What is Enlarged Prostate?
Enlarged prostate refers to a disease in which the prostate gland becomes larger than normal. It usually affects the middle aged and elderly men. The disease is characterized by hyperplasia of prostatic stromal and epithelial cells. This hyperplasia results in the formation of large, fairly discrete nodules in the periurethral region of the prostate. Due to the increase in size of the gland the urethra gets partially or fully obstructed and this results in interference in the normal flow of urine. This usually happens due to the compression exerted by the increased size of the nodules in the periurethral region.
Medically known as, benign prostatic hyperplasia (BPH), it affects nearly all adult males. According to a research, by age 60 nearly 50% of men show some signs of BPH. As the age increases, the number of patients having BPH also increases. By age 85, nearly 90% of men show some signs of BPH.
Symptoms of Enlarged Prostate
As the urethra, the tube that carries the urine is blocked due to enlarged prostate, most of the symptoms stem from this condition. The most common symptoms of BPH include the following;
• The urinary stream may get slowed down and dribbling may take place
• The starting of urination may get delayed, there may be hesitancy
• The frequency of urination may get increased
• Feeling of urgency or sudden need to urinate
• Need to get up at night to urinate
With the gradual progression of the disease, some other symptoms might come to light, including Bladder stone or infection and blood in the urine. Damage to your kidneys from back pressure caused may take place due to retaining large amounts of extra urine in the bladder. A sudden blockage of the urinary tube, leading to complete stoppage of urination may also happen.
Diagnosis of Enlarged Prostate
The diagnosis is usually started with an inspection of the medical history of the patient followed by a complete physical examination. After the physical examination the doctor may, sometimes, perform a digital rectal exam (DRE). It is a standard physical exam that includes insertion of a gloved, lubricated finger into the rectum to feel the prostate gland which lies in front of the exam. This test is usually performed to test whether an individual has prostate cancer.
The diagnosis may also include several other studies including A urine test (urinalysis), a seven-question BPH Symptom Score Index survey to evaluate the severity of your symptoms and a flow study to measure how slow the urinary stream is compared with normal flow. The doctor may also undertake a study to detect how much urine is left in the bladder after urination is done.
Causes of Enlarged Prostate
The exact cause for enlarged prostate is unknown, but it is believed that hormonal effects might play major role. With age, the levels of hormone circulating in the blood changes and this could affect the prostate gland.
The prostate gland may grow enlarged in size due to prostate or bladder cancer as well. Although these are not considered as the major reasons for prostate enlargement, they might be effective enough to cause an enlarged prostate.
Diabetes can also be a cause for prostate enlargement. Diabetics usually feel the urgent need to empty the bladder, which may gradually lead to infection and enlargement of the prostate.
Chronic inflammation of the bladder, known as interstitial cystitis may also contribute to the enlargement of the prostate gland.
Some medicines can also show side-effects of prostate enlargement. This type of medicine includes the diuretics which have been found to show major implications. Radiation therapies are also harmful for the prostate gland. Radiation may also lead to an enlarged prostate and it is advisable to consult with the doctor about the implications before going through any such therapy.
Another prominent reason for prostate enlargement is dysfunction of the bladder. It has been observed that bladder dysfunction leads to various prostate complications, including prostate enlargement.
Types of Enlarged Prostate
Benign prostatic hyperplasia is not divided into many types. Actually, the condition is judged by the symptoms and the treatment is offered according to one’s complications.
Treatment of Enlarged Prostate
The treatment of BPH is mainly aimed at reducing the symptoms because, till now, there is no exact cure of the disease. The treatment is offered depending upon the severity of the symptoms, how much they bother the patient and the complications.
The American Urological Association (AUA) symptom index is a helpful guide in the treatment of the disease. It is an interactive questionnaire that ranks the severity of the symptoms in a numerical scale. This scale is used to offer treatment to the patients. The higher the numerical value, the more you are affected by the symptoms.
If the symptoms are mild, i.e. the symptoms do not bother you (A score of 0 to 7 in AUA index, the treatment would include a watchful waiting strategy. Some lifestyle changes are made to cope with the disease but no medicines or surgery is offered. Regular checkups are used to see whether the symptoms are getting worse.
When the score is 8 or more, this means that the symptoms bother you from moderate to severely, the treatment may be based on how much you are bothered by the symptoms. If the symptoms are not affecting enough, the doctor might choose watchful waiting option. If it is affecting you greatly, some medication may be offered. For a more aggressive treatment, surgeries and some less invasive therapies may be offered. These therapies may include transurethral microwave therapy (TUMT) or transurethral needle ablation (TUNA).
The common medications for treating BPH include Alpha blockers, 5-alpha reductase inhibitors and Anticholinergics. Alpha blockers relax the muscles where the bladder narrows towards the urethra and thereby provides relief in urination. 5-alpha reductase inhibitors shrink the prostate but only a slight change is noticed in case of the patients who have considerably larger prostate, moreover it takes significantly long time to be effective. Anticholinergics help in inhibiting involuntary contractions and increasing the bladder’s capacity. It is also used to delay the urge to urinate.
Severe symptoms, such as bladder stones, kidney damages, ongoing inability to urinate or ongoing blood in your urine should be treated with surgeries.
Living with Enlarged Prostate
It has been observed that most forms of BPH can be treated with changes in lifestyle habits. Some of the precautions include the following;
The urination should not be rushed. One should relax while using the bathroom.
If it is found that the medications are affecting adversely, they should be stopped.
The fluid intake should be spread throughout the day. Taking much fluid in the evening should be avoided if the individual needs to wake up in the night due to urge of urination.
Sometimes, herbal therapies can also be greatly helpful. This might include saw palmetto or beta-sitosterol. However, the doctor should be consulted before opting for any herbal therapy.
Prevention of Enlarged Prostate
The benign prostatic hyperplasia, currently, cannot be prevented. Although some researchers believe that regular ejaculation can be a preventive measure, there is no scientific proof that this helps in preventing the disease.