Diagnostics

Better understand why you have difficulty urinating

In men, the appearance of urinary disorders is more and more frequent with age. In fact, nearly 30% of men in their fifties and 50% of men in their seventies and older are affected. These figures, by no means insignificant, are proof that this problem affects a significant part of the male population. Many people who suffer from this problem often do not understand the cause and, above all, the attitude to adopt in such a situation.

The Symptoms

There are many warning signs of urinary disorders in men. These symptoms are actually irregularities that occur when you feel the need to empty your bladder:

Dysuria

It is the difficulty to urinate par excellence in men. It is therefore the symptom by which the presence of urinary disorders is most often manifested. It is characterized by intense burning sensations during urination which can become very painful.

Urination by pushing

This is often linked to the previous symptom. Indeed, if you have difficulty urinating or notice that your urine flow is weak, you will instinctively want to make an abdominal push. However, this urge is not necessary in normal circumstances.

A dysfunctional stream

The stream may be watering can, choppy (urination interrupted or interrupted several times in a row) or hesitant (slow or delayed urinary process).

Weak urinary stream

If you notice that your urinary stream has lost its strength, then it is likely that you are suffering from urinary disorders.

Nocturia

The need to urinate several times in the middle of the night.

A feeling of incomplete urination

Where you will have the sensation that the bladder has not fully released after emptying.

The presence of delayed drops

Urine drops that occur after urination is complete.

Dragging micturition/terminal drips

The bladder emptying is very slow to the point of ending with a drip.

Urinary incontinence

Is the involuntary loss of urine. It can occur in different ways: spontaneously, in drips, during an effort or continuously.

The presence of blood in the urine

Causes in humans

There are several reasons why men may experience urinary problems. Indeed, from one case to another, difficulty in urinating in men can result from very different causes.

Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia, also known as prostatic adenoma, is the most common cause of male urinary problems. This non-cancerous condition mainly affects men over the age of 50 and results in an enlargement of the prostate. The person concerned will then experience various problems: incontinence, urinary thrust, weakness of the urinary jet, delayed drops, urgent need to urinate, etc.
Dysfunctional bladder contraction
The proper functioning of the bladder is essential to the urination process. When the bladder has contraction problems, it is not surprising to see urinary problems appear.

Dysfunctional bladder contraction can be explained in three ways:
- Hypocontractility of the bladder: The bladder is distended and contracts poorly. This is the main cause of dysuria;
- An overactive bladder: the bladder contracts too frequently and involuntarily;
- An acontractile bladder: the bladder is all flaccid and no longer contracts. This situation facilitates urinary incontinence by overflow.
A urinary tract infection
Because of their longer urethra, men are less prone to urinary tract infections than women. However, when they do occur, they can be more serious and just as painful.

Urinary tract infections are caused by the presence of bacteria. Depending on where they develop, there are four types of infections:
- Urethritis: is the presence and proliferation of germs in the urethra;
- Prostatitis: Prostatitis is when the urinary infection and/or inflammation affect the prostate. There are two types of prostatitis: acute prostatitis and chronic prostatitis. Prostatitis is often accompanied by fever, urinary burning, presence of blood in the urine, bladder emptying in bursts and frequent and urgent urges to urinate;
- Cystitis: Cystitis is a urinary infection located in the bladder. It is however very rare in men;
- Pyelonephritis: This is an inflammation of the kidney caused by an infection of bacteria. It does not occur on its own, but rather is the result of urethritis or cystitis. The infection starts in the bladder or urethra and then spreads to the kidney.
Prostate cancer
Urethral obstruction

When the urethra is blocked, the evacuation of urine becomes very difficult. If it is not unblocked quickly, urinary disorders start to appear.

Urethral obstruction can be caused by urethral stenosis (narrowing of the urethral canal), an internal element (blood clot) or an external element (sand, crystals, etc.).

However, some causes of urinary disorders (benign prostatic hypertrophy, urethritis or prostate cancer) can also lead to urethral obstruction.
Kidney cancer
Diabetes

As people age, nearly 40% of people with diabetes begin to experience urinary problems. However, these people often have the annoying habit of not informing their doctor. This can be either out of modesty, negligence or ignorance.

Diabetes attacks the nerves of the bladder, which then becomes hypoactive or overactive. It also makes patients particularly vulnerable to urinary tract infections.
Side effects of medications
Some medications can cause difficulty in urinating in men. More precisely, it is a question of the side effects linked to their taking. This case concerns mainly the following categories:
- Muscle relaxants;
- Nasal decongestants;
- Antidepressant medications;
- Diuretic drugs.
The treatments concerned can lead to a decrease in the control of micturition and therefore to urinary incontinence. The symptoms observed are: urinary incontinence by pushing, by overflow, by impetuosity but also urinary retention.

