If you have not already done so, we advise you to read our article on Urination. It will give you vital information for understanding what urine is, how the body processes liquid waste and which body parts are integral to the process.
Though not as uncomfortable to talk about as other bodily functions, when guys have problems urinating, we are often unwilling to tell our medical providers about the issues. There are five (5) concerns that you should never ignore when it comes to voiding yourself of liquid waste.
- Going too often (especially at night)
- Not going enough
- Inconsistent flow
- Hurts/Burns when you urinate
- Dark/unusual colour (including blood)
All of the medical issues we will be covering in this article are best diagnosed by a specialist in STDs, urology, and/or physiotherapy but sometimes a psychiatrist.
Problems with urination usually begin to occur as we age and are related to the enlargement of the prostate gland. This is a male reproductive organ that produces fluids to feed and protect sperm cells. At around the age of forty (40) to fifty (50) some men will start to experience some sort of urination symptoms.
But, this is not always true. Younger men can exhibit many of the exact same symptoms as their older counterparts. In this article, we are going to discuss the possible urination problems you may experience that are not related to age and/or an enlarged prostate.
Sexually Transmitted Diseases
A burning sensation or pain when urinating is one of the most well know signs of an STD. Chlamydia and gonorrhea are the usual suspects but producing a dark in colour urine may be a sign of hepatitis B.
Frequent urination often occurs due to an issue with the urethra. This tube transports urine from the bladder down and out of our bodies. For a situation in which the urethra is inflamed or infected, urination can become painful. Other times, it can have you visiting to the bathroom more often than expected or desired. Sexually transmitted diseases known to cause this symptom include:
- mycoplasma genitalium.
Unfortunately, fifty (50) percent of males are asymptomatic for these STDs and are able to infect others without their knowledge. For this reason, it is very important to keep a testing schedule of every three (3) months if you are sexually active.
Prostatitis is inflammation (swelling) of the prostate gland. It can be very painful and distressing, but will often get better over time. This can develop at any adult age but the average is between thirty (30) and fifty (50). Half of all men will experience some form of prostatitis within their life time. It is also the most common urinary tract issue in men under the age of fifty (50).
If you have anal sex, sexually transmitted illnesses, including HIV, you should pay very close attention to the symptoms and signs of prostatitis, as they are known to be risk factors.
Many men who are told they have prostatitis are misdiagnosed and actually have a different condition. There’s a lot of outdated information about prostatitis. It’s important to see a healthcare provider who is up to date on the latest prostatitis research, diagnostic tests and treatments.
Prostatitis is not prostate cancer and there’s no clear evidence that it increases your chances of getting it.
Types of prostatitis include:
- Acute bacterial prostatitis (category 1): A UTI causes an infection in the prostate gland. Symptoms include fever and chills. You may experience painful and frequent urination or have trouble urinating. Acute bacterial prostatitis requires immediate medical treatment.
- Chronic bacterial prostatitis (category 2): Bacteria become trapped in the prostate gland, causing recurrent UTIs that are difficult to treat.
- Chronic pelvic pain syndrome, or CPPS (category 3): CPPS is the most common prostatitis type. Prostate gland inflammation occurs in approximately 1 out of 3 men. As the name implies, this type causes chronic pain in the pelvis, perineum (the area between the scrotum and rectum) and genitals.
- Asymptomatic inflammatory prostatitis (category 4): This condition causes prostate gland inflammation but no symptoms. You may learn you have this condition after getting tests to find the cause of other problems. For example, a semen analysis for infertility may detect asymptomatic inflammatory prostatitis. This type doesn’t need treatment.
What causes prostatitis?
Different types of prostatitis have different causes. Risk factors for chronic pelvic pain syndrome (CPPS), the most common type, aren’t clear. Potential contributors to CPPS include:
- Autoimmune diseases.
- Pelvic floor muscle spasms.
Potential causes of bacterial forms of prostatitis include:
- Bladder infections or bladder stones.
- Surgery or biopsy requiring use of a urinary catheter.
- Prostate stones.
- Urinary retention (not emptying the bladder completely).
- a sexually transmitted infection (STI)
- HIV or AIDS
- Problem with your urinary tract
- Anal sex
- Injury to your pelvis
Prostatitis symptoms vary depending on the type and cause. People with asymptomatic inflammatory prostatitis don’t have any symptoms.
Men with chronic pelvic pain syndrome or chronic bacterial prostatitis may experience:
- Pain in the penis, testicles or perineum (area between the testicles and rectum). The pain may radiate to the lower back.
- Frequent urge to urinate.
- Painful urination (dysuria).
- Weak urine flow or urine stream that starts and stops.
- Painful ejaculation or pain during intercourse.
- Blood in semen (hematospermia).
- Erectile dysfunction.
