BPH affects the urethra first, then the bladder. As BPH begins to impede urine flow, men may experience symptoms that can be broken down into two categories: Obstructive and irritative. The first category is just what it sounds like—symptoms resulting from a mechanical obstruction, from the prostate squeezing the urethra. These include the following: A weakened urinary flow or stream; hesitancy in starting urination and difficulty in stopping; intermit-tency, when the urinary stream starts and stops repeatedly; “dribbling” after urination; a sense of not being able to empty the bladder completely; and occasionally, urinary retention—when the bladder stays completely or partly full.
Early on in BPH, men experience few symptoms because the powerful bladder muscle compensates for the narrowed urethra by making more vigorous contractions and forcing urine through the prostate. But over time, this extra effort takes its toll on the bladder. The mechanical obstruction means the force is diminished for each length of muscle fiber—the bladder becomes less efficient, thus the decreased flow rate and obstructive symptoms.
But as this is happening, the muscle hypertrophies—it gets larger—and there’s a marked increase in the smooth muscle tone. Here’s where the second category of symptoms comes in. The bladder wall becomes thick and doesn’t stretch like it used to; the bladder itself doesn’t hold as much, becomes unstable and overly reactive, and causes a need to urinate more often—unfortunately, sometimes spontaneously. These irritative symptoms can include urge incontinence (when a man knows he has to urinate, but can’t make it to the bathroom in time); and nocturia, which is frequent urination during the night. The major cause of nocturia from BPH is a thickened bladder that doesn’t hold as much as it once did. Another cause is leftover urine from a never-emptied bladder, which gready reduces the bladder’s functional capacity. (Imagine a glass that’s capable of holding a pint of fluid, but which is always half-full. This means the glass must be emptied every half-pint—twice as often as before!)
When the prostate’s pressure on the urethra gets to be too great for the bladder’s compensatory muscle power, a man loses the ability to empty his bladder completely during urination. Sometimes this leads to symptoms that go beyond merely annoying and require treatment—such as repeated urinary tract infections (UTIs) caused by stagnant urine; or damage to the bladder and kidneys from the backup of urine. Sometimes, in acute urinary retention, a man suddenly becomes unable to urinate at all.
*232\201\8*
No comments yet.