The prostate is a male reproductive gland that produces the fluid that carries sperm during ejaculation. It surrounds the urethra, the tube through which urine passes out of the body.
An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. As the gland grows, it can press on the urethra and cause urination and bladder problems.
An enlarged prostate is often called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. It is not cancer, and it does not raise your risk for prostate cancer
What Is BPH?
BPH is a non-cancerous increase in the size and number of cells that make up the prostate.
Who Gets BPH?
BPH is almost always found in older men. Since women do not have a prostate, they cannot get BPH. Young men almost never experience symptoms of an enlarged prostate either. The prostate enlarges over the course of many years of exposure to male hormones, and young men typically have not had enough years of exposure for symptoms to show up
What Causes BPH?
During puberty, the prostate goes through a phase of very rapid enlargement, but this levels off once puberty is completed. Starting in mid-life, the prostate begins growing again, but very slowly this time.
It is thought that these periods of growth result from increased levels of male hormones such as testosterone. Testosterone is produced throughout a man’s life and, subsequently, the prostate grows throughout a man’s life.
Due to the slow progression of this growth, most men do not notice any symptoms of BPH until they are older and the prostate has grown to such a size that it impinges on the outflow of urine from the bladder..
What are the Symptoms of BPH?
Less than half of all men with BPH have symptoms of the disease, which include:
- Dribbling at the end of urinating
- Inability to urinate (urinary retention)
- Incomplete emptying of your bladder
- Needing to urinate two or more times per night
- Pain with urination or bloody urine (these may indicate infection)
- Slowed or delayed start of the urinary stream
- Straining to urinate
- Strong and sudden urge to urinate
- Weak urine stream
A Simple Test for Early BPH
Respond to each statement with either a yes or no answer. We will only be concerned with the yes responses.
- 1.) Urination has become more difficult than it used to be.
- 2.) Many times I have to 'push' to start the flow of urine.
- 3.) I awake two or more times each night to urinate.
- 4.) When urinating, the stream stops and starts again several times.
- 5.) I have a feeling that after urination, my bladder is not fully empty.
- 6.) It is harder to wait, when I have to relieve myself, than it used to be.
- 7.) My urinary stream is weaker and less forceful than before.
Can other problems arise?
There are further complications with this disease.
- For some men, it suddenly becomes impossible to urinate (known as acute retention). Studies have shown that acute retention affects between 1 and 2 per cent of men with BPH each year. This condition is very painful and demands immediate medical treatment to avoid damage to the kidneys, among other things.
- Other men find it gradually harder to empty the bladder. As the condition develops, more and more urine is left in the bladder after urination (known as chronic retention).
- Blood in the urine needs immediate attention.
- Urinary Tract Infections is also a complication.
Other complications of the disease include: repeated attacks of cystitis (infection of the bladder) and the development of stones in the bladder.
Even after surgical treatment, a recurrence of BPH may develop over time.
Exams and Tests for BPH
After taking a complete medical history, your doctor will perform a digital rectal exam to feel the prostate gland. The following tests may also be performed:
- Urine flow rate
- Post-void residual urine test to see how much urine is left in your bladder after urination
- Pressure flow studies to measure the pressure in the bladder as you urinate
- Urinalysis to check for blood or infection
- Urine culture to check for infection
- Prostate-specific antigen (PSA) blood test to screen for prostate cancer
Treatment of BPH
The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. Treatment options include "watchful waiting," lifestyle changes, medication, or surgery.
If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.
If you have BPH, you should have a yearly exam to monitor the progression of your symptoms and determine if any changes in treatment are necessary.
For mild symptoms:
- Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
- Avoid alcohol and caffeine, especially after dinner.
- Don't drink a lot of fluid all at once. Spread out fluids throughout the day. Avoid drinking fluids within 2 hours of bedtime.
- Try NOT to take over-the-counter cold and sinus medications that contain decongestants or antihistamines. These medications can increase BPH symptoms.
- Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
- Learn and perform Kegel exercises (pelvic strengthening exercises).
- Reduce stress. Nervousness and tension can lead to more frequent urination.
