladder is located between the pelvic bones and is a balloon-shaped organ that expands as it fills. Children and adults control when their bladder empties, for the most part. Am adult bladder can hold up to two cups of urine at time. When the bladder fills, it sends signals to the brain that it needs to be emptied. Urine exits the bladder through the urethra.

Three sets of muscles hold urine inside the bladder. The urethra has a set of muscles that contract to hold urine in place. Your body also uses pelvic floor muscles to keep the urethra closed from the outside. Childbirth makes the pelvic floor muscles weaker, which is why many women have difficulty retaining urine. When these muscles relax, urine exits the bladder.

Trouble occurs when the organs and tissues surrounding the bladder grow beyond their normal size. This can block normal urine flow and cause difficulty urinating. 

Urinary Problems and the Prostate

The urinary system is closely tied to the prostate gland in men. The prostate gland is a walnut-sized secretory gland located just below the urinary bladder. The main function of this male reproductive organ is to secrete a white acidic fluid which forms a large percentage of the semen.

From the urinary bladder, a thin tube (prostatic urethra) runs through the prostate in a way that it appears to form a protection around the urethra. The urethra then leads to the opening at the tip of the penis.

Through some complex excretory processes, urine is formed from the kidneys and stored in the bladder. Some chemical and electrical transmissions then signal the urge to urinate when the stored urine reaches a certain level in the bladder.

During urination, urine passes through the urethra in the prostate region (prostatic urethra) and eventually leaves the body through the penis.

Therefore, any changes in the structure of the prostate will also affect the proper functioning of the prostatic urethra and thus affect the flow of urine in this tube.

Most cases of prostate problems are as a result of an enlargement of the organ.

When the prostate enlarges, it presses upon the prostatic urethra, constricting it and choking the passage of urine. This is what happens when men experience difficult, painful urination.

Naturally, like most of the other body organs, the prostate grows with age. But, unlike other body parts as well, the prostate grows in a very different manner. For example, prostate growth appears to be slow and dormant through late puberty while it begins an active growth at about the age of 40.

In most men, difficulty with urination is usually observed from this age and it does get worse from then on. At the age of 70, the prostate is known to grow to as much as an average weight of 40 g.

There are a few causes of prostate enlargement that, by extension, leads to difficulty with urination. Some of the known causes are discussed below.

Benign Prostatic Hyperplasia (BPH)

BPH is a benign enlargement of the prostate. It occurs when the cells (stroma and epithelial cells) of the prostate tissue increase in number. This consequently leads to large tissue lumps being formed in the periurethral region of the prostate.

The lumps are sometimes large enough to partially (and, in extreme cases, completely) block the urethra which runs through the prostate. As a result, the normal flow of urine is impeded and urination becomes difficult.

When there is difficulty with urination, trying to force out the urine often triggers the painful, burning and stinging sensations reported by the men affected.

BPH occurs in a very large percentage of men especially as they age. As much as a quarter of all men at 50 years of age will develop clinically significant BPH while the percentage and incidence will only increase from that age on. This is the reason why many elderly men find it very difficult to urinate.

The primary cause of BPH has been linked to the action of dihydrotestosterone (DHT), a metabolite of the male steroid hormone, testosterone. The female sex hormone, estrogen, has also been identified as a causative factor while various foods including trans fats and refined carbohydrates are also known to trigger BPH in older men.

The symptoms of BPH are usually classified as either storage or voiding.

Symptoms of BPH

Storage Urinary Symptoms

  • Increased urinary frequency
  • Incessant urge to urinate that cannot be delayed
  • Urgency incontinence
  • Pains when urinating
  • Nocturia

Voiding Urinary Symptoms

  • Hesitancy of urinary stream
  • Irregular or interrupted stream (intermittency)
  • Straining to void
  • Dribbling of the urine stream

If left untreated, BPH can cause other medical complications such as bladder stones, bladder hypertonia and urinary tract infections, all of which will further worsen the difficulty experienced with urination.

In extreme cases, the prostate can get so large that invasive surgeries would be required to cut out the part of the prostate blocking the urethra thereby creating a free passage for urine.

However, less invasive procedures are being adopted to widen the urethra or destroy a targeted portion of the prostate that is obstructing the flow of urine.

In addition, there are available BPH medications and natural supplements that can help shrink the size of enlarged prostates by different mechanisms including the inhibition of DHT action on the organ. These medications and natural remedies can effectively stop the enlargement of the prostate and, therefore, make the passage and flow of urine easier.

Prostate Cancer

Prostate cancer is another form of prostate enlargement that can lead to difficulty with urination.

It also occurs when cells in the prostate increase in number but, unlike BPH, the cell growth becomes uncontrollable and cancerous.

Although the increase in prostatic cells is usually benign in most men, some cases of these normal prostatic growths can turn malignant. Therefore, regular monitoring of the prostates of men suffering from BPH is advised in order to quickly detect any form of malignant growth.

In prostate cancer, the prostate can also become sufficiently large to press against the urethra and obstruct the flow of urine.

Prostate cancer and BPH show identical symptoms which include many urinary problems. During the early stages of prostate cancer in men, very few to no symptoms may be observed. However, as the condition progresses, urinary symptoms such as painful urination, straining during urination, nocturia, blood in urine and general difficulty with urination are all observed.

Because the vas deferens (a tube that transports seminal fluids) extends into the urethra in the prostate region, prostate cancer can also result in a number of complications with sexual functions.

Like BPH, men above the age of 45 are usually at risk of prostate cancer while it is less common in men below this age. The risk of the condition is also believed to increase with age.

Other risk factors of prostate cancer include obesity, diet, high blood pressure and family history.