Acute bacterial prostatitis causes a fever and chills.
There are two (2) methods to diagnose prostatitis. Depending on your symptoms and your doctor, they include:
Less invasive tests
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum to check the prostate gland for pain and swelling. This exam may include prostate massage to collect a sample of seminal fluid.
- Urinalysis: A urinalysis and urine culture check for bacteria and UTIs.
- Blood test: A blood test measures PSA, a protein made by the prostate gland. High levels may indicate prostatitis, BPH or prostate cancer.
- Cystoscopy: A cystoscopy can look for other urinary tract problems but does not diagnose prostatitis. Your provider uses a cystoscope (a pencil-sized lighted tube with a camera or viewing lens on the end) to view inside the bladder and urethra.
- Transrectal ultrasound: Men with acute bacterial prostatitis or chronic bacterial prostatitis that doesn’t improve with antibiotics may get a transrectal ultrasound. A slender ultrasound probe inserted into the rectum uses sound waves to produce images of the prostate gland. This test can show prostate gland abnormalities, abscesses or stones.
For chronic pelvic pain syndrome (CPPS), your healthcare provider may use a system called UPOINT to classify symptoms into six categories. Your healthcare provider may use multiple treatments at the same time to treat only the symptoms you’re experiencing.
- Urinary: Medications, such as tamsulosin (Flomax®) and alfuzosin (Uroxatral®), relax muscles around the prostate and bladder to improve urine flow.
- Psychosocial: Stress management can help. Some men benefit from counseling or medications for anxiety, depression and catastrophizing (over-reaction to minor stresses common in people with chronic pain).
- Organ: Quercetin and bee pollen supplements may relieve a swollen, inflamed prostate gland.
- Infection: Antibiotics kill infection-causing bacteria.
- Neurologic: Prescription pain medicines, such as amitriptyline (Elavil®) and gabapentin (Gralise®), relieve neurogenic pain. This pain can include fibromyalgia or pain that extends into the legs, arms or back.
- Tenderness: Pelvic floor physical therapy may include myofascial release (gentle massage to ease tension on tight pelvic floor muscles). This therapy can reduce or eliminate muscle spasms.
Antibiotics can kill bacteria that cause bacterial types of prostatitis. Men with acute bacterial prostatitis may need 14 to 30 days of antibiotics, starting with IV antibiotics in the hospital. Rarely, men need surgery to drain an abscess on the prostate.
Treating chronic bacterial prostatitis is challenging. You may need up to three (3) months of antibiotics to sterilize the prostate. If the prostate can’t be sterilized, low-dose antibiotics can be used long term to prevent recurrences. Some men need surgery to remove prostate stones or scar tissue in the urethra. Rarely, surgeons remove part or all of the prostate gland (prostatectomy).
The Pelvic Floor
One of the most important muscle groups in your body is probably one you have never heard of before.
The pelvic floor is a group of muscles that stretch like a hammock from the pubic bone at the front, to the coccyx (tailbone) at the back and from one ischial tuberosity (sitting bone) to the other (side to side).
A male’s pelvic floor muscles support his bladder and bowel. The openings from these organs (the urethra from the bladder and the rectum from the bowel) pass through the pelvic floor. The pelvic floor muscles wrap firmly around these passages to help keep them shut.
When the pelvic floor muscles are strong they help prevent the leaking of urine and faeces. The pelvic floor muscles also help with sexual sensation and function.
Your pelvic floor muscles may be too weak, and thus causing issues such as:
- leaking urine with activity, for example during running, jumping, coughing and sneezing
- a sudden and urgent need to pass urine
- leakage of stool from the back passage
- erectile dysfunction (the pelvic floor helps you to maintain erections).
- surgery for bladder or bowel problems
- being overweight
- persistent heavy lifting
- high impact exercise
- long-term, persistent coughing (such as smoker’s cough, bronchitis or asthma)
Pelvic floor muscles that are too tight (hypertonic), are known to cause such issues as:
- Bladder pain
- Pain while urinating.
- Frequent urination.
- Difficulty starting or maintaining a urinary stream
- Bowel symptoms
- Sexual dysfunction/pain
- Habitually holding in your urine or stool
- Injury or trauma to the pelvic muscles
- Muscular dysfunction caused by prolonged sitting, abnormal posture, irregular gait when walking or uneven pelvic bones.
- Other pain-causing conditions such as irritable bowel syndrome, anal fissures and painful bladder syndrome
- Butt Clenching
- Stress, depression and anxiety
The pelvic floor muscles for males are different than those of women and a proper diagnosis should come from a physiotherapist. Not only will this specialist be able to pinpoint whether your issue is caused by a too tight or too weak set of muscles but also what the best applicable treatment should be.
