The bathroom changes men think are normal – but shouldn't ignore

Millions of men notice changes in how they pee as they get older. They chalk it up to age, learn to live with it, and often don't mention it to anyone, not even their doctor.

That's exactly what concerns Dr. Katie Scott, a board-certified urologist with Intermountain Health.

"A lot of people wait until it's gotten so bad and they can't stand it anymore," she says. "Really, we would love to see people at the onset of symptoms."

The changes many men shrug off are often caused by an enlarged prostate, also called benign prostatic hyperplasia (BPH). It's one of the most common conditions men develop as they age. While it isn't cancer, waiting too long to get help can make treatment more difficult and, in some cases, permanently affect how well your bladder works.

What are the first signs of an enlarged prostate?

One reason an enlarged prostate often goes untreated isn't because men don't notice the symptoms. It's because they assume they're a normal part of getting older.

Many men watched their fathers or grandfathers deal with the same bathroom habits. Maybe Dad was always up during the night. Grandpa never passed up a rest stop. Friends now joke about having an "old man bladder." After seeing those patterns for years, it's easy to believe they're simply part of aging.

The symptoms also tend to appear gradually. Rather than noticing one dramatic change, men often adapt to a series of small ones.

You might notice:

• Your stream isn't as strong as it used to be.
• You're getting up once a night to pee. Then twice. Eventually, you can't remember the last time you slept through the night.
• You plan errands, meetings, or road trips around where you'll be able to find a restroom.
• It feels like your bladder never completely empties.
• You have to rush to the bathroom more often than you used to.

Before long, you've adjusted your routine without even thinking about it. You stop drinking water before bed, make one last trip to the bathroom before heading out the door, and instinctively choose the aisle seat whenever you can. Those habits become so automatic that they stop feeling unusual.

Dr. Scott often reminds patients that these changes aren't simply something they have to accept.

"If you're someone that knows every bathroom in the grocery store, that's not normal," she says. "You don't have to live like that."

Why does an enlarged prostate affect how you pee?

The prostate is a small gland that sits just below the bladder. The urethra, the tube that carries urine out of your body, runs through the center of the prostate.

As men get older, it's common for the prostate to slowly get bigger. When that happens, it can press against the urethra and make it harder for urine to flow.

Your bladder has to work harder to push urine through that narrowed space. That's why an enlarged prostate can cause a weaker stream, trouble getting started, more frequent trips to the bathroom, or the feeling that your bladder doesn't empty completely.

An enlarged prostate is one of the most common conditions men develop as they age, and family history can increase your chances of developing it. If your father or another close relative had an enlarged prostate, you may be more likely to experience it, too.

When should you see a doctor for an enlarged prostate?

Many men assume they'll seek treatment if their symptoms ever become severe. The problem is that the bladder may be changing long before that happens.

Dr. Scott explains that your bladder is a muscle, and every time you pee, that muscle has to work harder to push urine through the narrowed opening. It can keep up for a while, but years of extra work can eventually take a toll. The bladder may lose some of its ability to empty completely, even if the enlarged prostate is treated later.

"If your bladder is damaged enough, we can't reverse that," Dr. Scott says.

That's one reason she encourages men to come in when symptoms first appear instead of waiting until they're affecting every part of daily life.

Medication can often help relieve symptoms, and for many men it's an important part of treatment. As Dr. Scott points out, "The meds treat the symptoms, but they don't treat the actual problem, which is the enlarged prostate."

Regular follow-up with your provider can help make sure your treatment continues to meet your needs as symptoms change over time.

What are the treatment options for an enlarged prostate?

The first step is understanding what's causing your symptoms and how much they're affecting your life. Your provider may recommend tests to learn more about how well your bladder is working and whether an enlarged prostate is the cause.

From there, you'll talk through the treatment options that make the most sense for you.

"There are a lot of different things we can do to fix it," Dr. Scott says.

Some men do well with medication alone. Others may benefit from minimally invasive procedures that relieve the blockage with a shorter recovery than traditional surgery. Men with larger prostates or more advanced symptoms may need surgery, while others may be candidates for newer treatment options.

The best treatment depends on your symptoms, your overall health, and your personal goals.

Don't assume it's just part of getting older

If you're waking up several times a night to pee, avoiding long drives, or changing your daily routine because you're worried about finding a restroom, it's worth bringing those symptoms up with your primary care provider.

They can help determine whether it's time to see a urologist and discuss the treatment options that may be right for you.

At Intermountain Health, our urology experts work with men every day to understand what's causing their symptoms and develop treatment plans that fit their health, lifestyle, and goals. Whether your symptoms are new or you've been adapting to them for years, we're here to help you get back to living your healthiest life.

Visit Intermountain Health Urology to learn more or to find a provider.