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Urology/Can you explain the bladder pain related to the enlarged prostate?


The Cystoscopy found my bladder outlet has obstruction (BOO problem) due to the enlarged prostate. The CT scan indicates mildly enlarged prostate, indenting the base of the urinary bladder. No bladder wall thickening. I have no frequent urination at night or difficult urination. The main symptom is bladder pain, fullness and pressure above the pubic bone, just like the bladder pains and fullness when it fills with urine. When I bend down resulted in the bladder is pressed, the pain even gets worse. Sometimes even hard coughing can have the bladder area hurt. The doctor has already ruled out bladder or prostate cancer by the Cystoscopy and prostate biopsy. The Alpha Blockers only help smooth urine (actually my urine flow is not bad and I do not have to take it) but no effect on the relief of the bladder pain. The Oxybutynin, however, can relieve the bladder pain. The walking exercise can also relieve the bladder pain. Can you explain this kind of the bladder pain that is related to the BOO and enlarged prostate and how to effectively treat it? Thank you for your answer.

Randy, an enlarged prostate from benign prostatic hyperplasia (BPH) will NOT cause bladder pain.  BPH occurs to some degree in all men as they age.  Before answering your question specifically about your pain, let me attach part of a "macro" I have written on BPH for your information:

The prostate surrounds the urinary canal (urethra) just after its connection to the urinary bladder.  Inward growth of the prostate either into the bladder neck (opening) or into the urethra itself can cause difficulty with urinating.  The prostate is checked by digital examination through the rectum.  This gives the doctor an idea as to the size and benignity of the gland.  However, it does not always correlate to symptoms as a small gland may have significant inward growth and a large glands enlargement may be entirely peripheral.   

The ability to urinate involves the urinary bladder muscle actually becoming stronger as it works against increasing resistance from the prostate.  This delicate balance can be upset by any factor that decreases the bladder muscles ability to contract with sufficient force to open the prostate (such as medications, anesthesia, too much alcohol, ignoring the desire to urinate, etc.) or those factors that might cause the prostate to suddenly swell (ie acute prostatitis, sitting  for extended periods of time, biking, horseback riding, etc.). The typical symptoms that occur include diurnal frequency (daytime), nocturia (night-time frequency), urgency, hesitancy, slow stream and dribbling after voiding.  This complex of symptoms is termed “prostatism”.  From your history, you do not seem to have this symptom complex.  If the obstruction to flow progressively worsens, the bladder eventually may not be able to empty completely.  This leads to the accumulation of “residual urine” which may predispose to urinary infections and  kidney damage from back pressure.

However, relatively asymptomatic men with BPH do NOT necessarily require therapy.  Treatment is indicated to relieve symptoms and prevent complications.  In many cases medications can be used.  Alpha - blockers (ie Hytrin, Cardura, Flomax, Uroxatral etc.) work by relaxing the bladder neck and urethra so the pressure generated by a bladder contraction has less resistance to work against.  Natural herbal products such a saw palmetto and pygeum often provide symptomatic relief but the exact mechanism of action has not yet been defined.  The prescription drugs Proscar and Avodart actually shrink the prostate.  They work best in the larger glands and improvement may not be noted for up to 6 months.   In cases refractory to medication, interventional measures are indicated.  The “gold standard” for treatment is the time honored transurethral resection (TUR) of the prostate.  For huge glands, open surgery may be necessary.  In the past decade a number of other less invasive interventional therapies have been developed to reduce the obstructing prostate tissue utilizing various forms of energy.   These include laser prostatectomy, microwave (TUMP or transurethral microwave of the prostate), and radiofrequency (TUNA or transurethral needle ablation of the prostate).  TUMP is actually a minimally invasive, out-patient treatment that can be tried initially if the patient's gland size is appropriate.  

Now a bit about your bladder pain.  I cannot tell you the exact cause.  However, the fact that your pain is relieved by oxybutinin gives some clues.  This medication is an anti-spasmotic that works by relaxing the bladder muscle.  Therefore, something is going on that is causing the detrusor (bladder muscle) to spasm.  Usually this is a local inflammatory process in the bladder area or pelvis.  Common causes would be an inflammation of the prostate gland (so called prostatitis), a condition somewhat difficult to diagnose called interstitial cystitis (which can occur in men but is more common in women), and inflammatory processes in your pelvis adjacent to the bladder - such as inflammatory bowel diseases.  Of these, prostatitis would b the most common.  I suggest you discuss this further with your urologist or seek a second opinion as I do not believe BPH is causing the bladder pain.  Good luck.


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Arthur Goldstein, M.D.


Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.


I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

American Medical Association, American Urological Association, American College of Surgeons

College degree - BS Medical degree - MD Master of Science - MS

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