Most often, solutions may include:
- Pelvic floor exercises
- Bladder/Brain changes
- Change in posture
- Electro therapy
“There are a number of physical signs of kidney disease, but sometimes people attribute them to other conditions. Also, those with kidney disease tend not to experience symptoms until the very late stages, when the kidneys are failing or when there are large amounts of protein in the urine. This is one of the reasons why only 10% of people with chronic kidney disease know that they have it,” says Dr. Joseph Vassalotti, Chief Medical Officer at the National Kidney Foundation.
The kidneys are two bean-shaped organs. Each kidney is about the size of a fist. Your kidneys filter extra water and wastes out of your blood and make urine.
The primary function of your kidneys is to remove waste and extra fluid from your body. Kidneys also remove acid that is produced by the cells of your body and maintain a healthy balance of water, salts, and minerals—such as sodium, calcium, phosphorus, and potassium—in your blood.
Without this balance, nerves, muscles, and other tissues in your body may not work normally.
Your kidneys also make hormones that help
Kidney disease means your kidneys are damaged and can’t filter blood the way they should.
Diabetes and high blood pressure are the leading causes of kidney disease. Other factors that increase the risk of kidney disease include heart disease and a family history of kidney failure.
A person’s risk of kidney disease increases as they get older. The longer a person has diabetes, high blood pressure, or heart disease, the greater their risk of kidney disease.
The risk of kidney failure is especially high among African Americans, Hispanics, and American Indians, partially because these communities have high rates of diabetes and high blood pressure.
If you experience kidney failure, treatments include kidney transplant or dialysis. Other kidney problems include acute kidney injury, kidney cysts, kidney stones, and kidney infections.
The warning signs that you might have kidney disease that are associated with urination are:
- If you feel the need to urinate more often, especially at night, this can be a sign of kidney disease. When the kidneys filters are damaged, it can cause an increase in the urge to urinate. Sometimes this can also be a sign of a urinary infection or enlarged prostate in men.
- You see blood in your urine. Healthy kidneys typically keep the blood cells in the body when filtering wastes from the blood to create urine, but when the kidney’s filters have been damaged, these blood cells can start to “leak” out into the urine. In addition to signaling kidney disease, blood in the urine can be indicative of tumors, kidney stones or an infection.
- Your urine is foamy. Excessive bubbles in the urine – especially those that require you to flush several times before they go away—indicate protein in the urine. This foam may look like the foam you see when scrambling eggs, as the common protein found in urine, albumin, is the same protein that is found in eggs.
If you are experiencing any of these symptoms, it is important not to wait, and see your primary care physician as soon as possible. There is no cure for kidney disease but it, and its symptoms may be managed through diet, exercise, and or medication if diagnosed soon enough.
Living with HIV can also lead to medical complications regarding kidney disease. The issues can be related to the virus itself or due to the medications prescribed to treat it. Over the last few years, greater research into these problems have resulted in information that helps to not only combat kidney disease, predict which demographics are most likely to develop it, as well as monitor outcomes and change medications when necessary.
Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV. People on ART take a combination of HIV medicines (called an HIV treatment regimen) every day. HIV medicines are recommended for everyone who has HIV. Some HIV medicines can affect the kidneys. Health care providers carefully consider the risk of kidney damage when recommending specific HIV medicines to include in an HIV treatment regimen. If a person with HIV shows signs of kidney disease, their health care provider may adjust the dose of their HIV medicines or change which HIV medicines are included in their treatment regimen.
As a common practice, if you are living with HIV, your medical provider should be testing your kidney function with each lab draw and discussing with you the outcomes. But, you should make sure that you are aware of the signs of diminishing kidney function and alert your doctor as soon as you notice any changes.
The warning signs, symptoms and risks associated with kidney disease are exactly the same as those listed above, but those who are Black, of Latin American and Caribbean ancestry should pay extra close attention to these signs, as studies show they present a higher risk factor for developing kidney disease while living with HIV.
“Over 50% of Black people with end-stage kidney disease had high-risk variants of a gene called APOL1 in a recent UK study. These genes are most commonly found in people of West African and Caribbean descent, which may partly explain why people of Black ethnicity are three times more likely to develop end-stage kidney disease than White people. While these high-risk genes do not definitely mean that people who have them will develop end-stage kidney disease, it suggests that carriers of these genes need careful monitoring of their kidney function and good control of their HIV to reduce their risks of kidney damage.”
Before you go…
At some point, we all will have some type of issues urinating. This is a natural part of the aging process. When we are under the age of fifty (50) we still need to monitor our urine output and take time to periodically look at the colour and consistency of our liquid waste.
Other issues, like kidney pain, multiple bouts with STDs and high blood pressure are also risk factors for prostatitis and/or kidney disease that you should be on the look-out for. The sooner any of these medical concerns are diagnosed and treated, the better the long-term outcomes can be.