One of the most common problems a man faces as he ages is difficulty with urination. This is usually caused by a benign prostate enlargement.
The prostate is a walnut-shaped gland located beneath the urinary bladder, deep inside the male pelvis. It surrounds the urethra (urine channel) like a donut. The prostate begins to enlarge on a microscopic cellular level when a man is in his late twenties or early thirties. In some men, the prostate continues to grow, which may cause an impingement on the urethra and restrict urine flow. The bladder muscle may have to work harder to generate enough force to push the urine past the blockage. The bladder muscle may even become enlarged (hypertrophy) or irritated.
Causes of an Enlarged Prostate
We still don’t really know all the things that cause the prostate to grow. But we do know about two risk factors.
Your risk of having an enlarged prostate increases as you get older. Many men aged 50 or over have an enlarged prostate, but they don’t all get symptoms. And many men who do get symptoms aren’t really bothered by them.
The balance of hormones in your body changes as you get older. This may cause your prostate to grow.
Some studies show that obese men and men who have diabetes may be more likely to develop an enlarged prostate. Regular exercise may help to reduce your risk of urinary symptoms. But we still need more studies into the causes of enlarged prostate to know for certain if, and how, we can prevent it.
There is also some research that suggests you may be more at risk of developing an enlarged prostate if your father or brother has the condition. Again, further studies are needed to confirm this.
What are the symptoms?
An enlarged prostate is the most common cause of urinary symptoms in men as they get older. Possible symptoms include:
- a weak flow when you urinate
- a feeling that your bladder hasn’t emptied properly
- difficulty starting to urinate
- dribbling urine after you finish urinating
- needing to urinate more often, especially at night
- a sudden urge to urinate – you may sometimes leak before you get to the toilet.
You may not get all of these symptoms, and some men with an enlarged prostate don’t get any symptoms at all. These symptoms can also be caused by other things, such as cold weather, anxiety, other health problems, lifestyle factors, and some medicines. If you have any symptoms, visit your GP to find out what may be causing them.
Your physician will need to perform a urinalysis to check for infection or blood cells. A digital rectal exam to palpate the prostate will also be performed. Occasionally, a sample of prostatic fluid, which is obtained by pressing on the prostate during the digital rectal exam may be collected. This fluid is examined for white blood cells and bacteria. In some cases a culture is done on this fluid, or on semen obtained from a semen sample.
There are many ways to evaluate whether a patient has an enlarged prostate, some of the most common ways follow:
- Your doctor will ask you detailed questions about your symptoms. You will most likely be asked about other health problems, medications, including over-the-counter (OTC) drugs,,you’re taking and whether there’s a history of prostate problems in your family.
- Your doctor may perform a digital rectal exam. Due to the proximity of the prostate to the rectum, your doctor can determine whether your prostate is enlarged and also check for signs of prostate cancer.
- A urine test may help rule out an infection or other conditions that cause prostate enlargement-like symptoms, such as prostatitis, bladder infection or kidney disease.
Bladder Outlet Obstruction
Your doctor will ask detailed questions about your symptoms and medical history. A physical exam will be performed to help determine if a bladder outlet obstruction exists.
One of the most common causes of this condition is an enlarged prostate or BPH. A thorough history and physical examination evaluating other potential sources of lower urinary tract obstructive symptoms should be undertaken before empiric treatment for BPH is begun.
What are the treatment options?
There are three main types of treatment for an enlarged prostate:
- lifestyle changes