Dear Doctor,

My 80-year-old grandfather is experiencing trouble passing urine. Should I worry or not? How can it go back to normal? Ntwari

Dear Ntwari,

It is possible that your grandfather is suffering from an enlarged prostate. The prostate gland is found in men surrounding the urethra (tube connecting bladder to the exterior). It helps in formation of seminal fluid that stores and transports the semen. It starts getting enlarged due to aging, a change akin to cataract in the eyes or osteoarthritis in the knees and backbone.

The exact cause of prostate enlargement is not known. But it is presumed to be due to balance of hormones androgen and estrogen and growth pathways and cell-to-cell communication.

Depending on the severity of enlargement, the bladder is obstructed to some extent, which prevents its incomplete evacuation. Residual urine left in the bladder becomes a source of infection, causing repeated urinary tract infections. In the beginning, one has frequency of urination more in the night, which later on extends to the day as well. Along with this, there is a sense of incomplete evacuation of the bladder, causing frequency as well as urgency of urination. Dribbling of urine can occur due to incontinence.  Unchecked, the kidneys get damaged slowly due to back pressure of retained urine and repeated infections, thus causing kidney failure.  It is easily diagnosed by physical examination and ultrasound. Cancer of the prostate can be excluded by biopsy and estimation of prostate specific antigen (PSA).

Treatment in mild cases is wait and watch. Drugs like finasteride, terazosin, are used in a bid to reduce the enlarged prostate. If medications fail or symptoms are severe, surgery remains the only option.

Prevention or minimising symptoms consists of measures such as not drinking fluids in the late evening, avoiding use of bladder irritants like coffee, tea, alcohol, in the evening. Elderly men suffering from frequency and urgency of urination should visit the toilet every hour or so. This helps in emptying the bladder and prevents incontinence by conditioning the bladder to empty at fixed intervals. Cranberry juice is said to be useful in urinary tract infection.