Urinary Incontinence After Prostate Surgery: Everything You Need To Know

Incontinence After Prostate Surgery

Undergoing a prostatectomy (removal of the prostate due to cancer) can be difficult. And for many men, finding that they are incontinent post surgery may come as a shock.

But rest assured that there are many treatments available to manage incontinence treatment after surgery. Read below for some of the most common questions we receive about incontinence after prostate surgery.  

What causes incontinence after prostate surgery?

Urinary incontinence is a potential side effect of prostate removal surgery. The prostate surrounds the bladder. Removing it, or using radiation to treat it, can sometimes cause damage to the nerves and muscles of the bladder, urethra, and or sphincter, which controls the passage of urine from the bladder. This can result in urinary incontinence.

Is Incontinence Normal After Prostate Surgery?

Approximately 6-8 percent of men who have had surgery to remove their prostate will develop urinary incontinence. (Cleveland Clinic) The good news is that most men will eventually regain bladder control with time.

How bad is incontinence after prostate surgery?

The degree of incontinence varies from person to person and can be anywhere from full on incontinence, to light dribbles. And, the amount you leak right after surgery will likely lessen as you continue with your recovery and any additional bladder or pelvic floor treatments you may be doing.  

How long will I have incontinence after prostate surgery?

Most men who experience a loss of bladder control have symptoms for 6 months to 1 year post prostate surgery. However, a small percentage of men may continue to experience problems past the one year mark.

Does incontinence go away on its own after prostate surgery?

For most men, urinary incontinence will go away within about 1 year. Performing pelvic floor exercises, also known as kegels, which help strengthen the muscles that are located in the base of the pelvis between the pubic bone may help to speed the recovery process along.

Does incontinence happen if I treat prostate cancer with radiation?

Some men need radiation therapy after prostate removal. During radiation therapy, some of the normal tissues around the urinary sphincter, urethra and bladder may be exposed, causing irritation to occur post therapy, leading to incontinence. This typically subsides within a few months after radiation therapy, however if it persists, additional treatments described below may be helpful.

How can I improve incontinence after prostate surgery?

Want to stop incontinence after prostate surgery? Kegels may be your answer! As mentioned above, kegels are a common treatment option for incontinence after prostate surgery.  Among other things, the pelvic floor muscles help control bladder and bowel function and, like other muscles of the body, if they get weak they are no longer able to do their job effectively.  To improve muscle function, kegels must be done regularly, every day. The good news is that they can be performed pretty much anywhere, anytime, and in a variety of positions (sitting, standing, lying down, etc.). For a complete guide on performing a men’s kegel, click here.)

Biofeedback can sometimes be used to determine if you are performing a kegel properly. And, electrical stimulation may also be used to help re-teach the muscles to contract.

What treatments are available to me if my incontinence doesn’t go away after a year?

While kegels and behavioral therapy work well for most men with mild to moderate leaking, they may not be completely effective for some. Luckily, there are still some options for treating bladder leakage after prostate surgery.

Another surgery is sometimes needed when bladder leaks persist for more than a year after surgery. This may consist of having a urethral sling procedure, or an artificial urinary sphincter.

With a urethral sling procedure, a synthetic mesh tape is implanted to support the urethra. Up to an 80% improvement has been seen with this procedure and some men stop leaking completely.

An artificial urinary sphincter is used in patients who have more severe urinary incontinence that is not improving, or for those patients who may have had a lot of damage to the sphincter muscle after prostate surgery. An artificial urinary sphincter is a mechanical ring that helps close the exit from the bladder.

As will all surgeries, these come with pros and cons and potential complications. Be sure to discuss these options with your doctor. 

Incontinence after prostate surgery forums.

Going through prostate cancer and having your prostate removed can be a physically and emotionally trying time in life. Many men are unprepared for the extent to which they may experience bladder leaks after prostate removal and it can be disheartening to have undergone surgery only to experience a loss of bladder control for a period afterward.

Fortunately, this is usually resolved within a year. During that time though, you may find that you need someone to talk to about your experience. Finding a forum or message board filled with people who can relate can help ease some of the tensions that you may be going through. 

The NAFC message boards are a great way to connect with others who may also be experiencing incontinence, due to prostate surgery or other conditions.  They’re free to join and the forum is anonymous so you can speak freely without the worry of feeling embarrassed or ashamed. NAFC is proud of this amazing group of individuals who visit the forums and courageously share their stories, offer support, and provide inspiration to each other. We encourage you to check it out!

