Dr. Tariq Jagnarine
Family Medicine, Endocrinology/ Diabetes
The prostate is a small, muscular gland in the male reproductive system. The prostate surrounds the urethra, and makes most of the fluid in the semen. The muscular action of the prostate helps propel the fluid and semen through the penis during sexual climax.
In many men, the prostate can become enlarged. Sometimes it leads to symptoms, and, over time, other complications. However, there are treatments.
Enlargement of the prostate is called benign prostatic hyperplasia (BPH). It occurs when the cells of the prostate gland begin to multiply. These additional cells cause the prostate gland to swell and squeeze the urethra, thus limiting the flow of urine.
BPH isn’t the same as prostate cancer, and doesn’t increase the risk for cancer. However, it can cause symptoms that can affect the quality of life.
BPH is common in men from 45-50.
BPH CAUSES
BPH is considered a normal condition of aging. Although the exact cause is unknown, changes in male sex hormones that come with aging may be a factor. Any family history of prostate problems, or any abnormalities with the testicles, may increase the risk for BPH. Men who’ve had their testicles removed at an early age don’t develop BPH.
BPH SYMPTOMS
The symptoms of BPH are often very mild at first, but they become more serious if they aren’t treated. Common symptoms include:
• Incomplete bladder emptying
• Nocturia, which is the need to urinate two or more times per night
• Dribbling at the end of the urinary stream
• Incontinence, or leakage of urine
• Straining when urinating
• Weak urinary stream
• Sudden urge to urinate
• Slowed or delayed urinary stream
• Painful urination
• Blood in the urine
BPH DIAGNOSIS
When checking for BPH, doctors would usually begin by doing a physical exam and asking about a person’s medical history. The physical exam includes a rectal examination that allows the doctor to estimate the size and shape of the prostate. Other tests can include:
• Urinalysis. The urine is checked for blood and bacteria.
• Urodynamic test. The bladder is filled with liquid via a catheter to measure the bladder’s pressure during urination.
• Prostate-specific antigen (PSA) test. This blood test checks for cancer of the prostate.
• Post-void residual. This tests the amount of urine left in the bladder after urination.
• Cystoscopy. This is the examination of the urethra and bladder with a tiny lighted scope that’s inserted into the urethra.
The doctor may also ask about medications used that might be affecting the urinary system, such as:
• Antidepressants
• Diuretics
• Antihistamines
• Sedatives
BPH TREATMENT
Treatment of BPH can begin with self-care and lifestyle adjustments. If symptoms don’t subside, medication or surgery may be recommended. Age and general health would also influence the prescribed treatment.
BPH natural treatment
Natural treatment can include specific actions, or lifestyle changes that can help relieve the symptoms of BPH. These include:
• Urinating as soon as the urge is felt
• Going to the bathroom to urinate, even when you don’t feel the urge
• Avoiding over-the-counter decongestants or antihistamine medications, which can make it harder for the bladder to empty
• Avoiding alcohol and caffeine, especially in the hours after dinner
Reducing stress level, as nervousness can increase the frequency of urination
• Exercising regularly, as a lack of exercise can aggravate the symptoms
• Learning and practising Kegel exercises to strengthen the pelvic muscles
• Keeping warm, since being cold can make symptoms worse
Some people also include natural remedies in their treatment of BPH. However, there isn’t evidence that they’re effective.
BPH DRUGS
When lifestyle changes aren’t enough to relieve the symptoms, doctors may recommend medication.
Several medications can help to treat both the symptoms of BPH and BPH itself. These medications include:
• Alpha-1 blockers
• Hormone reduction medications
• Antibiotics
Alpha-1 blockers
Alpha-1 blockers are medications that relax the muscles of the bladder and prostate. Alpha-1 blockers relax the neck of the bladder, and make it easier for urine to flow. Examples of alpha-1 blockers in Guyana include:
• Doxazosin
• Terazosin
• Tamsulosin
Hormone reduction medications
Medications that reduce the levels of hormones produced by the prostate gland, such as dutasteride and finasteride, are commonly prescribed.
These two medications lower the levels of dihydrotestosterone (DHT), a more potent variation of testosterone that affects hair and prostate growth, among other functions.
Sometimes lowering the hormone levels would make the prostate get smaller and improve urine flow. However, in rare cases, these medications may also lead to side effects such as impotence and a decreased sex drive.
Antibiotics
Antibiotics may be used if the prostate becomes chronically inflamed from bacterial prostatitis related to BPH. Treating bacterial prostatitis with antibiotics may improve the symptoms of BPH by reducing the inflammation. However, antibiotics won’t help prostatitis or inflammation that is not caused by bacteria.
Surgery for BPH
Different types of surgical procedures can help treat BPH when medications aren’t effective. Some procedures are either non-invasive or minimally invasive, and can often be done in a doctor’s office or clinic (outpatient procedures).
Others are more invasive, and need to be done in a hospital (inpatient procedures).
COMPLICATIONS OF BPH
The symptoms of BPH can be easy to ignore. However, early treatment can help to avoid potentially dangerous complications.
People with a longstanding history of BPH may develop the following complications:
• Urinary tract infections
• Urinary stones
• Kidney damage
• Bleeding in the urinary tract
• Sudden inability to urinate
Sometimes urinary obstruction from BPH is so severe that no urine can leave the bladder at all. This is called bladder outlet obstruction. It can be dangerous because, urine trapped in the bladder can cause urinary tract infections and damage the kidneys.
BPH vs. prostate cancer
BPH and prostate cancer don’t share symptoms. Prostate cancer is almost always asymptomatic, and is identified by either an elevated PSA or prostate nodule. It’s also a more serious condition than BPH.
Doctors can test to make sure that the symptoms aren’t related to prostate cancer.
BPH doesn’t always require medical treatment. Sometimes a doctor would want to have regular check-ups to monitor the symptoms and the size of the prostate.
Lifestyle changes, medication, and surgery are all treatment options for symptoms that are affecting the quality of life. Health care providers can develop a treatment plan that helps manage the symptoms and cause you to live a healthy life. That’s why it’s important to discuss the symptoms of BPH with a clinician, no matter how minor you feel they may be.
