I am an 85 year old man and have to pee often, sometimes ten times a night. I have to push with all my strength to get the urine past the prostate. But my urologist says it’s a bladder problem and doesn’t want to operate on my prostate. My PSA is low, so I don’t have prostate cancer. What should I do now?
Joris Bartstra, journalist with a medical degree.
If the PSA is low, the prostate is not enlarged. You have to let go of the idea of the prostate as the culprit, because it stands in the way of finding a solution. Peeing is a complicated process. When the bladder fills, the muscle cells of the bladder wall relax, while those of the bladder neck tighten. When you go to pee, this should suddenly reverse. That is a complicated task for the local nervous system that has to organize this. At a higher age, these kinds of coordination tasks sometimes run less smoothly. What you should not do is squeeze, because then the bladder neck will think: ‘The pressure is increasing, so I have to contract harder’. This makes urination even more difficult. You should sit down and try to relax. There are medications that help relax the bladder neck. There are also many drugs that make urination more difficult. It is best to discuss with the urologist whether this is the case with you, what exactly is wrong with the bladder, and what can help you with this.
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