Urination Problems

A functional urinary system is required for several vital functions such as excretion of excess water and metabolites from the body, removal of toxins and maintenance of normal biochemical environment of the systems as a result of effective circulation. However, due to physiological aging, exposure to physical or environmental agents or due to several organic/ malignant illnesses, the integrity of urinary system may compromise.Following are some of the most frequently reported urination problems in males:

• Painful or burning micturition (pain while passing urine)
• Poor stream
• Incomplete voiding
• Higher frequency of micturition
• Passage of blood, pus or gas bubbles in the urine

What are some notable causes of Urination Problem?

Any organic lesion of the urogenital tract in males can present with one or more of the above-listed symptoms. Most common urinary disorders that are reported in clinical practice are:

1. Benign prostatic hyperplasia (BPH):

1. Male prostate gland secretes vital juices and enzymes to ensure the nourishment of sperms in the female genital tract after ejaculation. The gland encloses the major part of male urethra and is located beneath the urinary bladder.

BPH (also known as benign prostate hyperplasia to differentiate it from malignancy of prostate) is a disorder that is marked by abnormal growth of prostate cells. The resultant effect is, a moderate increase in the overall size of prostate gland. Due to anatomical location of the gland, even mild changes in size can lead to the compression of urethra; thereby leading to urination problems like:

• Poor urinary flow
• Difficulty in passing urine
• Feeling of incomplete voiding
• Poor stream

This disorder usually occurs at older age. In advanced cases, risk of complications increases significantly; such as painful urination, infection of urinary tract, urinary skepticism, persistent dribbling of urine or even inguinal hernia. The prevalence of BPH (after age adjustment) in general population is approximately 8% (1).

2. Urinary Tract Infection (UTI’S):

2. Presence of infectious agents in the urinary tract is referred to as the urinary tract infection. In most cases, urinary system is sterile (i.e. no bacterial/ viral agent is present); however, due to certain digestive or systemic ailments, pathogenic bacteria may gain access to the urinary system; presenting as painful urination, increase frequency or urgency of urination and lower abdominal/ flank pain.

Although the prevalence of UTI in younger males is fairly low when compared to adult females (30-times least likely); prevalence in elderly males is pretty high. Almost 10% elderly males harbor microorganisms/ bacteria in their urinary tracts (2). Most common cause of UTI in otherwise healthy males is Escherichia coli or E. coli. Additionally, many sexually transmitted infectious agents also presents with symptoms of UTI; these are gonorrhea, mycoplasma and chlamydia.Often times, the infectious agents may invade other parts of renal or urinary system; presenting as:

• Pyelonephritis - infection in Kidney
• Urethritis – infection in urethra
• Cystitis – infection in bladder

The best treatment for UTIs is antibiotics.

3. Bladder control problems (Urinary retention and incontinence):

An inability to void or empty out the bladder is referred to as the urinary retention. On the contrary, loss of bladder control is referred to as the urinary incontinence.Urinary retention and urinary incontinence are very frequently reported in elderly individual. Additionally, any major surgery, injury or neurological dysfunction can present with bladder control problems. The risk of complications is fairly high with acute urinary retention (such as uremia, septic shock, bladder injury, metabolic derangements etc.). Bladder control problems can be effectively managed with following interventions:

• Surgery
• Pelvic floor or kegel exercise that can add strength to bladder outlet.
• Give estrogen so that the lining of urogenital tract can be improved in females
• Behavior or bladder control.
• Collagen injections to help removing incontinence
• Certain medications that either increases bladder capacity or prohibit bladder from contracting much

The prevalence of urinary incontinence in adult males is approximately 17% which increases to 31% in males over 85 years of age (3)

4. Interstitial Cystitis\ Painful bladder syndrome (IC\PBI):

This condition is also referred to as the frequency-urgency-dysuria syndrome. Classic urination problems that are encountered in this syndrome are; painful urination, passage of blood in the urine, several abdominal or flank pain, high grade fever, urinary difficulty etc. The primary pathophysiology revolves around irritation or inflammation of bladder. In long standing cases, the bladder wall undergoes scarring and hardening of walls and formation of ulcers. Oral medications and bladder instillation are two recommended interventions for early restoration of bladder functions.

5. Prostatitis:

As the name suggests, inflammation of prostate gland is known as Prostatitis. Most common urination problems are; increase frequency of urination, feeling of discomfort or pain in the genital tract and lower back region, and complication and pain during urination. Usually antibiotics are used as the first-line of treatment, but alpha-blockers and muscles relaxants may be used if muscle spasm is significant. It is imperative to mention that 25% of all the male visits to the urinary clinics are due to prostatitis (4).Human urinary system is the biological cleaners of our body. Any obstruction (whether mechanical or neurological) or infection in the urinary tract can significantly impact the genital and reproductive systems as well (especially in males). It is highly recommended to maintain optimal urinary health by:

• Adopting a healthy lifestyle (such as intake of nutritious, balanced diet, regular exercise and weight management)
• Increasing daily water intake to allow your kidneys to flush out toxins
• Seeing a primary care physician at intervals for early identification and prompt management of organic illnesses.

References:

1. Stroup, S. P., Palazzi‐Churas, K., Kopp, R. P., & Parsons, J. K. (2012). Trends in adverse events of benign prostatic hyperplasia (BPH) in the USA, 1998 to 2008. BJU international, 109(1), 84-87.
2. Markland, A. D., Richter, H. E., Fwu, C. W., Eggers, P., & Kusek, J. W. (2011). Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. The Journal of urology, 186(2), 589-593.
3. Anger, J. T., Saigal, C. S., Stothers, L., Thom, D. H., Rodriguez, L. V., & Litwin, M. S. (2006). The prevalence of urinary incontinence among community dwelling men: results from the National Health and Nutrition Examination survey. The Journal of urology, 176(5), 2103-2108.
4. Hedelin, H., Johannisson, H., & Welin, L. (2013). Prevalence of the chronic prostatitis/chronic pelvic pain syndrome among 40-69-year-old men residing in a temperate climate. Scandinavian journal of urology, 47(5), 390-392.