What To Do About An Enlarged Prostate?

What To Do About An Enlarged Prostate

Enlarged prostates are common as you age. Men aged 60 and older have a 50/50 chance of having an enlarged prostate and those who are 85 have a 90% chance. Those may be scary stats, but what exactly does having an enlarged prostate mean? Is it something to worry about? And if so, what are the treatment options? Keep reading to learn more about this very common condition and what it may mean for you.

Anatomy Review – function of the prostate

The main function of the prostate glad is to serve as a reproductive organ. It is responsible for producing prostate fluid, which is one of the main components of semen. The prostate gland muscles also help to transport semen into the urethra during ejaculation.  

The prostate gland sits just below the bladder, where the bladder and urethra (the tube that inside the penis that carries urine and semen out of the body) connect. In early life, it’s about the size and shape of a chestnut, and grows to different sizes throughout a man’s life. 

What causes the prostate to get enlarged?

As men age, the prostate gland grows. It’s estimated than as many as 17 million men have an enlarged prostate, or symptoms of Benign Prostate Hyperplasia (BPH). While it’s unclear why the prostate begins to grow, its thought that an excess of certain hormones may be to blame.

Symptoms of an enlarged prostate include the following:

  • A weak or interrupted urinary stream

  • The sudden urgency to urinate

  • Frequent urination

  • An inability to empty the bladder during urination

  • Trouble initiating urine flow, even when you feel like your bladder is full.

Should I worry? 

Even if your prostate becomes enlarged, it may never become an issue for you. The problems start when the prostate begins to constrict or block the urethra. This can compromise the bladder’s ability to effectively empty, causing chronic retention of urine. And, because the bladder still continues to send signals that it needs to empty, urgency and frequency can occur (this is also known as overactive bladder).  If left for too long, the bladder may become distended, making it even harder for it to empty completely. 

For these reasons, it’s important to see your doctor right away if you start experiencing any of the symptoms listed above. Additionally, the symptoms of an enlarged prostate can also mimic those of other conditions, such as bladder cancer or overactive bladder. Your doctor will be able to help diagnose your condition to determine an appropriate treatment.

What’s the treatment for an enlarged prostate?

There are many treatment options for enlarged prostate, depending on your symptoms.

Active surveillance, or “watchful waiting” is a term used to describe the act of monitoring your condition regularly for any changes. This approach is often used for men whose symptoms are mild and not too bothersome. 

There are several medications that are approved for BPH, but most of them fall into two categories: Alpha blockers and inhibitors. Both are effective at treating BPH and sometimes are even prescribed in combination with each other.  

Non-invasive treatment options include things like laser therapy, which decreases the size of the prostate by removing some of the tissue, or laser vaporization, which enlarges the prostate obstruction and opens the urethra.  Transurethral microwave therapy or transurethral needle ablation are other non-invasive treatment options that destroy excess prostate tissue that is causing blockage.

Finally, surgery is also commonly used to help relieve symptoms of an enlarged prostate. The most common form of surgery is transurethral resection of the prostate, or TURP. This surgery requires no incisions, relying instead on a surgical instrument inserted through the tip of your penis and the urethra. Using this tool, the doctor is able to trim excess prostate tissue that may be preventing the flow of urine. 

Other less common surgeries are also used to both trim excess tissue from the prostate, or to decrease pressure on the urethra in order to make urinating easier. You can read more about additional surgical options here.

What Causes Incontinence In Men

What Causes Incontinence In Men?

Bladder leaks can happen to anyone at any age. While we’ve been conditioned to think that mostly older women are affected by the condition, many men suffer from incontinence too. 

There are many conditions that can lead to urinary incontinence in men. But luckily there are also many ways to treat it. Keep reading to learn some of the reasons men develop leaky bladders, how it’s diagnosed, and ways to treat it.

What is urinary incontinence?

Urinary incontinence is the accidental leakage of urine. Many people wrongly assume that developing urinary incontinence is something that just happens as you age. This couldn’t be further from the truth. It can develop in anyone, at anytime. And there are several possible causes for it.

First, let’s start off with learning a bit about how everything works.

The urinary system is composed of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The muscular, tube-like ureters move urine from the kidneys to the bladder, where it is stored until it flows out of the body through the urethra. A circular muscle, called the sphincter, controls the activity of the urethra and keeps urine in the bladder until it is time to urinate.

Normally, the bladder wall is relaxed while storing (or filling with) urine and the urethra is closed off by the sphincter. Your pelvic floor muscles also help keep the bladder outlet closed by supporting the urethra.

