Enlarged
prostate
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.
Causes
The actual
cause of prostate enlargement is unknown. Factors linked to aging and the
testicles themselves may play a role in the growth of the gland. Men who have
had their testicles removed at a young age (for example, as a result of
testicular cancer) do not develop BPH.
Similarly,
if the testicles are removed after a man develops BPH, the prostate begins to
shrink in size.
Some facts
about prostate enlargement:
- The likelihood of developing an
enlarged prostate increases with age.
- BPH is so common that it has
been said all men will have an enlarged prostate if they live long enough.
- A small amount of prostate
enlargement is present in many men over age 40 and more than 90% of men
over age 80.
- No risk factors have been
identified other than having normally functioning testicles.
Symptoms
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
- Incontinence
- 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
Exams
and Tests
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
- Cystoscopy
In
addition, you may be asked to complete a form to evaluate the severity of your
symptoms and their impact on your daily life. Your score may be compared to
past records to determine if the condition is getting worse.
Treatment
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.
SELF-CARE
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.
MEDICATIONS
- 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.
SAW
PALMETTO
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.
SURGERY
Prostate
surgery may be recommended if you have:
- Incontinence
- Recurrent blood in the
urine
- Inability to fully empty the
bladder (urinary retention)
- Recurrent urinary tract
infections
- Kidney failure
- Bladder stones
The choice
of a specific surgical procedure is usually based on the severity of your
symptoms and the size and shape of your prostate gland.
- Transurethral resection of the
prostate (TURP): This is the most common and most proven surgical treatment
for BPH. TURP is performed by inserting a scope through the penis and
removing the prostate piece by piece.
- Transurethral incision of the
prostate (TUIP): This
procedure is similar to TURP, but is usually performed in men who have a
smaller prostate. It is usually performed without the need for a hospital
stay. Like TURP, a scope is inserted through the penis until the prostate
is reached. Then, rather than removing the prostate, a small incision is made
in the prostate tissue to enlarge the opening of the urethra and bladder
outlet.
- Simple prostatectomy: An open prostatectomy is
usually performed using general or spinal anesthesia. An incision is made
through the abdomen or perineum (the area behind the scrotum). Only the
inner part of the prostate gland is removed. The outer portion is left
behind. This is a lengthy procedure, and it usually requires a hospital
stay of 5 to 10 days.
Most men
who have prostate surgery have improvement in urine flow rates and symptoms.
See prostate removalfor a description of complications.
Other, less-invasive
procedures are available. These use different forms of heat to destroy
prostate tissue. None have been proven to be better than TURP. Patients who
receive these less-invasive procedures are more likely to need surgery again
after 5 or 10 years. However, these procedures may be a choice for:
- Younger men (many of the
less-invasive procedures carry a lower risk for impotence and incontinence
than TURP, although the risk with TURP is not very high)
- Elderly patients
- Patients with severe medical
conditions, including uncontrolled diabetes, cirrhosis,
alcoholism,psychosis, and serious lung, kidney, or heart disease
- Men who are taking
blood-thinning drugs
Another
form of treatment is prostatic stents.
Support
Groups
See: BPH
support groups
Possible
Complications
Men who
have had long-standing BPH with a gradual increase in symptoms may develop:
- Sudden inability to urinate
- Urinary tract infections
- Urinary stones
- Damage to the kidneys
- Blood in the urine
Even after
surgical treatment, a recurrence of BPH may develop over time.
When to
Contact a Medical Professional
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
Also call
your doctor if:
- 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
Alternative
Names
BPH; Benign
prostatic hypertrophy (hyperplasia); Prostate - enlarged
