Patient information · Urology and men's health
Prostate and urinary symptoms
what is normal ageing, and what is not
The prostate enlarges in most men from middle age onwards, and the resulting urinary symptoms are common, benign and treatable. They are not a sign of cancer — prostate cancer usually causes no symptoms at all, which is precisely why the testing conversation is worth having separately and properly.
Go to an emergency department immediately if you
- cannot pass urine at all and your bladder feels painfully full
- have visible blood in the urine, particularly with clots
- have fever, shivering and pain in the lower abdomen, back or perineum
- have sudden severe pain in the loin or groin
- have new back pain with leg weakness or numbness, or loss of bowel or bladder control
Acute urinary retention is painful and needs a catheter urgently — do not wait it out overnight. New back pain with neurological symptoms in a man with known prostate cancer is a spinal emergency. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
The two groups of symptoms
- Storage symptoms — going frequently, urgency, getting up at night, and occasionally leaking before reaching the toilet.
- Voiding symptoms — a weak or hesitant stream, straining to start, stopping and starting, dribbling at the end, and a feeling of incomplete emptying.
- Most men have a mixture. Keeping a three-day bladder diary — times, volumes, and what you drank — is genuinely the most useful thing you can bring to an appointment.
Practical measures that work
Helps
- Reducing caffeine and alcohol, both of which irritate the bladder
- Stopping fluids two hours before bed, while drinking normally through the day
- Double voiding — waiting a moment and going again
- Treating constipation, which presses on the bladder
- Bladder training to extend the interval gradually
Worth reviewing
- Diuretics taken in the evening rather than the morning
- Decongestants and some antihistamines, which worsen retention
- Drinking large volumes late at night
- Fizzy drinks and artificial sweeteners in some men
- Being significantly overweight
The PSA test
PSA is a blood test that can help detect prostate cancer early, but it is not a straightforward screening test and there is no national screening programme, because the harms and benefits are finely balanced.
- A raised PSA does not mean cancer. It rises with benign enlargement, infection, recent ejaculation, cycling and catheterisation.
- A normal PSA does not exclude cancer. A proportion of significant cancers occur with a normal level.
- Testing may lead to biopsies and to finding slow-growing cancers that would never have caused harm, with real treatment side effects.
- It also finds aggressive cancers early, when they are curable.
- Avoid ejaculation and vigorous exercise for 48 hours before the test, and do not test during or shortly after a urine infection.
Men over 50 can request a PSA test after a discussion of these trade-offs. That threshold is lower — from 45 — for black men and for men with a father or brother diagnosed with prostate cancer, both of whom carry substantially higher risk.
Treatment for benign enlargement
- Alpha blockers relax the muscle at the bladder neck and work within days. Dizziness on standing and retrograde ejaculation are the common side effects.
- 5-alpha reductase inhibitors shrink the prostate over months and reduce the need for surgery. They halve the PSA reading, which must be accounted for in interpreting future tests.
- The two are often combined for larger prostates.
- Surgical and minimally invasive options exist for men whose symptoms are not controlled, or who develop retention, stones or kidney problems.
Book an appointment if urinary symptoms are affecting your sleep or daily life, you want a PSA discussion and test, you have blood in your urine, or you would like an examination and ultrasound assessment of bladder emptying. We offer urology, imaging and blood tests on site, seven days a week.
PSA, ultrasound and urology on site
Discreet men's health appointments seven days a week on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.