- Alpha 1-blockers (doxazosin, prazosin, tamsulosin, terazosin, and alfuzosin) are a class of medications also used to treat high blood pressure. These medications relax the muscles of the bladder neck and prostate. This allows easier urination. Most people treated with alpha 1-blocker medication find that it helps their symptoms.
- Finasteride and dutasteride lower levels of hormones produced by the prostate, reduce the size of the prostate gland, increase urine flow rate, and decrease symptoms of BPH. It may take 3 to 6 months before you notice much improvement in your symptoms. Potential side effects related to the use of finasteride and dutasteride include decreased sex drive and impotence.
- Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may accompany BPH. Some men note relief of their BPH symptoms after a course of antibiotics.
What kind of surgery is available?
An operation on the prostate will involve the removal of parts of the enlarged tissue.
The most common operation is an endoscopic surgical procedure where parts of the enlarged tissue are peeled off. This is called transurethral resection of the prostate (TURP).
If the prostate is only slightly enlarged, it may be enough to make a little cut in the prostate, without removing tissue, to reduce the constriction of the urethra. This is called transurethral incision (TUI).
If the prostate is considerably enlarged, it may be necessary to make an incision in the lower abdomen and to carry out an open operation. But this procedure is rarely carried out.
Surgery carries more risk than medical treatment and there are possible complications including retrograde ejaculation. In retrograde ejaculation, the sperm enters the bladder during ejaculation instead of being expelled through the penis. Later it is flushed out with urine.
Studies estimate that 74 per cent of men will experience retrograde ejaculation after transurethral resection of the prostate (TURP).
Surgery has also been linked with side effects of erectile dysfunction (in 14 per cent of men after TURP) and urinary incontinence (5 per cent). But studies are inconclusive as to whether the same rates of these problems would have occurred anyway in men not undergoing surgery.
The benefits of surgery are long lasting, but because only part of the prostate is removed, some men may eventually need another operation.
Are there other more gentle surgical treatments?
Newer treatments for benign prostate hyperplasia already exist and are continually being developed. These techniques are minimally invasive. Some need only local anaesthesia and the risk of complications is smaller.
A couple of general points about these new techniques:
- it is still not fully known whether the results are as effective as endoscopic surgery. Doctors are continually learning which patients are most suitable for each treatment.
- the techniques concerned are still being developed and tested.
Microwave thermotherapyIn this treatment, the prostate tissue is heated to around 45ºC by means of microwaves. This reduces the size of the prostate by causing cells in the centre of the prostate to die. This treatment is carried out through the urethra.
ElectrovaporisationIn this procedure, part of the prostate tissue is removed by evaporation by means of electrical current. The treatment is performed with an endoscope.
Laser-resectionAnother endoscopic treatment, in which part of the prostate tissue is removed with laser energy. For this treatment, a passage is created by inserting a tube made of metal or plastic - which remains in place where the prostate gland obstructs the urethra.
This procedure is used only on rare occasions, for those patients who are unable to be considered for other forms of treatment.
Is treatment with a catheter a possibility?
Some patients with urine retention who cannot endure an operation, may have to have a permanent catheter. This can be placed through the urethra or through the lower abdomen into the bladder. But with a permanent catheter, the patient is at greater risk of cystitis (infection of the bladder).
An alternative, is for the patient to learn to empty the bladder himself with a catheter. This way the catheter is removed after each use and the danger of infection is reduced.
INTERESTING FACT OR FICTION?
Many herbs have been tried for treating an enlarged prostate. Saw palmetto has been used by millions of men to ease BPH symptoms and is often recommended as an alternative to medication. Some studies have shown that it helps with symptoms, but there is evidence that this popular herb is no better than a dummy pill in relieving the signs and symptoms of BPH. Further studies are needed. If you use saw palmetto and think it works, ask your doctor if you should still take it.
Call your doctor right away if you have:
- Less urine than usual
- Fever or chills
- Back, side, or abdominal pain
- Blood or pus in your urine
- Your bladder does not feel completely empty after you urinate
- You take medications that may cause urinary problems, like diuretics, antihistamines, antidepressants, or sedatives. Do NOT stop or adjust your medications on your own without talking to your doctor
- You have taken self-care measures for 2 months without relief.