Care and Advice
Prostate Enlargement
What is the Prostate?
The prostate is a gland found only in men that sits just below the bladder. It is about the size of a walnut. The urethra is the tube that carries urine from the bladder out through the penis. The prostate surrounds the urethra.
Fluid produced by the prostate forms part of the semen when you ejaculate.
What can go wrong with the prostate?
Benign Prostatic Hyperplasia (BPH)
As men age the prostate increases in size. The amount of enlargement varies from man to man. The medical term for an enlarged prostate is Benign Prostatic Hyperplasia (BPH). 'Hyperplasia' means prostate cells are growing in number. BPH is not cancer.
BPH is present in more than 60% of men over 60 and more than 40% of men over 60 have symptoms.
Prostatitis
Prostatitis implies there is inflammation in the prostate. This may be the result of an infection. Prostatitis causes similar symptoms to an enlarged prostate but may be accompanied by fever, chills or pain.
Prostate Cancer
Cells in the prostate begin to divide and grow out of the normal pattern. These cells grow into bundles of cells called tumours. Tumours disrupt the normal functioning of the prostate.
Approximately four out of ten men who are over the age of 70 will have prostate cancer, but most of them will live out their whole lives without this ever being discovered.
Signs and symptoms of BPH
As the prostate grows larger it can squeeze the urethra and block the normal flow of urine. When if becomes more difficult for the urine to flow freely, the bladder muscles work harder to force the urine through the narrowed urethra. This leads to the bladder wall becoming thicker and more sensitive, and makes it more difficult for the bladder to empty completely.
When the prostate becomes enlarged some men expreince no symptoms. However, you may experience one or more of the following symptoms:
- A feeling of not completely emptying your bladder
- Frequent urination
- Stopping and starting during urination
- Needing to urinate immediately when you get the urge
- Weak urine stream
- Having to push and strain to start urinating
- Getting up often at night to urinate
BPH can be annoying but it is not a life threatening condition.
In order to understand your treatment options, it helps to have an idea of how severe your symptoms are and how much they are affecting your life. A simple form such as the Prostate Symptom Score Sheet can be of use for this.
Complications
Urinary Incontinence
Some men with BPH experience incontinence, which means that urine may leak out at times without their control. This may be an urgent need to urinate before they are ready or it may be dribbling after they have finished.
Acute Retention
This is the sudden inability to urinate despite having the urge to do so. It can be very painful and requires the insertion of a urinary catheter (tube) through the urethra in order to drain the urine from the bladder. You may be sent home with the catheter or be required to stay in hospital for a few days.
Other Complications
Long term blockage of the bladder can cause:
- Weak bladder muscle
- Stones in the bladder
- Bladder infection or bleeding
Severe blockage can also cause back pressure of urine on the kidney causing kidney disease or damage. Fortunately this complication of BPH is very rare.
Diagnostic Tests
Your Urologist may ask you to get one or more of the following tests done as part of the diagnostic process:
- PSA (blood test to measure the prostate specific antigen) - this may be raised if your prostate is very enlarged but is also used in screening for prostate cancer
- Flow rate and post-void residual - you are asked to urinate into a machine which measures the strength of your flow. A bladder ultrasound is then done to check that you are emptying your bladder sufficiently
- TRUS (trans rectal ultrasound) - this is used to measure the size of your prostate