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The Prostate and Male urine leakage

While the prostate and incontinence ‘isn’t the sexiest of cocktail party topics,’ it’s important to know how one impacts the other. To clear up any confusion on the issue, we sat down with Ralph Peeker, Professor and Chief Physician at the Department of Urology, Sahlgrenska University Hospital, Gothenburg.

Illustrated icon of a walnut apricot kiwi and lemon with their weight on the left hand side

At 18-20 years, the male prostate is around 20 grams, or the size of a walnut. It can grow up to 500 grams.

Your prostate, it’s like a walnut

First things first. How much do you know about your prostate gland? Situated in between the bladder and the penis, its main job is to produce a fluid that combines with sperm to make semen. In your twenties, your prostate is around the size of a walnut, or about 18-20 grams.

Like your ears, your prostate never stops growing

The good thing to know is that prostate growth is normal. ‘For some men their prostate grows a little bit. For others, a little bit more and, for some men, a whole lot more – it can grow up to half a kilogram,’ says Peeker. Often prostate growth goes unnoticed. But for some men an enlarged prostate, or benign prostatic hyperplasia (BPH), can cause pain and range of symptoms including difficulties storing urine, hesitancy, slow stream, inability to void or residual urine which can lead to infection. Known as lower urinary tract symptoms (LUTS) it’s quite common, affecting around 25% of men 40 years and older. With good treatments available it doesn’t need to affect your quality of life.

An enlarged prostate doesn’t mean cancer

According to Peeker it’s a ‘very common misconception’ to think that LUTS are a symptom of prostate cancer. While there are not so many early warning sign of prostate cancer, family history and diet can both be risk factors. The first step in checking is via a simple blood test known a PSA test.
Interestingly, prostate cancer grows slowly in a lot of cases. That’s why active monitoring is often a preferred management rather than surgery where incontinence, amongst other things, can be a side effect. Stress incontinence, which more commonly affects women, can be a temporary, or permanent, side effect of pelvic surgeries like a prostatectomy. This surgery involves removing the entire prostate which can disrupt the sphincter function and result in urine leakage. There are medicines and surgeries available to help ease, if not cure this. In mild cases, pelvic floor exercises, which help to strengthen your pc muscles, can help improve your bladder control and reduce urine leakage. Regardless, if you’re concerned about any symptoms, testing or risks related to prostate cancer, it’s best to chat to your doctor so you’re well informed. 

‘The prostate is often not the guilty organ’

While an enlarged prostate can cause some urination problems, Peeker says we need to look beyond the pelvic region and to the brain when it comes to the main cause of male incontinence. 
Your central nervous system is responsible for governing your ‘micturition reflexes’, or the ability to hold on when you need to go to the toilet. These critical circuits in the brain can be disrupted when you experience a trauma such as a brain injury or a stroke, resulting in the involuntary drips and dribbles some men experience. Known as urgency incontinence, it’s the most common form of male incontinence.  
But the disruption doesn’t even have to be as severe as a stroke. ‘It could be a minor disruption of blood and oxygen to the brain based on general atherosclerosis,’ says Peeker. 
Where atherosclerosis is the hardening and narrowing of the arteries caused by smoking, a poor diet and inactive lifestyle. And while a bad diet hasn’t been clinically proven to cause incontinence, a healthy diet and active lifestyle can only be beneficial. ‘Everything gets better when it comes to the oxygenation of tissues in the body,’ adds Peeker.
As for Peeker’s advice; ‘If I had a symptom of any kind, I would seek help for it.’ So if you do have any questions regarding the prostate and urinary incontinence, have a chat with your doctor.

For some men their prostate can grow up to half a kilogram.

Ralph Peeker
Professor and Chief Physician

Did you know

One in four men between 40 years and over experience lower urinary tract symptoms.

Illustration of four men with one shaded a lighter blue one in four

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