When the bladder is working correctly, the bladder sends signals to the brain to let you know how full it is, and to the sphincter to tell it to stay closed and prevent the bladder muscle from contracting.

When the bladder is full, you allow the pelvic floor as well as muscles at the outlet of the bladder to relax and open up. As this is happening, the muscle in the wall of the bladder (detrusor muscle) begins to contract and continues contracting until the bladder is completely emptied.

This process of bladder filling and emptying is obviously very complex. When any part of the urinary system or pelvic floor does not work correctly, incontinence can result.

If any of these signals don’t happen or get confused, bladder leakage can happen. 

What causes urinary incontinence in men?

Many things may contribute to bladder leakage in men.

The most common reason men experience incontinence is due to problems with the prostate. As men age, the prostate gland grows. It is estimated that 17 million men have an enlarged prostate, or symptoms of Benign Prostate Hyperplasia (BPH). The prostate gland wraps around the urethra (the bladder outlet), so an enlarged prostate can constrict or block the urethra. This is known as prostatic obstruction.

Prostatic obstruction can compromise the bladder’s ability to effectively empty, causing chronic retention of urine. This contributes to urgency and frequency because the bladder still signals that it needs emptying. If left untreated, the bladder can become distended, worsening its ability to contract and completely empty. It is possible to have prostatic obstruction even if the prostate is not enlarged.

Men may also experience Overactive Bladder (OAB) which is characterized by a sudden and urgent need to urinate, and needing to urinate frequently. This becomes urgency urinary incontinence when you are not able to reach the bathroom before losing control of the bladder.

Additionally, conditions that cause damage to the nerves, such as diabetes can cause bladder problems since it disrupts the normal signaling from the bladder to the brain to help control bladder function. Other conditions, such as stroke, can also cause incontinence, and even some medications or certain foods or drinks can contribute to urinary incontinence. 

How is urinary incontinence in men diagnosed? 

Before your appointment, take note of your symptoms so that you can relay them to your doctor. Symptoms of incontinence to look for are:

  • Diminished or interrupted urine flow

  • An urgent or sudden need to urinate

  • Increased frequency of urination

  • Inability to empty the bladder completely when urinating

  • Difficulty starting the urine flow, even when the bladder feels full

  • Getting up more than once per night to urinate (nocturia)

  • Accidental urine leakage

Talking to your doctor is the first step toward treatment.  At your appointment, your doctor will likely ask for your medical history, give you a complete physical examination, and provide a urine specimen. You may be asked to keep a bladder diary to record your symptoms.  Other tests to examine the bladder and/or prostate may also be necessary. 

Once your doctor has diagnosed your bladder condition, you can work together to decide on a treatment option that best fits your needs and works with your lifestyle.

What treatment options exist for men with urinary incontinence?

The good news is that there are lots of treatments available to men with urinary incontinence.  Your treatment path will depend on what is causing your condition.

For men with an enlarged prostate, your doctor may recommend medications to reduce symptoms and reduce the size of the prostate. Minimally invasive treatments, or even surgery is sometimes done to increase the flow of urine.  

Men with OAB may also be prescribed medications to help calm the bladder.  In cases where medication is not an option or isn’t working, minimally invasive treatments such as InterStim may be used.  This is an implanted device that helps to establish more normal function of the bladder by gently stimulating the sacral nerve. Behavioral modifications can also help with OAB. Changes in your diet, bladder training, and pelvic floor muscles are often used to help control urinary incontinence caused by OAB.

Many men also experience incontinence after prostate cancer surgery. When the prostate gland is removed, damage may occur to nerves, tissues, and the sphincter muscle that can impair the bladder's ability to store urine without leaking. This may last for just a few months during recovery, or longer. Depending on the severity of incontinence, there are several options that may help.  

Performing pelvic muscle exercises (kegels) are an important part of treating incontinence in men. Kegel exercise done before and after surgery can help to recover bladder control and are important for maintaining erectile function.  When done correctly, kegels can strengthen the muscles that support the bladder, causing fewer leaks, and improving bladder and bowel control. (Click here for a men’s guide to doing kegels.)

 If additional help is needed, other surgical options may be available. Your doctor can talk about the pros and cons of the various surgical options available.

Seeking Help Is The First Step

If you’re struggling with urinary incontinence, the most important thing to remember is that help is available. It’s not just a women’s issue – MANY men live with this condition too and there is no need to suffer in silence.  Talk with your doctor to learn the root cause of your bladder leakage and to find a treatment that works for you. 

