Thursday, September 3, 2009

When nature calls ... a little too often

Frequent urination could indicate an enlarged prostate

Eveline Gan

FIVE years ago, Felix (not his real name) began to urinate more frequently. He initially brushed it off as work stress or another sign of ageing. He was then 56 years old.

Then, his trips to the toilet - which took place every half an hour - began to affect his daily routine. Locating the nearest toilet became top priority.

"It was so inconvenient. I became afraid of travelling or even doing simple things like watching a movie. When I had to take a flight, I would book seats by the aisles so my regular trips to the toilet wouldn't disturb my fellow passengers," said the 61-year-old architect.

For many older men, such annoying and embarrassing experiences are a sign of an enlarged prostate, a condition known as benign prostate hyperplasia in medical speak.

Aside from frequent runs to the toilet, another symptom is having a slow urine stream. This means that sufferers will take a longer time to urinate.

Without treatment, the problem gets progressively worse, said Dr Michael Wong, president of the Singapore Urological Association.

"It doesn't go away on its own. A man's lifestyle can be completely changed because of his need to go to the toilet so often," he said.

"In the worst case scenario, the bladder builds up and the man is unable to pee. He will have to rush to the hospital so the urine can be drained." Dr Wong added. This occurs in about 3 per cent of patients.

Aside from frequent runs to the loo, another symptom of an elarged prostate is slow urine stream.


Prostate enlargement is one of the most common urological problems in men over 50. One in two will get it and by 60, about two-thirds of men will be affected, said Dr Wong. 

For men, urine flows from the bladder through the urethra. The prostate - a walnut-sized male organ that adds lubrication to semen - sits at the "front door" of the bladder.

With age, the prostate becomes larger, obstructing the urinary tract, Dr Wong explained. 

Besides having to live with the symptoms, sufferers are at greater risk of contracting urinary tract infections.

"Every time the bladder is not emptied completely, stale urine is left behind and this can cause infections," explained Dr Wong.

Sometimes, an enlarged prostate may be an indication of prostate cancer. If so, the symptoms will only surface during the advanced stages of cancer.


Most men delay seeking medical attention until their daily routines are affected, said Tan Tock Seng Hospital's nurse clinician Heng Lee Choo, who has 12 years' experience in counselling patients with enlarged prostate.

She said that many of them have a fatalistic mindset.

"They believe it's a part of the ageing process, and that there's nothing they can do about it. Plus, such problems are not something you'd discuss with anyone," said Ms Heng.

What men fear the most, added Ms Heng, is hearing that they need surgery.

"They are usually worried. Most of them don't even know where their prostate is. They think the doctor will cut into their penis or abdomen, or remove their testicles," she said.

In mild cases, surgery is not necessary. In fact, there's less need to operate with the roll-out of advanced drugs that help to shrink the size of the prostate and alleviate symptoms, said Dr Wong.

He added that current medication for an enlarged prostate also reduces a man's chances of getting prostate cancer by up to 24 per cent. With medication, the success rate is about 85 per cent.

Only when medication fails or there are complications will surgery be required. It usually involves a tiny tube being passed through the urethra to remove the prostate. The good news is, with current technology, prostate surgery is "virtually bloodless", Dr Wong said.

For Felix, timely medical attention and medication have helped him recover swiftly.

From TODAY, Health – Tuesday, 11-Aug-2009