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Urology/Bladder distention and spasms due to the enlarged prostate

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QUESTION: I have been diagnosed mild enlarged prostate, about 30 grams at early 50s. Though the cystoscopy detects the bladder neck has obstructions due to the enlarged prostate, the post-void residual urine is 26 ml. The symptom is bladder distention and spasms, feeling pressure in the bladder but no urine urgency problem. The alpha 1 blockers have no help to relieve the bladder distention and spasms. Can you explain why the enlarged prostate and bladder neck obstructions can cause the bladder distention and spasms (maybe overactive bladder) and what medication as well as herbs is effective to relax the bladder muscles and treat the bladder distension and spasms? Thank you for your answer.

ANSWER: Ray:

Since the post void residual measured only 26 ml, there is probably no actual high residual.  Alpha 1 blockers would not be expected to work on any sensation of bladder distension or spasms; they work to relieve some of the obstruction from the bladder neck and prostate.

Whent he prostate is enlarged and clogs the channel, the bladder can react in several ways including overfilling and spasms or cramps.  

You did not indicate any flow issues or flow testing so we will assume your flow is OK.  You may just have a type of overactive bladder.  If so, various medications are available for bladder overactivity and might be worth a try.  Avoid caffeine as it is irritating to the bladder and can make spasms worse.  There are no proven herbs or nutrition supplements that will help.  

Now go talk to your urologist and get treated.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your answer. The urine flow is only a little difficulty in the morning, the first urination. The doctor said the BPH is in the early stage, 5x6.1cm according to the CT. The Alpha 1 blockers cannot relieve the bladder distention and pain in the pubic area but only helps the urine flow easier in the morning. The doctor has prescribed Oxybutynin. It can relieve the bladder distention and pain. It also helps urine flow a little easy in the morning. I wonder whether the BPH/bladder neck obstructions can cause the overactive bladder or they are unrelated. Can you explain it?

Answer
Ray:

Blockage to the urinary flow can stimulate the bladder to push harder which can cause overactive bladder type problems.

Oxybutynin does not relieve bladder distention.  It causes bladder relaxation.  If this is helping your problem, then you may not have actually had bladder distentino at all; just spasms.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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