Enlargement of the prostate gland is called benign prostatic hyperplasia (BPH). Hyperplasia means an increase in the number of cells that cause the prostate gland to swell, which squeezes the urethra and limits the flow of urine.
BPH is not the same condition as the prostate cancer and does not increase the risk of cancer. However, it can cause symptoms that affect a Man’s quality of life. Enlarged prostate is a term used for Benign Prostate Hyperplasia (BPH).
The actual cause of enlargement of prostate is unknown. There are certain risk factors including any family history of prostate problems or any abnormalities in testicles may increase the risk of BPH. Men who had their testicles removed at a younger age, they do not develop BPH.
There are several effective treatments for enlarged prostate, including medications, minimally invasive therapies and surgery. The Urologist defines the best option for treatment based on the symptoms, the size of prostate gland and other health conditions of patient.
Symptoms of Enlarged Prostate
The signs and symptoms of Enlarged Prostate are often very mild at early stage, but they worsen if they are not treated. Symptoms include:
- A weak or slow urinary stream
- Frequent urination
- Urgency to urinate
- A feeling of incomplete bladder emptying
- Difficulty starting urination
- Getting up frequently at night to urinate
- A urinary stream that starts and stops
- Straining to urinate
- Dribbling of urine
- Pain with urination
- Urinary tract infection
- Blood in the urine
Causes of Enlarged Prostate
The causing factor for the prostate to grow is unknown. Nevertheless, there are certain risk factors that can increase the risk of having an enlarged prostate.
- Obesity: Obesity increases the risk of Enlarged prostate.
- Age: The risk of prostate enlargement increase as a Man gets older. Many men aged 45 or above have an enlarged prostate, but they do not all get symptoms. Prostate gland enlargement rarely shows signs and symptoms in men younger than 40 years.
- Hormone level: The balance of Oestrogen and testosterone in a man’s body changes, as he gets older. This may cause the prostate gland to grow.
- Family history: A man is more likely to have prostate enlargement if his blood relative, such as a father or a brother had prostate problems.
- Diabetes and Heart disease: Studies show that Diabetes, Heart disease and use of beta blockers may increase the risk of Benign Prostate Hyperplasia.
How to diagnose Enlarged Prostate
Diagnosis of Benign Prostatic Hyperplasia is based on:
- Physical exam
- Personal and family medical history
- Medical tests
Physical Examination by the Urologist
The Urologist often checks the following during physical examination:
- Discharge from the Urethra
- Tender lymph nodes in the groin
- Swollen or tender scrotum
The examination helps the Urologist to see if the prostate is enlarged or tender or has any abnormalities that require further evaluation.
Medical Tests and investigations
The Urologist may recommend a few medical tests to confirm the diagnosis: Benign prostatic hyperplasia. These tests include:
- Blood test – Prostate-specific antigen (PSA):
PSA level increases on having an enlarged prostate however elevated PSA levels can also be due to recent procedures, infection, or prostate cancer.
An ultrasound image shows the size of the prostate and any other abnormalities.
- Post void residual volume test: This test measures whether a Man can empty his bladder completely. This test can be carried out using ultrasound or by inserting a catheter into the bladder after urination to measure how much urine is left in the bladder.
- Uroflowmetery or Urinary flow test: This test determines the flow of Urine out of one’s bladder. It checks on the functioning of Urinary Bladder.
- Prostate biopsy: The urologist recommends biopsy of prostate tissue when the PSA level is abnormally high and the patient is not getting positive response from antibiotics. Examining the tissue helps rule out prostate cancer.
- Cystoscopy: The Urologist examines inside the Urethra and Bladder using Cystoscope- a flexible instrument inserting into the urethra. This test is carried out under Local anaesthesia.
Treatment options for Enlarged Prostate
Treatment for enlarged prostate depends on several factors including:
- The prostate size
- Patient’s age
- Patient’s overall health
- The amount of discomfort or symptoms patient is experiencing
Types of treatment options for an enlarged prostate:
One can wait and watch if prostate enlargement is not causing any significant urinary problem. However, it is always suggested to consult the Urologist in case of even early signs.
There are simple lifestyle changes one can make to his lifestyle that might help to overcome the symptoms:
- Cut on food that can irritate the bladder and worsen the urinary symptoms such as alcohol, caffeine, artificial sweeteners and fizzy drinks.
- Less intake of fluids in the evening so you are less likely to get up in the night for urination. Parallely, make sure you take enough fluids during the day.
- Remember to empty the bladder before leaving the house.
- Double voiding – After urination wait for a while and try to urinate again. This can help to empty the bladder completely.
- Eat more fruits and fibres to avoid constipation, hence reducing the pressure on the bladder.
- Maintain a healthy weight – Being overweight can make the urinary symptoms worse.
- Exercise regularly
Medication is the preferred mode of treatment for mild symptoms of prostate enlargement.
Surgery is considered as the treatment option if the urinary symptoms do not improve with lifestyle changes or medicines or if the symptoms are severe.
1. Transurethral resection of the prostate (TURP):
TURP is the most common surgery for benign prostatic hyperplasia and considered as the gold standard treatment for treating urethral blockage due to enlarged prostate.
The Urologist cuts pieces of enlarged prostate using a scope through the urethra to reach the prostate.
2. Enucleative procedures:
Enucleative procedures, such as Holmium laser enucleation of the prostate (HoLEP), generally removes all the prostate tissue blocking urine flow and prevent regrowth of tissue. Recovery of the patient is fast in this type of procedure.
3. Laser therapy:
A high-energy Laser removes the overgrown prostate tissue. Laser therapy relieves the urinary symptoms right away also has a lower risk of side effects than does non-laser surgery.
4. Open or robot-assisted prostatectomy:
In an open prostate surgery, the Urologist makes a cut through the skin to reach the prostate and remove all or part of the prostate through the cut. This type of surgery is done most often when the prostate size is greatly enlarged, complications occur or the bladder is damaged and needs repair. Open prostatectomy or prostate removal through open surgery is done under general anaesthesia.
Complications of an enlarged prostate if left untreated can include:
- Urinary retention -Sudden inability to urinate: In some cases, if enlarged prostate is not treated patient might need to have a tube (catheter) inserted into his bladder to drain the urine.
- UTI-Urinary tract infections: Inability to empty the bladder completely can increase the risk of infection in the urinary tract. If UTIs occur frequently, patient might require surgery to remove part of the prostate.
- Bladder stones: Bladder stones are formed because of inability to completely empty the bladder that can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.
- Bladder damage: Urinary bladder when not getting empty completely can stretch and weaken over time.
- Kidney damage: Pressure in the bladder created due to urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.
- Blood in the urine
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To know more, Read our Enlarged Prostate Blog.