At four o'clock in the morning in silence, a gentleman in his sixties, with a sleepy face and a faint smell of alcohol on his body, walked into the emergency department carefully supported by his partner. He began to describe his discomfort to the doctor: "Doctor, I am extremely unwell. Even though my bladder felt like it was going to explode, I just couldn't urinate......" he recalls, and after a few drinks with friends that night, he came home late at night feeling like he couldn't empty his bladder and his belly was swollen like a small mountain bag.
To his surprise, this sudden acute urinary retention was actually closely related to the urinary problems he had recently encountered. This problem he has been trying to ignore is actually a direct consequence of an enlarged prostate, a common condition that many older men may experience.
As soon as the diagnosis is confirmed, the emergency physician takes steps to insert a urinary catheter in the gentleman to allow the urine accumulated in the bladder to flow out slowly. Still, due to the swelling of the prostate, it would take him a few days to recover.
What are the commonly used medications to treat dysuria?
Voiding disorders are mainly caused by weakened bladder activity and obstruction of the urethra or prostate. Especially in middle-aged and older men, an enlarged prostate is the most common cause. The intravesical pressure in normal people is more than 60cm of water, while the intravesical pressure of middle-aged and elderly people is usually not more than 40cm of water.
When the prostate gland is enlarged due to hypertrophy, it is significantly more difficult to urinate in the setting of detrusor strength, especially if both conditions are present. Therefore, treatment for voiding disorders is feasible. For men, the problem is mainly related to the prostate, and for women, it is more related to urethral obstruction, bladder obstruction, and weakened bladder function. The biggest harm of urination disorders is the damage to bladder function, which can lead to hydronephrosis, recurrent infections and even kidney failure. Some middle-aged and elderly people need to rely on hemodialysis because it is difficult to urinate to kidney failure. Early intervention is effective in preventing severe bladder and kidney damage.
Long-term problems with urination can also lead to urinary tract infections and other complications such as bladder stones. Therefore, prompt treatment is essential to prevent these complications. There are three main classes of drugs used to improve dysuria: α-adrenergic receptor antagonists (eg, terazosin, Doxazosin and tamsulosin, etc.), tamsulosin selectively blocks the α1 receptors of the prostate and bladder neck, relaxes smooth muscle, and alleviates urodynamic obstruction, thereby improving urination;5α-reductase inhibitors, represented by finasteride, can reduce the volume of the prostate and relieve the symptoms of obstruction, especially when combined with α-receptor antagonists; and antibiotic treatment for urinary tract infection, according to the results of bacterial culture and drug susceptibility testing, appropriate antibiotics are selected, such as ofloxacin, Cephalosporins and penicillins are effective in treating urinary tract congestion and edema caused by infection.
α-receptor antagonists may cause a drop in blood pressure and are recommended to be taken at bedtime, finasteride has a slow onset of action and needs to be continued for 3 to 6 months, severe prostatic hyperplasia or other causes of voiding disorders may require surgery, and neurogenic bladder caused by diabetes mellitus and other disorders require targeted treatment.
Prostate health care methods:
Avoiding prolonged patient urination is key. Older people should act immediately if they feel the need to urinate to avoid a decrease in detrusor function caused by a persistent bladder fullness, which may lead to increased difficulty in urination and even acute urinary retention. At the same time, it is also important to avoid sitting for long periods of time.
It is also important to maintain a regular lifestyle. Avoid physical and emotional fatigue, learn to manage stress effectively, and face life's challenges with a peaceful attitude. Doing a moderate amount of outdoor activity when the sun is shining can help strengthen your physical fitness.
A nutritionally balanced diet is fundamental for older adults. It is recommended to have a balanced intake of animal and plant proteins, limit fat intake, and eat more green leafy vegetables, fruits and soy products. Eat whole grains as the staple food and ensure adequate dietary fiber intake. At the same time, eat more antioxidant foods, reduce the intake of spicy and irritating foods, and quit smoking and alcohol to prevent urinary retention caused by prostate congestion.
Finally, it is crucial to have a timely health check-up. It is recommended that men have a professional medical examination at least once a year after the age of 50 in order to detect prostate and other related diseases early. Once a diagnosis of urethral stones, urethritis or prostate problems is made, treatment should be done immediately and without delay.