Patient Perspective: Brad's Story

Brad's Story - Opening Up About Incontinence

My friends and I are close. Growing up in a small town, we’ve always been there for each other – to joke with, lean on in hard times, and to razz each other. We have a tight-knit group of 5 and they’ve been my chosen family since I was 12. It’s hard to believe so much time has passed since our early days, but here we all are.

I experienced incontinence after having my prostate removed in 2013. It wasn’t a fun thing to go through, and I certainly didn’t enjoy it, but the one thing that made it easier was that I knew to expect it – and that I wasn’t the only one.

You see, one of my buddies in our group, Joe, had also gone through something similar a few years back. He pulled me aside before surgery and told me that the worst thing that was going to happen was that I’d probably have some leaks – maybe a lot. It had happened to him for at least a year after his surgery and he said it was “hell “.

But he told me that the thing that had made it worse was not knowing it was coming, That was why he was talking to me – he wanted to me to know that I wasn’t alone. And, if it weren’t for his advice and pick-me-up talks, I don’t know how I would have gotten through that first year.

I’ve recovered well and don’t really experience the leaks anymore. But I still talk about it. Because that’s what we should all do with those we are close to. You never know who might benefit from your experience, or who might also go through something similar and just need a friend or to know they are not alone.

Don’t let your own embarrassment get in the way of opening up to your loved ones. I’m sure glad Joe didn’t.
 
Brad T., Auburn, AL

Patient Perspective: Nick's Story

Nick's Story - Incontinence After Prostate Removal

In August of 2015, I underwent surgery to have my prostate removed.  I had been diagnosed with prostate cancer the year before and my doctor had been closely observing me since then. 

When it seemed that my cancer was growing more quickly than he liked, he suggested surgery.  “Afterall”, he said, “you’re only 63.  You can still have a long life without worrying about this.”

So, after a lot of research, I went for it.  I knew there would be complications afterward, but incontinence was not something that I had anticipated being that big of a deal.  I thought I’d probably have to wear diapers for a couple of weeks and that would be the end of it. 

Boy was I wrong. 

Nine months later and I was still having a difficult time making it to the restroom.  It was so embarrassing as a man to face this problem. I couldn’t do the things I wanted to because I was scared of having an accident or a leak, and I felt ashamed of the bulky diapers that I was forced to constantly wear. 

I finally made an appointment with a surgeon in May to discuss a sling procedure and will be having the procedure done next month.  I’m hopeful that this will be a solution for me so that I can get on with my life and get back to doing the things that are important to me. 

Nick W., Houston, TX

Your Guide To The New Prostate Screening Guidelines

Prostate Cancer Screening Guidelines

The new guidelines on prostate cancer screening have left some men wondering what they should do. Here’s a quick breakdown on what the US Preventative Services Task Force recommends.

Prostate cancer is the 3rd leading cause of cancer death in men in the US, with about 1 in seven men being diagnosed in their lifetime.   You may have recently heard the news that, despite previous cautions against getting screened for prostate cancer, new recommendations from the US Preventative Services Task Force are now recommending that men ages 55 to 69 at least have a discussion about prostate-specific antigen (PSA)-based screening, including the risks that go along with it.  So, what’s the deal? Will the test help or hurt you?

It depends. Back in 2012, the USPSTF recommended no routine screening at any age, because of the potential harm that could result after testing, including:

  • False Positives: A fair amount of PSA testing has suggested that prostate cancer may be present when there is in fact no cancer. Elevated PSA levels can be caused by many other things that don’t have anything to do with cancer. This can lead to worry and anxiety, and follow up tests that may not be needed.
  • Risk of infection with additional tests. In order to dig deeper after a PSA test, follow-up tests are done, which can potentially cause complications (fever, infection, bleeding, urinary problems, and pain).
  • Even if prostate cancer is diagnosed correctly, it sometimes never causes a problem for men. However, it’s difficult to tell what cancers will, or won’t be an issue later on, so most of the time, aggressive treatment is performed.
  • Treatment for prostate cancer can lead to other side effects, including erectile dysfunction, or urinary or fecal incontinence.

Due to these potential risks, the USPSTF recommended against screening men, since the benefits of screening really didn’t really outweigh the expected harm that could result. What has changed? 

The US Preventative Services Task Force now recommends that men ages 55 to 69 years of age should talk with their doctor about the potential benefits and harms of PSA screening for prostate cancer, and should make individualized decisions on how to proceed. This decision was made after determining that the potential benefits and harms of PSA tests are closely balanced in men ages 55 to 69. However, men over 70 are still recommended to not receive PSA screening.

