"Discomfort during urination, is it a prostate problem?"... Why you shouldn't take medication based solely on symptoms

When men experience discomfort while urinating, they often first think of 'benign prostatic hyperplasia.' However, symptoms such as frequent urination, waking up at night to go to the bathroom, or a weakening urine stream are not all caused by prostate problems. Caution is required because taking medication based solely on symptoms can actually worsen the condition or cause one to miss the optimal timing for treatment.

Frequent urination and weak urine stream: treatments differ completely depending on the cause

According to a video from Uihak Channel Biondwi, Professor Kim Seong-cheol of the Department of Urology at Ulsan University Hospital warns that it is dangerous to conclude a disease based only on urinary symptoms. Many patients assume it is unconditionally a prostate problem if they experience urinary discomfort, but in reality, the causes are very diverse.

For example, in the case of 'frequency' (frequent urination), it can occur because the bladder is sensitive, but it can also be a case where the volume of urine itself has increased simply because one drank a lot of water. For the former, medication that reduces bladder sensitivity can be helpful, but for the latter, simply controlling water intake is the fundamental solution. Additionally, the reason for frequent urination might be 'residual urine' (urine remaining in the bladder). While it can happen because benign prostatic hyperplasia is severe, it can also happen because the bladder's own contractility has weakened. If medication that makes the bladder less sensitive is given to a patient whose bladder strength is weak, causing residual urine, it could actually lead to a situation where they cannot urinate at all.

The symptom of a weakening urine stream is the same. If it occurs because the urethra is being pressed by benign prostatic hyperplasia, prostate medication will be effective, but if 'urethral stricture' (narrowing of the urethra itself) is the cause, surgical treatment is required rather than medication. Furthermore, the urine stream may feel weak if there is a habit of unconsciously straining while urinating, or if it is 'overactive bladder' where the bladder itself is small. As such, because the mechanisms are diverse even for the same 'weak urine' symptom, it is inappropriate to be prescribed prostate medication without an accurate diagnosis.

Nocturia (waking up at night): sleep quality is as important as bladder capacity

'Nocturia,' which involves waking up at night to go to the bathroom, is a factor that lowers the quality of life for many middle-aged and elderly people. Professor Kim Seong-cheol categorizes the causes of nocturia into two main types. First, when the amount of urine produced during sleep is greater than the capacity the bladder can hold. Second, when the bladder capacity is sufficient, but it occurs because the bladder is sensitive or the quality of sleep is low.

In particular, the correlation between sleep and nocturia is noteworthy. Patients who wake up at night even though the bladder is not full are highly likely to be suffering from sleep disorders that prevent deep sleep, rather than just having a bladder problem. This is because if one cannot sleep deeply, they wake up easily even at small bladder stimuli. In such cases, improving sleep quality through consultation with sleep specialists, in addition to a urological approach, can be the key to treating nocturia.

Types of urinary incontinence: identifying the relationship with the act of urinating comes first

'Urinary incontinence,' where urine leaks, also has completely different treatment directions depending on the pattern of symptoms. Professor Kim explains that when distinguishing urinary incontinence, it is most important to check 'whether it is related to the act of urinating.' For 'functional incontinence,' where urine leaks just before going to the bathroom, habit correction may take priority, but in cases where urine leaks while moving toward the bathroom due to difficulty in mobility, environmental improvements, such as placing a urinal nearby, may be more effective.

Additionally, for men, the symptom of urine leaking after they have finished urinating is due to urine remaining in the urethra, so an action of lightly squeezing the urethra from bottom to top, like squeezing toothpaste, can be helpful. On the other hand, 'urge incontinence,' which occurs because the bladder is excessively sensitive, is mainly treated with medication, while 'stress incontinence,' caused by weak muscle strength, considers surgical treatment. For 'overflow incontinence,' where the bladder is full and overflows because urine cannot be discharged, treatment that facilitates the urination itself must come first. As such, depending on the cause, treatments for urinary incontinence are clearly divided into habit correction, medication, and surgery.