If you have trouble going to the bathroom, you’re not alone. Urination problems—such as the frequent need to go, especially at night—are more common in men as they get older.
Going to the bathroom is a natural yet a surprisingly complex process. Nerves carry signals from your brain through your spinal cord to your bladder and sphincter muscles, telling your bladder to open at the right time or stay closed. But any number of diseases, conditions or injuries can interfere with bladder signals and urination. Some of the most common urinary problems in men include:
Urinary Incontinence
Urinary incontinence refers to the involuntary loss of urine when you’re coughing, sneezing or lifting (stress incontinence); the involuntary urge to urinate (urge incontinence); or the constant dribble of urine (overflow incontinence).
Damaged Nerves in the Urinary Tract
Damaged nerves in the urinary tract can result from diabetes, stroke, Parkinson’s disease, multiple sclerosis, or a spinal cord injury. These conditions may affect bladder control by interrupting the nerve signals required for bladder control.
Overactive Bladder
In overactive bladder, the bladder misfires, squeezing at the wrong time, causing you to go frequently during the day or night, or suddenly needing to urinate.
Prostate Problems
The prostate is a gland that adds fluid to semen before ejaculation. It surrounds the urethra, which is the tube that carries urine from the bladder out of the body. The prostate typically enlarges as men get older. This condition, benign prostatic hyperplasia (BPH), can cause the prostate to enlarge, squeezing the urethra and affecting the urine stream. BPH can cause the urine stream to be weak. It can also bring on the need to go urgently more frequently, especially at night.
Prostate Cancer
Problems passing urine, including a slow or weak urine stream, can also be a sign of prostate cancer.
See your doctor if you’re experiencing problems with bladder control, including the frequent need to urinate at night or during the day, or the urgent need to go. Your doctor will take a detailed medical history and ask you questions about how much fluid you drink daily, the medicines you take, and medical conditions you may have.
You may be asked to keep a voiding diary, which is a record of your fluid intake, trips to the bathroom, and leakage episodes. Your doctor may perform a digital rectal exam (DRE), in which he examines the prostate for size and condition.
Depending on your symptoms and the results of your DRE, you doctor may order additional tests before making a diagnosis including:
An abdominal or transrectal ultrasound, for images of the prostate
Prostate-specific antigen blood test, which measures PSA, a protein produced by prostate cells. The PSA test is used to detect prostate cancer, but the test isn’t foolproof because other conditions can elevate PSA besides cancer.
Urodynamic testing, which measures pressure in the bladder as it’s filled with fluid through a small catheter
Your treatment will depend on your condition, the severity of your problem, your preferences, and your lifestyle. Some treatments may even be behavioral, such as limiting fluids at certain times of the day or doing Kegel exercises—squeezing your pelvic muscles to strengthen them and, as a result, increasing their capacity to hold urine in the bladder.