Although the bladder weakness caused by these medications is usually temporary, it is always wise to talk to your doctor.
Trauma
Emotional instability
Urination problems can be caused by an unstable emotional state, or the reason for their persistence. Two main psychological causes are often responsible:
- Depression: incontinence problems can affect people with a (very) fragile psychological state. These people have a severe lack of self-confidence and only have a distorted image of themselves and their bodies as portrayed by society and those around them. This loss of self-confidence, coupled with a state of renunciation, eventually impacts the pelvic floor. This leads to a loss of bladder control. Urinary difficulties such as leakage or retention begin to appear;
- Stress and anxiety: Since the emotional side is closely linked to the physical side, it is normal that instability of the former has repercussions on the latter. A person who is constantly stressed and/or anxious will feel the slightest tension in the bladder. They will then feel the need to urinate frequently and urgently, even if the bladder is not really full.
Neurological ailments

Various illnesses can cause difficulty in urinating in men (Parkinson’s disease, multiple sclerosis, strokes, etc.). Indeed, a properly functioning bladder depends on the cervical nervous system and the spinal cord. When these control points are affected by a neurological disorder, it is therefore logical to see urinary disorders. Of course, the type of urinary difficulties observed depends on the affected part, the ailment in question and the person concerned.

Generally, when the spinal cord is affected, the patient may suffer from urinary retention (complete or partial), frequent urination (urinary frequency), leakage, nocturia or the urge to urinate.

On the brain side, the urinary disorders noticed are practically the same (with less urinary retention). The frequency of urinary infections also increases drastically.

The treatments

Treatments for urinary disorders are varied. They fall into two categories: medication and surgery. However, there are also new types of treatments with promising results.

Medication

When you suffer from urinary problems, you should never treat yourself. If you have a number of urinary problems, it is best to consult a urologist. Only the latter, after a series of tests and interviews, will be able to determine the most suitable treatment for you. The situation will be even more delicate if you have mixed symptoms.

Generally, when you have emergency urinary incontinence, doctors recommend anticholinergics. If you are prone to urinary tract infections, your treatment will be based on antibiotics. If benign prostatic hyperplasia is what you have, the doctor may prescribe alpha-blockers.

Your doctor may even recommend rehabilitation instead of medication. In any case, it will depend on the doctor’s observations of your health.

Surgeries

If the doctor feels that medication will not be effective, then surgery is likely to be considered. From minor to major surgeries, there are many ways to treat, and possibly resolve, male urinary difficulties.

Here are some of them:

Urethral dilatation

Urethral dilatation is a minor surgery whose objective is to enlarge a urethral canal that is too narrow and makes it difficult for urine to pass.

The patient is first put under local anesthesia using an anesthetic gel. Then, the doctor inserts dilators (lubricated sterile candles) of increasing size into the urethra in order to have a satisfactory opening. A urinary catheter may be inserted at the end of the operation.

This operation is performed to treat urethral stricture. However, it can also be used to treat recurrent urinary tract infections or abnormal emptying.
Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate is intended to reduce or remove a central obstruction of the prostate that prevents urine from flowing. It can be recommended in certain cases of retention, thus promoting better bladder emptying. However, it is more commonly used to treat cases of benign prostatic hyperplasia. It consists of the introduction of a small device into the penis to resect the inside of the prostate.

There are three types of RTUPs:
- Bipolar resection;
- Enucleation of the prostate;
- Vaporization of the prostate.
Meatotomy of the urethra

Still called “meatoplasty” of the urethra, urethral meatotomy, like urethral dilatation, aims to widen the opening of the urinary meatus. It is recommended when several urethral dilatations have been insufficient. It is therefore performed in cases of severe and recurrent urethral stenosis.

This procedure consists of making an incision in the stenosis to obtain a good opening.

Internal urethrotomy for urethral stenosis

It consists in using a laser to make an incision in the scar responsible for the stenosis.

Innovative treatments

New treatments are constantly being developed to treat men’s urination difficulties. Among these innovations, two are particularly interesting: Optilume and Rezum.

Conclusion

There are different reasons for urinary problems. It can be an infection, an enlarged prostate or even kidney cancer. If you have difficulty urinating or notice irregularities during urination, contact our urologists as soon as possible!

Would you like to make an appointment, or do you have any questions? Write to us and we will get back to you as soon as possible!

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Dr. Marois is a urologist who is not a member of the Régie d’Assurance Maladie du Québec (RAMQ). As such, the clinic can not claim the RAMQ for the payment of his services. If you consult Dr Marois, you must pay for the services rendered.

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To ensure the smooth running of the clinic and a minimum of courtesy towards other patients and our staff, we ask you to notify us 48 hours in advance for the cancellation of a consultation, 5 working days in advance for a surgery at the office and 21 working days in advance for a major surgery. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.

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We understand that events occur, so we ask you to provide us with at least a 24-hour notice for any change in their appointment; we will be happy to accommodate you, the best we can. However, if you fail to inform us within this timeframe or do not show up, we will charge a $ 100 fee.

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Dr. Marois is a urologist who is not a member of the Régie de l’Assurance Maladie du Québec (RAMQ). As such, if you require his professional services, you will have to pay directly the Cliniques Marois for the services rendered.

Cancellation Policy:

To ensure the smooth running of the clinics aa well as a minimum of courtesy towards other patients and staff members, we ask you to notify us 48 hours in advance for cancelling an appointment, 5 working days for cancelling a minor surgery in the office and 21 working days for major surgery at the CMC. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.

Change of appointment:

We understand that events occur and schedules change, so we ask patients to give us at least a 24-hour notice for any changes of appointment. We will be happy to reschedule another one for you. Failure to provide such notice within this timeframe will result in a $ 100 fee.

Thank you for your understanding.

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