Really, what all this boils down to is you. No longer should you just ignore the test if you are within the 55-69 age range. After all – it has been shown that of 1,000 men screened, testing may prevent up to 1 to 2 deaths from prostate cancer and up to 3 cases of metastatic prostate cancer over the course of 13 years.

But, you should weigh your options. Have an open dialogue with your doctor about your specific risks – your background and health history, your lifestyle, your healthcare beliefs and wishes – these are all important factors to take into consideration when deciding if and when to get tested.

You should also talk with your doctor about what the course of action would be if your PSA levels do turn out to be on the high side. While this could be a sign of cancer, it may also be caused by something else, such as enlarged prostate, which can be treated.

In the end, the Task Force is really just recommending a discussion. Which is something you should be having with your doctor anyway. Talk with your doctor about the risks so that together you can make an educated decision about your options.

Ask The Expert: Are There Other Things Besides Prostate Trouble That Can Cause Incontinence In Men?

Prostate Trouble and Incontinence

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: Are There Other Things Besides Prostate Trouble That Can Cause Incontinence In Men?

AnswerProstate problems in men typically get the blame for incontinence issues for good reason – many men experience issues with their prostate (BPH, prostate cancer) which can often cause incontinence, even if it’s just for a brief time. But there are other conditions that may be contributing to the root of the issue as well. Being overweight can put extra pressure on the bladder, which may cause leaks. Certain foods can also irritate the bladder, causing incontinence – especially if you’re already prone to the condition.  Additionally, neurological conditions, such as Parkinson’s or diabetes can lead to neurogenic bladder, where the brain is unable to communicate properly with the bladder. Even still, urinary tract infections or blockages can lead to bladder troubles.

The most important thing to consider is that incontinence is generally a symptom of something else, and can almost always be treated. If you’re experiencing bladder leaks, see your doctor today and ask for help. Your doctor will be able to dig deeper to find the root cause of your incontinence and work with you to find a solution.   

Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Have a question you'd like answered? Contact us!

Incontinence During Sex - It Happens To Men Too

Incontinence During Sex Happens To Men Too

Prostate cancer is one of the most common types of cancer in men. According to the American Cancer Society, 1 in 7 men will get prostate cancer in their lifetime (only skin cancer has a higher rate).  And, while many men will go on to survive prostate cancer, the side effects of treatment can be difficult to deal with for many.

A common treatment for prostate cancer is a radical prostatectomy, or the complete removal of the prostate.  This is generally considered a good approach especially if the cancer is contained within the prostate gland and has not spread.  However, one side effect of this procedure is often incontinence.

Stress urinary incontinence, the type of incontinence that happens when you place pressure on the bladder, is common for men who have had their prostate removed or are undergoing other treatments for prostate cancer.  Treatment can sometimes weaken the bladder muscles, causing leakage when a man sneezes, coughs, exercises, or even during sex.  This can be extremely embarrassing for men, and can be discouraging when going through the healing process of having a prostatectomy. The good news is that many men regain full control of their bladder with time after a prostatectomy.

here are 4 tips that may help you avoid some awkward situations in the bedroom:

  • Try to watch your fluid intake in the hours leading up to sex.

  • Avoid consuming bladder irritating food and drinks, such as caffeine, chocolate, or alcohol.

  • Prior to sex, completely empty your bladder.

  • Keep a thick towel nearby in case of any accidents

While this problem can be an embarrassing one, keep in mind that many men deal with this in the months after prostate cancer treatment and with time, this condition should improve.  If you still experience problems a few months after your treatment, talk to your urologist about treatments for incontinence.  He or she can help you navigate the many options available to you and find one that fits best with your needs.

Ask The Expert: Surgery For BPH?

Ask The Expert: Surgery For BPH?

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: What types of surgery options are available for BPH?

Answer: BPH, or Benign Prostatic Hyperplasia, is when a man’s prostate is enlarged.  BPH is a common occurrence in aging men, but may not always require surgery.  Surgery may be considered if you have certain issues (you can’t urinate, have seen blood in your urine, have a partial blockage in your urethra, or have kidney damage), or if your symptoms are so bothersome that surgery makes sense to you.

