Problems urinating

Not long ago, we blamed all the problems on the prostate, which lies just below the bladder, grows over the years and consequently blocks the urethra. Today, it is clear that in addition to the prostate, other causes also influence the problems. Bladder cancer, prostate cancer, urethral obstruction, prostatitis, urinary tract inflammation, lower urinary tract stones, nighttime urination, overactivity of the bladder muscle... all these causes must be ruled out before the patient can be prescribed appropriate therapy.


Every man who has difficulty urinating needs to be examined by a urologist. We talk to the patient in detail, perform a clinical examination of the prostate through the anus, and order tests. Very important tests are an abdominal ultrasound - with an assessment of urine retention in the bladder after urination, a blood test for PSA, a urine test, and uroflow - an objective assessment of urine flow. With the aforementioned tests, we get a very good insight into the severity of the patient's problems and the background that influences the symptoms. Quite often, a very serious illness is hidden behind mild urination problems.

The IPSS (The International Prostate Symptom Score) questionnaire is very helpful in assessing the symptoms a patient has. The questionnaire consists of seven questions relating to symptoms and one question relating to quality of life. The patient assesses the condition with points from 0 to 5. The points are finally added up and we get the result of how much the symptoms affect the patient's life. If the patient scores 1-7 points, we are talking about mild symptoms, 8-19 about moderate symptoms and 20-35 about very severe symptoms.

Urination diaries are also very helpful. Patients carefully record the frequency of urination and the amount of urine excreted for several days.

The urologist reviews the results and assesses whether the patient needs treatment. In the initial phase, we try to alleviate the symptoms without the use of medication. The patient receives precise instructions that have a beneficial effect on the symptoms. If this does not help, we prescribe medication to the patient. We have several different medications available that act on different targets and are very effective. They can also be used in different combinations. If the medications also have no effect, the patient is operated on. Using various surgical techniques, we widen the urethra in the prostate area, thus enabling better urine flow.

As a preventative measure, I advise you to avoid overly spicy foods and excessive caffeine intake. Ensure adequate hydration throughout the day, limit fluid intake in the evening. Avoid stress and try to exercise a lot.

Author: asst. Simon Hawlina, MD, FEBU, urologist specialist