What is the relationship between prostate enlargement and lower abdominal pain?
Prostate enlargement (benign prostatic hyperplasia, or BPH) can sometimes be associated with lower abdominal pain due to the impact it puts on the urinary tract. That’s the connection:
Urinary Retention and Bladder Distension: When the prostate gland enlargement obliterates the urethra, it can render emptying of the bladder difficult. This leads to urinary retention, or the build-up of urine in the bladder. Over time, the bladder becomes distended (stretched) due to this, and this can lead to pain or discomfort in the lower abdomen. The more severe the degree of bladder stretching due to retention, the more severe the pain will become.
Increased Pressure on the Bladder: As the prostate enlarges, the bladder has to work harder to push the urine through the narrowed urethra. The increased pressure may cause pain or dragging sensation in the lower abdomen. Pain is more noticeable when the bladder is full or when one attempts to pass water but cannot empty the bladder completely.
Urinary Tract Infections (UTIs): Recurrent lower urinary retention and partial voiding can predispose to urinary tract infection. UTI can cause pain or burning on lower abdomen, etc., and other symptoms including urgency, frequency, and cloudy urine.
Prostate Inflammation: Sometimes, the enlarged prostate becomes inflamed (prostatitis), which in turn causes lower abdomen or pelvic region pain, sometimes which can be more akin to pressure or ache.
Straining to Urinate: Straining to urinate because of the blockage caused by the enlarged prostate places additional pressure on the lower abdomen and leads to discomfort or pain.
If a person is experiencing repeated lower abdominal pain and also along with it the signs of enlarged prostate (such as frequent urination, weak urine stream, or straining while urinating), it is strongly recommended to see a doctor. The pain could be because of complications such as bladder distension, urine infection, or prostatitis that may require medication.
Prostate enlargement (most commonly because of benign prostatic hyperplasia or BPH) can lead to urinary incontinence, which is involuntary leakage of urine. While the main symptoms of BPH are related to the effort of urinating (e.g., weak stream, hesitancy, nocturia), incontinence can also occur because of the changes in the urinary system because of prostate enlargement. This is how prostate enlargement can lead to urinary incontinence:
Mechanisms of Urinary Incontinence Associated with Enlargement of the Prostate:
Obstruction of the Urethra:
The tube through which the urine escapes from the bladder is called the urethra. The prostate surrounds the urethra. With enlargement of the prostate, the prostate can compress or obstruct the urethra, thus it becomes harder for the urine to pass through normally. This could lead to incomplete emptying of the bladder.
If the bladder cannot empty, it may deposit residual urine behind and increase bladder pressure. The increased pressure can result in urge incontinence (an urgent, severe feeling to void but inability to void).
Bladder Dysfunction
Enlargement of the prostate may result in overactivity of the bladder. The bladder may become irritated and hyperactive due to obstruction by the enlarged prostate, resulting in frequent contraction of the bladder or forceful contraction, particularly when the bladder is not full. Such contractions, even when the bladder is not full, may result in urge incontinence.
Over time, this repeated irritation may result in weakening of the bladder’s ability to hold urine, resulting in leakage.
Weakening of Pelvic Floor Muscles
In some men with prostate enlargement, the muscles of the pelvic floor (which help control release of urine) may weaken or become dysfunctional, either as a result of the prostate enlargement or as a surgical or other therapy complication for BPH (such as transurethral resection of the prostate or TURP).
Weak pelvic floor muscles are unable to adequately support the bladder, resulting in stress incontinence (leakage of urine when coughing, sneezing, laughing, or exerting physical pressure on the bladder).
Post-Surgical Incontinence:
Surgical repair of an enlarged prostate, such as TURP or laser prostatectomy, may in some instances cause temporary or permanent urinary incontinence. During surgery, the prostate is severed or resected, but along with it, nerves, tissue, or bladder control structures are also destroyed. At times, it causes stress incontinence.
Prostatectomy, or removal of the prostate, has a higher risk of long-term incontinence, though the majority of men regain bladder control in the long term.
Increased Risk of Urinary Tract Infections (UTIs):
Chronic urinary retention due to prostate enlargement increases the risk of urinary tract infections. UTIs can cause symptoms such as urgency, frequency, and incontinence, which further add to incontinence symptoms of prostate enlargement.
Impaired Function of the Sphincter:
The external urethral sphincter’s role is to keep the urethra closed and prevent urine leakage. An enlarged prostate can disrupt the normal functioning of this sphincter, resulting in the inability to control urination and in causing incontinence.
Types of Urinary Incontinence Related to Prostate Enlargement:
Urge Incontinence:
Due to irritation or overactivity of the bladder, urge incontinence occurs by way of abrupt and uncontrollable needing to urinate with leakage preceding being able to get to the bathroom.
Stress Incontinence:
Occurring when force (e.g., sneezing, coughing, or heavy lifting) leaks urine out, stress incontinence increases post-prostatectomy, though it also can occur through weakening of pelvic muscle due to secondary chronic retention.
In chronic urinary retention, the bladder may become overdistended and unable to empty. This may result in ongoing dribbling of urine since the bladder is too full to hold any more. This is because the bladder is not able to contract properly due to prolonged obstruction.
Mixed Incontinence:
Certain prostate enlargements in men can be linked with a combination of urge and stress incontinence, referred to as mixed incontinence. This occurs when bladder overactivity and reduced muscle strength of the pelvic floor lead to urine leakage.
Risk Factors for Urinary Incontinence Secondary to Prostate Enlargement:
Age: BPH and urinary symptoms increase with increasing age, thus making urinary incontinence more probable.
Severity of Prostate Enlargement: More severe enlargement may lead to more significant urethral obstruction with more severe urinary retention and incontinence.
Prostate Surgery: Hospital admission for BPH treatment may result in transient or permanent incontinence, particularly following surgery like TURP or prostatectomy.
Pre-existing Bladder Dysfunction: Individuals with a pre-existing degree of bladder dysfunction, such as a history of urinary retention or bladder infection, have a greater likelihood of developing incontinence.
Treatment of Urinary Incontinence Due to Prostate Enlargement:
Treatment for urinary incontinence caused by prostate enlargement typically involves a combination of lifestyle change, medication, and, in some cases, surgery:
Medications: Alpha-blockers (such as tamsulosin) calm the bladder neck and prostate, facilitating urination and reducing retention. 5-alpha-reductase inhibitors (such as finasteride) can reduce the size of the prostate with extended use.
Pelvic Floor Exercises: Relaxation of the muscles of the pelvic floor with exercises such as Kegels may improve bladder control and reduce stress incontinence.
Surgical Treatment: In men with severe symptoms or complications, surgical intervention like TURP or laser treatment can relieve the obstruction, but these will occasionally cause temporary or permanent incontinence.
Lifestyle Changes: Reducing fluid intake, fluid restriction, and voiding schedules can reduce the severity of incontinence.
If urinary incontinence occurs in the context of prostate enlargement, it is important to consult a healthcare provider for appropriate diagnosis and treatment regimen.