The typical surgical option that is usually used is transurethral surgery of the prostate.  This is where surgical instruments are passed through the opening in the penis to the prostate. Transurethral resection of the prostate (TURP) is the most common type of transurethral surgery used for BPH. This is when a portion of the prostate is removed.  Other methods of removing some of the prostate include laser therapies, transurethral microwave therapy (TUMT), or transurethral needle ablation (TUNA).  Transurethral incision of the prostate (TUIP) is also sometimes used, which places incisions on the prostate which help to relax the opening to the bladder and allow urine to flow from the bladder more freely.

If you are considering surgery for BPH, talk with your doctor about these options and decide together which one may be the best for you.

The NAFC Expert Panel is made up of some of the top medical professionals in the fields of urology, urogynecology, physical therapy, and surgery. Each month, the experts weigh in on important topics and answers to your questions.  To have one of your questions featured in our Ask an Expert series, send it to us here.

Overactive Bladder in Men

Overactive Bladder In Men

You've all probably seen ads on television showing women rushing to the bathroom because of a severe or sudden urge to urinate. That's overactive bladder (OAB). You've also seen ads of men rushing to the bathroom at football games. Those ads say it's a prostate or "growing problem" - the prostate is getting too big or causing a blockage resulting in the bladder becoming overactive. Whether you are a man or a woman, if you have to rush to get to the bathroom to urinate, you might have overactive bladder.

Most of the time, there are other symptoms that accompany OAB - including frequency of urination, loss of urine control on the way to the bathroom, or waking from sleep to urinate. Sometimes OAB presents with other related symptoms such as difficulty starting urination, having to push or strain, and having a weak stream. Occasionally it can get so bad that you cannot urinate at all and a tube (catheter) needs to be inserted temporarily into the bladder to let the urine out.

The causes of overactive bladder are different in men and women. In men, about two-thirds of the time, a blockage to the flow of urine by the prostate is the culprit, but there are other causes as well. These include weakness of the muscles of the bladder, infection of the bladder or prostate (prostatitis), bladder stones, and even bladder cancer. Neurologic conditions such as Parkinson's disease, nerve damage from a stroke, multiple sclerosis, and diabetes can also cause symptoms of OAB.

So, if you're a man and you have OAB, what should you do? The first step is to see your doctor. The doctor should take a brief history focusing on the urinary tract and previous medical conditions and procedures. The doctor then should examine you.

Typical examinations include a digital rectal examination, focus neurological examination, and anal sphincter tone. The doctor should also check a urine specimen for infection or microscopic blood. He/she should also check how well you are emptying your bladder. That can be done by a simple examination or by an ultrasound - a simple, non-invasive, painless test done in the office. If there are signs of infection, you will be started on antibiotics and you should be better within a matter of days.

Once you are better the doctor might suggest that you have more tests to determine why you got the infection in the first place. The usual reason is that there is a blockage by the prostate and he/she might recommend treatment for that.

If you are not emptying your bladder completely and/or if there are other signs of a blockage by the prostate, your doctor will probably recommend either a medication called an alpha-blocker or want you to see a urologist right away.

An alpha-blocker is a medication that helps to relax the muscles in the wall of the prostate and that helps to relieve the blockage. It is also effective in relieving the OAB symptoms. If the medication alone or a combination with other medications does not alleviate your symptoms, then you should see a urologist.

The urologist will likely recommend more tests to determine the cause of your symptoms. He/she may want you to complete a diary for 24 hours in which you record the time and amount of each urination, perform an uroflow test (urinating into a special toilet in the bathroom that measures how fast the urine comes out) and check for residual urine with an ultrasound.

On the basis of these tests, he can determine whether there might be a blockage by the prostate. If there is, he will likely prescribe an alpha-blocker, if you are not already taking one, or possibly add another type of medication called a 5 alpha reductase inhibitor, if the prostate is enlarged. If there are no signs of a blockage he/she may recommend a behavior modification approach or prescribe an anticholinergic medication that relaxes the muscles in the walls of the bladder and diminishes the strong urge to urinate.

These treatments are effective in the majority of men and often have long lasting results. When they are not effective or if the effect wears off, surgical treatment of the blockage by the prostate is effective in the vast majority of men and those results are long lasting too.

The two best operations are transurethral resection of the prostate (TURP) and laser ablation of the prostate. Both operations are done by passing a surgical instrument through the penis and cutting out (TURP) or vaporizing (laser) the prostate. The operations are very safe, require no incisions, and no or very short hospital stay. There are very few serious complications and the success rate is very high.

In conclusion, most men with OAB also have prostatic obstruction. Treatment of the obstruction is effective in majority of patients. For those without obstruction, there are a variety of effective treatments.