Treating urinary symptoms

Information for the public

Medicines
Catheters
Treating urinary retention
Surgery

Treating urinary symptoms

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options covered in this information, please talk to a member of your healthcare team.

Urinary symptoms can often be improved using self‑help methods or products that help to manage the symptoms. If these don't help enough or aren't suitable, there are medicines that may be able to ease the symptoms. In some circumstances, surgery may be an option.

Depending on the type of symptoms you have, you may be able to manage them yourself. Your healthcare professional should explain what you can do to improve your symptoms – for example, by using a technique called urethral milking. This empties the urethra, which helps prevent drops of urine leaking after you finishing urinating. You can improve symptoms of an overactive bladder (see storage symptoms) by bladder training (which involves increasing the time between wanting to urinate and actually urinating), and changing how much or when you drink fluids.

If you have storage symptoms such as incontinence, your healthcare professional should offer you a range of products that help to manage these symptoms by, for example, absorbing urine in a pad or collecting it in a small bag that can be emptied when it is convenient for you. This would depend on your circumstances and what you prefer. Your healthcare professional should offer you these products until you have discussed and made a plan for how to manage your symptoms. They should not generally be a long‑term solution, unless other treatments don't help.

If you have stress incontinence (see storage symptoms) caused by an operation to remove all or part of the prostate, your healthcare professional should offer to teach you exercises to train and strengthen your pelvic floor muscles (the muscles that support your bladder). The exercises can take a while to have an effect, so you should try them for at least 3 months before moving on to other options.

Questions you might like to ask about managing urinary symptoms

What can I do to improve my symptoms?
What kinds of products are available to help with incontinence?

Medicines

If the methods described so far don't help to manage your urinary symptoms or aren't suitable for you, your healthcare professional may offer you medicine. This may include the medicines described in the table below (or combinations of these) depending on your symptoms, any other conditions you have and any other medicines you are taking.

What medicine might my doctor offer?	How does this work?
Alpha blocker	By relaxing the muscle in the prostate gland and at the base of the bladder, making it easier to pass urine.
Anticholinergic	By relaxing the bladder muscle if it is overactive.
5-alpha reductase inhibitor	By shrinking the prostate gland if it is enlarged.
Diuretic*	By speeding up urine production. If taken during the day, it reduces the amount of urine produced overnight.
Desmopressin*	By slowing down urine production so less urine is produced at night.
* These medicines have not been 'licensed' (approved) specifically for treating urinary symptoms in the UK. If you are offered these, it will be an 'off‑label' use of the medicine. Your healthcare professional should make sure you understand the risks and benefits before agreeing to treatment. In the UK, medicines are licensed to show that they work well enough and are safe enough to be used for specific conditions and groups of people. Some medicines can also be helpful for conditions or people they are not specifically for. This is called 'off‑label' use. Off‑label use might also mean the medicine is taken at a different dose or in a different way to the licence, such as using a cream or taking a tablet. There is more information about licensing medicines on NHS Choices.

If you take any of these medicines, your healthcare professional should ask you to go for regular check‑ups to check how well they are working and find out if they are causing any unwanted effects.

You will not normally be offered a medicine called a phosphodiesterase‑5‑inhibitor, unless you are taking part in a clinical trial. This is because it isn't clear how helpful they are for men with urinary symptoms.

There is more information about clinical trials on NHS Choices.

Your healthcare professional should not offer you homeopathy, herbal treatments or acupuncture (a type of complementary therapy using needles) to treat urinary symptoms. This is because there is not enough reliable evidence about how well they work or how safe they are. Herbal treatments may also cause side effects or interact with other medicines.

Questions you might like to ask about medicines

Why have you offered me this type of medicine?
How will it help my symptoms?
Are there any possible side effects?
How often do I need to come for check‑ups?
What are my options if this medicine doesn't work?

