Symptom guide

Weak urine stream, trouble urinating or up at night: is it your prostate?

Standing at the toilet waiting for the stream to start, a flow that trickles or stops and starts, and two or three trips every night are among the most common reasons men come to see us. Often the cause is an enlarged prostate, and there is a lot our urologists in Marietta, Canton and Jasper can do about it.

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Which symptoms point to the prostate?

• Waiting for the stream to begin, or having to push
• A flow that is weak, sprays or stops and starts
• Dribbling after you think you are done
• Feeling the bladder still is not empty
• Going again soon after you just went
• Waking at night to urinate, often more than once

The prostate is a walnut-sized gland tucked under the bladder, wrapped around the urethra. As it grows with age, a condition called benign prostatic hyperplasia (BPH), it can narrow that channel. The bladder then works harder to push urine out, and over time it can become irritable and less able to empty.

Could something other than the prostate be causing it?

Yes, which is why a check matters. A narrowed urethra from scar tissue, an infection, an overactive bladder, diabetes, some cold and allergy medicines, and evening fluids or alcohol can all cause similar symptoms. Night-time trips in particular are often linked to sleep apnea or swollen ankles whose fluid returns to the bloodstream once you lie down. Women with night-time trips can read our bladder leakage and frequent urination page.

When is it urgent?

If you cannot pass urine at all, or you have a painful, swollen lower belly, go to an emergency department; the bladder may need to be drained. Fever with urinary symptoms or blood in the urine also calls for prompt care.

What happens at the visit?

• A short symptom score questionnaire, so we can track change over time
• A urine test to rule out infection or blood
• A quick bladder scan to measure what is left after you urinate
• A prostate exam and usually a PSA blood test
• Imaging of the prostate's size and shape when a procedure is being considered

These steps can usually begin at the office where you start, and any procedure is scheduled at our Marietta Clinic & Surgery Center.

What can I change at home?

Small habits help many men: finish most drinks two to three hours before bed, ease up on evening coffee, tea and alcohol, empty the bladder twice before sleep, and ask whether any of your current medicines could be adding to the problem. Track your night trips for a week before your visit.

What enlarged prostate treatment do our urologists offer?

• Medicines that relax the prostate and bladder neck, or that shrink the gland over months
• UroLift, which holds the prostate tissue open with small implants, done as an outpatient procedure; our enlarged prostate doctor page compares it with the other options
• Aquablation, a water-jet procedure that removes prostate tissue
• TURP and ThuLEP, procedures that remove the tissue blocking the channel from the inside
• Robotic simple prostatectomy for very large glands

Which one fits depends on the size and shape of your prostate, how strong your bladder is, other health issues and what matters to you, including protecting sexual function. Procedures take place at our Marietta surgery center, and your follow-up can return to Canton or Jasper. Our enlarged prostate (BPH) page explains each option further, and men with a large prostate who would rather avoid surgery can read about prostate artery embolization, which Advanced Urology performs at its Alpharetta and Decatur locations.

Where can I be seen for this?

• Marietta Clinic & Surgery Center, 1371 Church Street Extension NW, Marietta, GA 30060. Seen here for this concern: Jason Lomboy, MD, Andy Ostrowski, MD, Daniel Roberson, PA-C, Amanda Boulos, PA-C, Ionela Turcin, PA-C, Britany Howard, FNP. Procedures for all four offices happen in this building.
• Canton Clinic, 2205 Riverstone Blvd Suite 101, Canton, GA 30114. Seen here for this concern: Jason Lomboy, MD, Andy Ostrowski, MD, Daniel Roberson, PA-C, Amanda Boulos, PA-C, Ionela Turcin, PA-C. Procedures are scheduled at our Marietta Clinic & Surgery Center.
• Dallas Clinic, 2713 Charles Hardy Parkway, Bldg 100, Suite 122, Dallas, GA 30157. Seen here for this concern: Daniel Roberson, PA-C. Visits here are with Daniel Roberson, PA-C. Physician visits and procedures are arranged in Marietta.
• Jasper Clinic, 49 Gordon Rd Suite 103, Jasper, GA 30143. Seen here for this concern: Jason Lomboy, MD, Britany Howard, FNP. Procedures are scheduled at our Marietta Clinic & Surgery Center.

Questions people ask us

Enlarged prostate on advancedurology.com

Other symptoms we help with

• Blood in your urine? Here is what to do next
• Your PSA came back high. What happens now?
• Kidney stones causing pain? Deciding between the ER and our office
• Bladder leakage or frequent urination? Start by noticing when it happens

Educational information, not medical advice or a diagnosis. Every treatment has risks, benefits and alternatives to discuss with your clinician.