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Enuresis and Micturition Problems
Coming of age, most men need to visit the men’s room more frequently. It is a fact of life that usually doesn’t attract any particular medical attention, even if the consequences can be serious enough in terms of social and practical inconvenience.
The extent of the problem is massive:
20% of men aged 40-50 experience voiding problems
33% of men aged 50-60 experience problems
More than 50% of men aged 60 or more find their micturition problematic
Prostate and the Ageing Bladder
Most micturition problems are caused by a benign enlargement of the prostate gland, but problems can have other causes as well, like cancer in the prostate gland or in the bladder, constipation, or cystitis.
Urination difficulties are usually caused by a combination of aging of the bladder and enlargement of the prostate gland.
The bladder is a muscle. As one gets older, the muscle controlling the bladder gets weaker and the compliance of the bladder is reduced. The consequence is on one hand that the capacity of the bladder is reduced, while on the other hand the muscle has problems contracting sufficiently to empty the bladder entirely. As a result of this, the volume at disposal is significantly reduced – forcing the patient to go more often to the bathroom.
The prostate gland keeps growing all life. Situated around the urethra under the bladder, it will press on the urethra as it grows and make it increasingly difficult to urinate.
Nerves get less sensitive with age. Therefore the elderly gets the signal of the full bladder later, and the time from registration of the urge until one must, is shortened. Sometimes down to 1-2 minutes. You will then define it as “urge-incontinence”
Micturition problems are caused by a combination of these effects.
Living with Enuresis – The four Strategies
Common enlargement of the prostate gland is harmless as such. It should be accepted as a sign of age. But the waiting has to be “watchful” in order not to overlook a prostate cancer or other disease.
In rare cases, where the squeeze on the urethra prevents you from emptying the bladder entirely, or causes increased pressure in the kidneys even a benign enlargement of the prostate may require treatment.
A watchful waiting could be combined with the use of incontinence products like UROX.
Surgical treatment usually means pealing the prostate gland from within by means of a cystoscope. In this operation, the cystoscope is often directed through the urethra up to the prostate gland, where the gland is sliced of, or burned away with a laser. The surgical treatment is very effective but since there is a significant risk of side effects it is only used in cases of severe micturition problems.
Adverse effects can be impotence (<10%), stricture* in the urethra (<10%), and 1-5% becomes chronically incontinent.
Medicine will either relax the muscle cells in the prostate gland, to reduce the tension it is exerting on the urethra, or control the growth of the prostate gland.
In both cases the medicine has a number of known unpleasant side effects, like dizziness and nausea – which may be out of proportion to the problem the medicine was intended to cure.
Except for an extract of the plant “saw palmetto”, which has been shown to have a moderate but measurable effect on enuresis, no alternative medication has been clinically or experimentally proven to work.
Never the less, many men tend to find some relief in alternative medicine, the most popular being an extract of pumpkin seeds. Since alternative treatments are felt to relieve, but not cure enuresis, it can be an excellent companion to a UROX system.