Catheters

If the methods described so far do not manage your symptoms well enough, your healthcare professional may offer you a catheter. A catheter is a soft tube that carries urine to the outside of the body from the bladder. It can pass through your urethra, or through a small hole made in the abdomen above your pubic bone. For some men, it can be passed through the urethra just when you need to empty the bladder (this is called intermittent catheterisation). This is something that you or a carer can learn to do. It can be more convenient and you may prefer it to having a permanent catheter. However, some men may need a catheter in place permanently. Your healthcare professional should discuss this with you, and explain the benefits and risks.

Treating urinary retention

Urinary retention is when someone regularly cannot empty their bladder completely (chronic retention) or cannot empty their bladder at all when it is full (acute retention).

If you have acute retention, you should be given a catheter (see above) straight away to drain the urine from your bladder. Before the catheter is removed, you should be offered a medicine called an alpha blocker. This relaxes the muscle around the prostate gland and the base of the bladder so that it is easier to pass urine when the catheter is removed. It should also help to prevent the retention happening again.

Chronic retention can make urine back up into the kidneys, which can cause damage. So if you have chronic retention, your healthcare professional should offer you some tests to check how well your kidneys are working, and may offer you a catheter or possibly surgery.

Surgery

Most men with urinary symptoms do not need to have surgery, but it may be an option for some men if other treatments have not worked. There are several types of surgery that may be appropriate. If your healthcare professional thinks surgery may help you, they should tell you about alternatives, and explain the benefits, risks, limitations and long‑term effects of any operations they are offering.

The procedures that you may be offered are described in the tables below.

Surgery for voiding symptoms

What is the operation called?	What is it?	Who is it suitable for?
Transurethral resection of the prostate (TURP), transurethral vaporisation of the prostate (TUVP), holmium laser enucleation of the prostate (HoLEP), and transurethral incision of the prostate (TUIP)	Removing part of the prostate gland, generally using a tube that passes through the urethra	Men who have an enlarged prostate. The most suitable procedure partly depends on the size of the prostate gland
Open prostatectomy	Removing the prostate gland through a cut in your body	Men who have an enlarged prostate, over a certain size

Surgery for storage symptoms

What is the operation called?	What is it?	Who is it suitable for?
Cystoplasty	Increasing the size of the bladder by sewing a piece of tissue from the intestine into the bladder wall	Men whose bladder muscle contracts before the bladder fills^a
Botulinum toxin	Injections of botulinum toxin into the walls of the bladder^b	Men whose bladder muscle contracts before the bladder fills^a
Implanted sacral nerve root stimulation	A small electrical device that is implanted under the skin and sends bursts of electrical signals to the bladder and urine system for better control	Men whose bladder muscle contracts before the bladder fills
Urinary diversion	Linking the tubes that connect the kidneys to the bladder (the ureters) directly to the outside of the body, so the urine can be collected without flowing into the bladder	Men whose symptoms cannot be managed by self‑management and medicine, and who cannot have, or do not want, cystoplasty or sacral nerve root stimulation
Artificial sphincter	An adjustable inflatable cuff fits around the urethra, close to the join with the bladder, and stops urine leaking involuntarily	Men with stress incontinence
^aIf you have this procedure you need to be able and willing to insert a catheter yourself because it can lead to problems fully emptying the bladder. ^b Botulinum toxin has not been 'licensed' (approved) for this use in the UK. If you are offered botulinum toxin, it will be an 'off‑label' use of the medicine. Your healthcare professional should make sure you understand the risks and benefits before agreeing to treatment. In the UK, medicines are licensed to show that they work well enough and are safe enough to be used for specific conditions and groups of people. Some medicines can also be helpful for conditions or people they are not specifically for. This is called 'off‑label' use. Off‑label use might also mean the medicine is taken at a different dose or in a different way to the licence, such as using a cream or taking a tablet. There is more information about licensing medicines on NHS Choices.

There are some surgical options that your healthcare professional should not offer you, or should only offer as part of a clinical trial (research). This is because there is not enough evidence about how well they work compared with existing effective techniques. For further details, please refer to the short version of the guideline, which is available on the NICE website.

Questions you might like to ask about surgery

Why do you think I need to have an operation?
Please tell me about the procedures that might be suitable.
Are there any alternatives to surgery?
What are the benefits, limitations and risks of this operation?