If you’re a man age 40 or older, the No. 1 thing Novant Health urologist Dr. Brandon Craven wants to talk about with you is — well — No. 1.

Urinating. Peeing. Tinkling. Seeing a man about a horse. Whatever you call it, you’ll likely be doing it more frequently — because almost every man will experience some urinary symptoms as they age.

If you read no further, understand:

• Urinating more frequently, more urgently and/or less efficiently is very common in men 40 and older.
• Ignoring these symptoms can lead to bigger problems.
• If symptoms are bothering you, you have options.

Why urinary changes happen in men

The most common reason men start experiencing urinary symptoms is an enlarged prostate, also known as “benign prostatic hyperplasia” or “BPH.”

The prostate sits just below your bladder, wrapping around the tube called the urethra that carries urine out of your body.

The prostate slowly grows as you age. The bigger your prostate gets, the harder the muscles in your bladder have to work to push urine through the urethra. Although an enlarged prostate doesn’t always cause symptoms, many men experience symptoms like:

• You urinate more frequently than you used to.
• You need to get up at night to urinate.
• A feeling of urgency: You have to go right now.
• It takes longer to empty your bladder — instead of 30 to 40 seconds, it’s taking 60 to 90 seconds.
• It’s harder to start urinating — you’re standing there for a while before anything happens.
• Your stream is weak or intermittent.

Or, in patients’ own words to Craven:

• “When peeing in the woods, I’m dribbling on my shoes when I used to be able to strip the bark off of the trees.”
• “I used to be able to drive to the beach without stopping — now I have to stop for the bathroom.”
• “While shopping with my wife, I have to go to the bathroom more times than her.”
• “My grandson and I were side by side at the urinals. By the time I got started, he had finished and left the bathroom.”

Are urinary changes a normal part of aging?

BPH is the most common prostate problem among men 50 and older.

About half of men in their 50s have BPH, and by age 70, roughly 80% of men have BPH.

Because it’s so common — and symptoms emerge slowly — men tend to downplay it, Craven said. He’s heard comments like, “If everyone has it, and it's sneaked up on me slowly, why should I worry about it?”

But there are reasons to be concerned: “While it takes many years, or sometimes many decades, it damages your bladder to push against a big prostate for so long,” Craven said. “Eventually, your bladder is going to quit, and bladder damage is not reversible.”

If your bladder stops contracting, you can lose the ability to empty your bladder completely and develop a higher risk for infections of the urinary tract or bladder. BPH can also cause bladder stones, blood in your urine and kidney damage.

When should you see your doctor about urinary symptoms?

Some men don’t register their symptoms as problematic, and only find out that they have BPH after a blood test shows they have a high PSA, or prostate-specific antigen level.

But Craven encourages you to be more proactive.

If you’re noticing urinary symptoms, tell your primary care doctor, who will likely:

• Ask you questions about your symptoms.
• Conduct a digital rectal examination — inserting a lubricated and gloved finger into your rectum to estimate your prostate size.
• Order a blood test to check your PSA level, as an elevated PSA level is often the result of an enlarged prostate.
• Order a urine test to make sure that your symptoms aren’t being caused by another infection or bladder cancer.

If your bladder is functioning well and your kidneys are healthy, your primary care clinician can often manage early-stage BPH.

But if your bladder’s showing signs of damage or you aren’t emptying your bladder fully, you’ll need treatment now. Your primary care doctor will likely refer you to a urologist to explore your options.

What treatments are available for BPH?

There isn’t a cure for BPH, but treatments can minimize symptoms.

Early stages of BPH: Watchful waiting

In early stages when bladder damage hasn’t occurred, “BPH treatment is largely a lifestyle decision at first — we treat it when it bothers you,” Craven said.

If your symptoms are mild, you may just be scheduled for regular check-ins to monitor your BPH.

Medication options

If symptoms are bothering you, medication options include:

• Alpha blocker medications, like tamsulosin (brand name Flomax), that relax muscles in the prostate and bladder, relieving pressure on the urethra and improving the flow of urine.
• 5-alpha reductase inhibitor medications, like finasteride (brand name Proscar) and dutasteride (brand name Avodart), which shrink the prostate.
• Combination therapy, when you take both an alpha blocker and a 5-alpha reductase inhibitor to improve symptoms.
• Tadalafil (brand name Cialis), used if you’re experiencing BPH as well as erectile dysfunction since “this medication benefits both,” Craven said.

Other treatment options

If you already have bladder damage, are having kidney problems, or aren’t getting satisfactory results from medication, you have surgical options.

You may have heard horror stories about side effects, but “this has been the source of much medical innovation over the last 120 years — and about every two years, there’s something new,” Craven said.

Your urologist can walk you through options; the best option for you will depend on your prostate size, the severity of your symptoms, your overall health, your age and the side effects you’re most concerned about.

Minimally invasive surgical therapy

Minimally invasive outpatient procedures are quick, offer short recovery time, and have fewer sexual side effects than traditional surgical options — however, the results may not last as long.

Novant Health urologists offer several minimally invasive surgical therapy options to address BPH. The most popular include:

• Urolift, which lifts and holds the extra prostate tissue out of the way.
• Rezum, which uses blasts of sterile steam to shrink enlarged areas of your prostate.

Traditional surgery

These procedures are more invasive and can cause sexual side effects, but they are highly effective.

Physicians can perform multiple surgical procedures to address BPH. The most popular include:

• Aquablation, which uses water pressure to precisely remove the enlarged prostate tissue. This is a newer procedure which reduces some of the classic side effects of other surgical treatments.
• Transurethral resection of the prostate (TURP) surgery, where your urologist inserts an instrument through your urethra to remove some of your prostate tissue.
• Holmium laser enucleation of the prostate (HoLEP), where a laser is used to remove large amounts of prostate tissue.
• Robotic prostatectomy, where your urologist removes your prostate through small incisions using a robotic tool that can operate in small spaces. This is typically reserved for the most extreme cases.

Isn’t it awkward to talk about urinary changes and an enlarged prostate?

You might feel uncomfortable bringing it up, but your doctor isn’t.

“Everyone in medicine understands that life can be embarrassing,” Craven said. “But this is what we do.”

And statistically speaking, you’re in very good company: “This is normal, and is nothing you've done wrong,” Craven said. “Almost every man is going to have this at some point in their life.”

A parting pep talk

If you’re 40 or older, look out for changes in your urinary habits.

If you have symptoms — even if they’re subtle — bring them up with your primary care clinician.

And if they’re causing problems, there are options to help you feel better — and maintain function over time.