BPH

What Role Does the Urinary Tract Play in Prostate Health?

The urinary system or the renal system is composed of organs (kidney, bladder), tubes (ureter, urethra), muscles, and nerves that work together to filter store and carry urine.

This system filters blood plasma and regulates blood volume by excreting excess water, ions, and secreted molecules. Urine transport follows the urinary tract through the kidneys, ureters, bladder to the urethra.

In men, the urinary tract is intricately linked with the prostate gland. The urethra passes through the prostate gland, running from the bladder to the penis. The prostate secretes fluid that nourishes sperm.

Following ejaculation, sperm travel from the spermatic cord to the prostate and empties into the urethra. Thus, prostate problems can affect the urinary tract and vice versa.

Many men experience urinary symptoms as they age, which may be caused by prostate conditions like inflammation, BPH, or cancer. Persistent lower urinary infections can increase the risk of prostate conditions through inflammation and oxidative stress.

Though not all urinary symptoms are due to prostate conditions, keeping a healthy prostate reduces the risk of urinary complications. Here, we discuss the link between prostate conditions and urinary tract symptoms. We highlight approaches to improve urinary symptoms, especially relating to prostate conditions.

How is urine function controlled?

The urinary tract comprises the kidney, ureters, bladder, and urethra, which work together to create, store, and carry urine. Urine leaves the collecting duct of the nephrons of the kidney and flows into the ureters. The ureters drain urine to the bladder, where it is stored before elimination through the urethra.

Two urinary valves control urination at two key points: the bladder neck (inflow valve) and below the prostate (outflow vale). These two valves act together, opening and closing around the bladder neck and urethra when signaled by the brain.

Pelvic floor muscles also play essential roles in supporting the bladder and controlling urination. Here, the bladder muscles’ contraction pushes urine out of the body, while other pelvic area muscles provide anatomical support for the bladder and the rectum.

What role does prostate health play in urinary function

The prostate gland is below the bladder. It surrounds parts of the urethra, a tube that carries urine and semen to the penis. More than 20% of men will experience a prostate condition at some point in their lives. Because of the anatomical location of the prostate, prostate diseases can cause both urinary and sexual complications.

Three common prostate conditions, including prostatitis, benign prostatic hyperplasia, and prostate cancer, cause a range of urinary problems.  

Prostatitis – is a set of symptoms induced by prostate inflammation or infection. The condition can cause painful urination, a frequent or urgent need to urinate (urinary incontinence). Prostatitis can affect men of any age, but young and middle-aged men (36 – 50 years of age) have an increased risk of developing the condition.

Benign prostatic hyperplasia – is the abnormal enlargement of the prostate gland. It is the most common cause of lower urinary tract complications in men (Kok et al., 2009). One in three men over the age of will experience symptoms of prostate enlargement.

Enlarged prostate puts pressure on the bladder, obstructing the urethra. This pressure is the cause of BPH induced urinary symptoms, including painful urination, weak urine flow, frequent urination, difficulty starting, and stopping urinating. Men with an enlarged prostate also experience a feeling of not fully able to empty the bladder.

The prostate gland will naturally grow in size as men age. It starts enlarging around 25 years, but most men will not experience urinary difficulties until the age of 50. More than half of men over the age of 50-years of age will suffer from symptoms of an enlarged prostate.

Prostate cancer – develop when cells in the prostate gland multiply in an uncontrolled manner. Prostate cancer increases the prostate gland’s size over time and causes urinary symptoms that are similar to those in BPH. Thus, it is crucial to seek a medical opinion on urinary symptoms to rule out prostate cancer. Possible urinary symptoms of prostate cancer include difficulty starting to urinate or emptying the bladder, weak urine flow, dribbling, blood in the urine, and sudden urge to urinate.

The risk of prostate cancer increases as a man ages, affecting mainly those over the age of 50 years. Men with a family history of the disease and black men are more likely to develop the condition than those without family history and other ethnic backgrounds.

What is urinary incontinence

Urinary incontinence is the reduction of bladder control over time, leading to a sudden uncontrolled need for urination or leaking due to strain. Like other urinary problems, prostate conditions increase the risk of urinary incontinence.

This condition can also develop after procedures to treat prostate conditions such as radical prostatectomy and radiation therapy. The severity of leakage depends on the extent of the underlying cause. It can vary from a single drop to total emptying of the bladder.

Further, there are different types of urinary incontinence, including:

  • Stress urinary incontinence – is the leaking of urine due to pressure around the abdomen. In affected individuals, events like coughing, laughing, and exercise can increase abdominal pressure and urine loss.  

  • Urge urinary incontinence – is the urgent need to urinate without any bladder control, leading to leaking of urine before reaching the restroom. It is caused by overactive bladder or uncontrolled bladder contraction.

  • Overflow incontinence – is the inability to empty the bladder, causing urine to leak completely. Men with an enlarged prostate or treatment-related injury to the bladder or urethra may experience overflow incontinence.

  • Total incontinence – is the complete lack of bladder function. Here the bladder cannot store any urine, leading to constant urination or frequent leaking.

  • Mixed incontinence – is the occurrence of multiple types of urinary problems, especially stress and urge urinary incontinence.

The experience of men with urinary incontinence differs much. In some men, treatment resolves problems quickly, but others may experience more severe presentation. These cases may require further support and help from the care team. It is essential to consult with your doctor for accurate diagnosis and treatment.