Early detection of prostate cancer can go a long way in reducing its spread and preventing other complications from the condition. Usually, a high PSA (prostate-specific antigen) level in the serum is believed to indicate the presence of prostate cancer but this method is not a conclusive test.

The only confirmatory test that can detect the presence of prostate cancer is through the microscopic examination of a small piece of prostate tissue obtained from the body in a process known as biopsy.

After diagnosing prostate cancer, the various treatment options can then be considered. Not all cases of prostate cancer, however, require treatment. Low-grade forms of prostate cancer, for example, do not require treatment because it grows very slowly.

Treatment therapies for prostate cancer include: radiation therapy, radical prostatectomy, hormonal therapy, chemotherapy and oral chemotherapeutic medications.

Only by treating the cancer, the root problem, can the difficulty with urination be resolved.

Prostatitis

Prostatitis is the enlargement of the prostate gland caused by the inflammation of the tissue of the prostate gland.

Unlike the other forms of prostate enlargement that are caused by an increase in the population of prostatic cells, inflammation of the prostate is more or less a form of swelling. However, both the swelling and prostate cell overgrowth cause the enlargement of the prostate and block the easy movement of urine in the prostatic urethra.

There are different forms of prostatitis depending on the causative factors and symptoms. However, all the different forms of prostatitis result in urinary problems but the severity of the symptoms may differ.

Like some other forms of inflammation, prostatitis may result as a normal immune response to infections but it has also been known to occur in the absence of an infection.

Chronic prostatitis for instance is not caused by bacteria but is triggered by factors which include immune dysfunction, stress, neurological disorders and hormone problems. Acute prostatitis on the other hand is a bacterial infection of the prostate gland.

Treatment of prostatitis involves the use of antibiotics in the case of prostatitis caused by bacteria infections while medications such as NSAIDs and alpha blockers (also used for BPH) are considered for non-bacterial forms of prostate inflammation.

Other Causes of Urinary Difficulties

Other factors that can result in difficult urination in men include kidney stones, chlamydia, cystitis, bladder stones, atrophy, and congestion of the kidneys.

It is unclear in certain circumstances if some of these health conditions are a direct cause of urinary problems. In some cases, it has been discovered that enlargement of the prostate and the associated difficulty with urination can result in some of these health problems.

Therefore, medical conditions such as bladder stones, atrophy and hydronephrosis that are related to urinary difficulties may be complications of prostate problems rather than the main causative factors of difficulty with urination.

Some of the most common causes of urinary retention include:

  • obstruction of the urethra
  • nerve problems
  • medications
  • weakened bladder muscles


Obstruction of the Urethra


Obstruction can be caused by more than just BPH. For example, tumors, urinary tract stones, urethral stricture, and cystocele can also cause obstructions.
 
Urethral stricture
Urethral stricture is a closure or narrowing of the urethra. Typically, scar tissue and inflammation causes this problem. Frequent UTIs can also cause this chronic narrowing of the urethra. Men have longer urethras than women, which means that men are more likely than women to have urethra problems. Women, on the other hand, are more likely to have problems with the muscles supporting the urethra. When the external muscles do not relax properly, women can have urinary retention problems.

Urinary tract stones
Urinary tract stones are similar to kidney stones. These stones develop from crystals that form in urine and stick to the walls of the kidneys, urinary tract, or bladder. These stones can block some or all of the opening to the urethra, making urination difficult.

Cystocele
Cystocele is a condition that only affects women that has similar effects to BPH. This is when the muscles between a woman's bladder and vagina weaken, which causes the bladder to sink nearer the vagina. This causes the bladder to narrow the urethra, making it harder to fully empty the bladder.
Constipation
Constipation can cause trouble in the bladder as well. A person with hard, dry stools will have an enlarged colon, which pushes against the bladder. Easing constipation symptoms will also make urination easier.

Nerve Problems


Nerve problems can make it difficult to urinate. Common nerve triggers include:

  • Diabetes
  • Brain and spinal injuries and infections
  • Stroke
  • Multiple sclerosis
  • Pelvic injuries
  • Metal poisoning
  • Injuries to the scrotum or penis

Medications


Some medications can also cause difficulty urinating. These medications include:

antihistamines

  • cetirizine (Zyrtec)
  • chlorpheniramine (Chlor-Trimeton)
  • diphenhydramine (Benadryl)
  • fexofenadine (Allegra)

decongestants

  • ephedrine
  • phenylephrine
  • pseudoephedrine
  • nifedipine (Procardia)
  • carbamazepine (Tegretol)
  • cyclobenzaprine (Flexeril)
  • diazepam (Valium)

nonsteroidal anti-inflammatory drugs
amphetamines
opioid analgesics

tricyclic antidepressants

  • amitriptyline (Elavil)
  • doxepin (Adapin)
  • imipramine (Tofranil)
  • nortriptyline (Pamelor)
  •  

anticholinergics/antispasmodics

 

  • hyoscyamine (Levbid)
  • oxybutynin (Ditropan)
  • propantheline (Pro-Banthine)
  • tolterodine (Detrol)

 

Difficulty Urinating Can be Stopped

If you have trouble urinating, there are remedies that can resolve the problem and make urination easier. Multiple herbal remedies have been credited with the ability to reduce BPH and make urination easier. These remedies improve urinary flow and boost the function of the bladder to make urination easier and prevent the continued growth of the prostate. If your urination problems are caused by BPH, the right supplements can make a difference.


Sources


http://www.rightdiagnosis.com/sym/urinary_difficulty.htm

http://www.freemd.com/difficulty-urinating/overview.htm

http://www.bladderandbowelfoundation.org/bladder/bladder-problems/urinary-retention.asp

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