The prostate gland is a walnut-shaped organ located below a man's bladder that makes seminal fluid. It actually surrounds a portion of the bladder and the beginning of the urethra, the tube that carries urine away from the bladder.
If they live long enough, most men will eventually get an enlarged prostate gland. Doctors call it benign prostatic hypertrophy (BPH).
An enlarged prostate is usually not cancerous or life threatening. It may cause some problems such as:
- Increased urgency to urinate.
- Frequent urination, especially during the night.
- Delay in onset of urine flow.
- Diminished or slow stream of urine flow.
- Incomplete emptying of the bladder.
These symptoms indicate that the prostate gland has enlarged enough to partially obstruct the flow of urine. Sometimes, BPH causes a urinary tract infection. Over time, a few men might have bladder or kidney problems or both.
Your doctor can diagnose BPH through a number of things. These include:
- A physical exam which includes asking questions about your current symptoms and past medical problems, an examination of your prostate gland, checking your urine for signs of infection and a blood test to see if the prostate has affected your kidneys.
- Tests that measure urine flow, the amount of urine left in your bladder after you urinate and the pressure in your bladder as your urinate.
- A blood test called Prostate-Specific Antigen (PSA) which can help find prostate cancer. Not all doctors agree that being tested for PSA levels lowers a patient's chance of dying from prostate cancer. The PSA test is not always accurate either. You should discuss this test with your doctor.
- Other tests such as X-rays, cystoscopy (the doctor looks directly at the prostate and bladder) and an ultrasound (sound wave pictures of the prostate, kidneys or bladder). Many men do not need these tests. They are costly and are not very helpful for most men with BPH.
Treatment for BPH varies depending on symptoms. Discuss the benefits and possible problems with your doctor for each treatment option. Treatment options include:
- Watchful waiting - getting regular exams to see if your BPH is causing problems or getting worse
- Medications - There are two types:
- Alpha blockers which help relax muscles in the prostate. Hytrin is the only one approved for BPH treatment by the Food and Drug Administration (FDA).
- Finasteride (Proscar) which causes the prostate to shrink
There is no evidence that these medications reduce the rate of BPH complications or the need for future surgery. They can have side effects, too, so you will need to see your doctor for monitoring.
- Balloon dilation - a surgical procedure done in the operating room or doctor's office. A balloon-tipped catheter is inserted into the penis through the urethra and into the bladder. The balloon is inflated to stretch the urethra which aims at allowing urine to flow more easily.
- Enlarged Prostate, continued
- Surgery - There are three types:
- Transurethral resection of the prostate (TURP).
- This type is the most common one done. It relieves symptoms by reducing pressure on the urethra. It is a proven way to treat BPH effectively.
- Transurethral incision of the prostate (TUIP)
- This, too, reduces the prostate's pressure on the urethra making it easier to urinate. TUIP may be used instead of TURP when the prostate is not enlarged as much.
- Open prostatectomy - This may be used if the prostate is very large. An incision is made in the lower abdomen to remove part of the inside of the prostate.
Prostate surgery can result in problems such as impotence and/or incontinence. It is important to discuss the benefits and the risks of these operations with your doctor. Most men who undergo surgery have no major problems.
Self-Care Tips
- Remain sexually active.
- Take hot baths.
- Avoid dampness and cold temperatures.
- Do not let the bladder get too full. Urinate as soon as the urge arises. Relax when you urinate.
- When you take long care trips, make frequent stops to urinate. Keep a container in the car that you can urinate in when you can't get to a bathroom in time.
- Whenever possible, sit on a hard chair instead of a soft one.
- Limit coffee, alcohol and foods that are spicy.
- Drink eight or more glasses of water every day, but don't drink liquids before going to bed.
- Reduce stress.
- Don't smoke.
- Avoid taking over-the-counter antihistamines.
Questions to Ask
Do you have one or more of these problems?
- A feeling that you have to urinate right away or the need to urinate often especially at night
- A feeling that you can't empty your bladder completely
- A feeling of hesitancy or delay or straining to urinate
- A weak or interrupted urinary strain
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Do you have one or more of these symptoms of an infection that may result from BPH?
- Burning, frequent or painful urination
- Pain in the lower back, groin or testicles
- Pain in or near the penis
- Pain on ejaculation
- Discharge from the penis (blood or pus)
- Fever and/or chills
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