What causes urinary symptoms?

Urinary symptoms are a disruption of the normal process of storing and excreting urine. They can occur through a variety of mechanisms. Factors like age and obesity may increase the risk of developing urinary problems secondary to diseases.

The following are some of the common causes of urinary symptoms:

  • Obesity and diabetes – Increased abdominal pressure due to obesity with or without diabetes can induce urinary symptoms.

  • Bladder damage and stones – Surgical injury to the bladder or bladder stones can disrupt its ability to store urine and control urination.

  • Neurological conditions and injury – Diseases that affect the brain and spinal cord, such as Parkinson’s disease, can disrupt the neurological control of urination. A spinal injury can also disrupt the nerve signal between the brain and the bladder leading to reduced bladder control.

  • Lower urinary tract conditions – Conditions affecting the urethra and bladder, such as urinary tract infections (UTIs) and cancers, impair urinary function.

  • Prostate conditions – BPH, prostatitis, prostate cancer can obstruct or irritate the bladder and the urethra.

Some of these causes lead to short-term problems that be easily be treated, persist long-term.

How can you naturally improve urinary symptoms?

If you are experiencing urinary symptoms and discomfort due to the conditions described above, there are simple strategies to improve bladder control and reduce pain.

These strategies usually revolve around lifestyle modifications, behavior therapies, and physiotherapy. They are safe, effective, inexpensive, and can work alongside other treatment methods such as surgery.

You can take the following steps to improve symptoms:

Fluid intake:

First, drinking copious amounts of fluid too quickly can put pressure on the bladder, creating a strong sense of urgency. In urinary incontinence, it is recommended to drink smaller amounts of fluid throughout the day. Further, more of the fluids should be taken in the day rather than at night to avoid disrupting sleep. Note that drinking too little can increase the concentration of urine, irritating the bladder. Bladder irritation increases the urge and frequency of urination.

Bladder irritants:

In addition to natural compounds excreted in the urine, certain foods metabolize to compounds that irritate the bladder. Alcoholic, caffeinated, and carbonated drinks can irritate the bladder and worsen urinary symptoms.

Other foods implicated with bladder irritation include acidic fruits (lemons and limes) and spicy foods. Reduce or avoid the consumption of these possible bladder irritants to improve urinary symptoms.

Bladder training:

Adjusting urination habits can help reduce wrong signals from the bladder to the brain, even if it is empty. Using the toilet on a set schedule can help improve bladder control over the urge to urinate. Usually, you need to identify your urination patterns, gradually extend the intervals, and adhere to the schedule.

Pelvic floor exercise:

The pelvic floor muscles and urinary sphincter provide bladder support and control urination, respectively. Regular pelvic floor exercises (Kegels) strength bladder support during everyday activities such as lifting, standing, and walking.

Manage contributing factors:

Medications, obesity, smoking, and digestive problems can contribute to urinary problems. Speak to your doctor about managing your blood pressure drugs, muscle relaxants, or antidepressants to reduce the severity of urinary symptoms.

Obesity and diabetes can reduce bladder control. Engage in regular physical activity to improve bladder control (Yeh et al., 2012). Smoking reduces bladder control and the severity of urinary symptoms (Maserejian et al., 2012). Stop smoking to improve urinary symptoms as well as over health.

Drink cranberry juice:

Studies suggest that cranberry juice may improve urinary symptoms. It can prevent recurrent urinary tract infections and inflammation (Campbell et al., 2003; Jepson et al., 1998).

Conclusion

Certain groups of men have an increased risk of developing prostate conditions such as BPH, inflammation, and cancer. These conditions often present with significant urinary complications that reduce the quality of life.

Natural approaches like controlling fluid intake, reducing bladder irritation, and pelvic floor exercises can improve urinary symptoms. The advantages of these strategies included improved safety and improved quality of life. However, treating the underlying cause of the urinary symptoms is essential to achieve permanent relief.

Sources

  1. Campbell, G., Pickles, T., D’yachkova, Y., 2003. A randomised trial of cranberry versus apple juice in the management of urinary symptoms during external beam radiation therapy for prostate cancer. Clin. Oncol. 15, 322–328.
  2. Jepson, R.G., Mihaljevic, L., Craig, J.C., 1998. Cranberries for treating urinary tract infections. Cochrane Database Syst. Rev. Kok, E.T., Schouten, B.W., Bohnen, A.M., Groeneveld, F.P., Thomas, S., Bosch, J.R., 2009.Risk factors for lower urinary tract symptoms suggestive of benign prostatic hyperplasia in a community based population of healthy aging men: the Krimpen Study. J. Urol. 181, 710–716.
  3. Maserejian, N.N., Kupelian, V., Miyasato, G., McVary, K.T., McKinlay, J.B., 2012. Are physical activity, smoking and alcohol consumption associated with lower urinary tract symptoms in men or women? Results from a population based observational study. J. Urol. 188, 490–495.
  4. Yeh, H.-C., Liu, C.-C., Lee, Y.-C., Wu, W.-J., Li, W.-M., Li, C.-C., Hour, T.-C., Huang, C.-N., Chang, C.-F., Huang, S.-P., 2012. Associations of the lower urinary tract symptoms with the lifestyle, prostate volume, and metabolic syndrome in the elderly males. Aging Male 15, 166–172.

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