Prostate – A rite of passage for men

The prostate is a nut-sized gland located between the bladder and the penis. The urethra is a tube that runs through the centre of the prostate, from the bladder to the penis, letting urine flow out of the body.

The role of the prostate is to secrete fluid that protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled as semen. A man’s prostate gland usually starts to enlarge after he reaches 40 years old. For most men, the nightly bathroom runs may be the first sign of an enlarged prostate.

Other symptoms may include trouble starting a stream of urine, leaking, or dribbling.

Causes

In men, urine flows from the bladder through the urethra. Enlargement of the prostate blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra through which urine and semen exit the body.

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As the urethra narrows, the bladder has to contract more forcefully to push urine through the body. Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently.

Other conditions which can lead to symptoms similar to those caused by enlarged prostate include:

• Urinary tract infection;
• Inflammation of the prostate;
• Narrowing of the urethra;
• Scarring in the bladder neck as a result of previous surgery;
• Bladder or kidney stones;
• Problems with nerves that control the bladder; and,
• Cancer of the prostate or bladder.

Risk factors for prostate gland enlargement include

• Ageing. Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.
• Family history. Having a blood relative, such as a father or brother, with prostate problems means you’re more likely to have it.
• Ethnic background. Prostate enlargement is less common in Asian men than in white and black men. Black men might experience symptoms at a younger age.
• Diabetes and heart disease. Studies show that diabetes, as well as heart disease and the use of certain medications, might increase the risk of BPH.
• Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk.

Signs and symptoms of BPH

Benign prostate hyperplasia is often a diagnosis of exclusion after we make sure nothing more serious is going on.

The symptoms commonly are:

• A weak or slow urinary stream;
• A feeling of incomplete bladder emptying;
• Difficulty starting urination;
• Frequent urination;
• The urgency to urinate;
• Getting up frequently at night to urinate;
• A urinary stream that starts and stops;
• Straining to urinate; and,
• Returning to urinate again minutes after finishing.

Also when the bladder does not empty completely, you are at risk of developing urinary tract infections. Other problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate).

Diagnosis and tests

A physical exam is required to see if other medical problems may be causing your symptoms. The doctor will conduct a digital rectal exam for the prostate gland. He or she can feel the prostate by inserting a gloved, lubricated finger into the rectum. This procedure allows your doctor to estimate the size and condition of the prostate. Most importantly, it allows the doctor to feel for lumps or hard areas that could indicate the presence of prostate cancer.

Your doctor may check your urine (urinalysis) for blood or signs of infection. Your blood may be tested for kidney problems or sent for a prostate-specific antigen level, which is a screening test for prostate cancer. Some men are referred to a specialist (urologist) for further tests. Before you are treated for benign prostate enlargement, it is important to rule out other possible causes of an enlarged prostate, such as cancer. ‘

Treatment

Immediate treatment may not be necessary if symptoms are mild. A watchful waiting approach may be initiated because for many men symptoms can lessen without treatment. On the other hand, medications should be started early for moderate symptoms.

Also, if symptoms are severe, your doctor may recommend surgery. You will also need to visit your doctor once or twice a year to be sure that you are not developing any complications from prostate enlargement. Should your symptoms become more severe, both medical and surgical treatments are available.

Some precautions can help to avoid worsening symptoms of prostate enlargement and complications. Do not delay urination once you experience an urge. Urinate empty bladder completely.

Prevention

There is no known way to prevent prostate enlargement. It is a common part of ageing.

Other things you may do include:

• Avoid drinking liquids after 6pm to reduce the need to urinate frequently during the night.
• Drinking more fluid, up to eight glasses of water per day, may help prevent infection. However, for men already suffering from increased urinary frequency, this may only exacerbate the problem. In most cases, drinking a normal amount of fluid based on thirst is all that is necessary.
• There is evidence that cranberry juice may be helpful in the prevention of urinary tract infections in those who are prone to developing these.
• Limit caffeine and alcohol. They can increase urine production, irritate the bladder and worsen symptoms.
• Limit decongestants or antihistamines. These drugs tighten the band of muscles around the urethra that control urine flow, making it harder to urinate.