Dr. Tariq Jagnarine
Fam Med, Endocrinology/Diabetes
An enlarged prostate is a condition that commonly affects older people with a prostate. Symptoms include increased urinary frequency and urgency. People may also have trouble starting a urine stream. The prostate gland makes some of the fluid that goes into semen. The most common prostate issue in people over 50 years old is benign prostatic hyperplasia (BPH). This refers to a prostate that is enlarged but not cancerous. According to the National Institutes of Health, BPH affects approximately 50% of males ages 51–60 years old. It may also affect up to 90% of males older than 80 years old. Research suggests the prevalence of BPH in older males is increasing.
CAUSES
Medical professionals do not fully understand the exact causes of BPH. Some researchers believe it may have something to do with the hormone estrogen. Throughout their lives, people assigned as male at birth produce the hormone testosterone and small amounts of estrogen. As they age, the amount of testosterone in their blood decreases, leaving a higher proportion of estrogen.
Studies suggest BPH may occur because the increased estrogen levels in the prostate increase the activity of substances that promote prostate cell growth. Research also suggests metabolic syndrome, obesity, and genetic factors may increase a person’s risk of developing BPH.
Other conditions that may cause an enlarged prostate
Other causes of an enlarged prostate that medical professionals do not associate with BPH include prostate cancer and chronic prostatitis.
Prostate cancer occurs when cells in the prostate gland begin to grow out of control. An enlarged prostate is one symptom of prostate cancer.
Chronic prostatitis, or inflammation of the prostate, can also cause the prostate to become enlarged.
Symptoms
A person with BPH may experience the following symptoms:
• Increased urinary frequency, or needing to urinate eight or more times a day
• Increased urinary urgency, or an inability to delay urination
• Difficulty starting a urine stream
• A weak or interrupted urine stream
• Dribbling at the end of urination
• Increased need to urinate when sleeping
• The inability to empty all the urine from the bladder, also known as urinary retention
• Urinary incontinence
• Pain when urinating
• Pain after ejaculation
• Unusually colored urine
• Unusual smelling urine
COMPLICATIONS OF AN ENLARGED PROSTATE
Most people with BPH do not develop complications. However, possible complications include:
• Acute (sudden) urinary retention
• Chronic (long-term) urinary retention
• Urinary tract infections
• Blood in the urine
• Bladder stones
• Bladder damage
• Kidney damage
TREATMENT
Treatment for BPH varies. Healthcare professionals treat BPH based on: the severity of the symptoms
how much the symptoms affect a person’s life and an individual’s preferences
Below are some of the possible treatments for BPH.
• Lifestyle changes
A doctor may recommend that people with BPH make the following lifestyle changes:
• Reducing their intake of liquids, particularly before going out in public or sleeping
• Avoiding caffeine and alcohol
• Avoiding or monitoring the use of medications such as:
• Antihistamines
• Antidepressants
• Decongestants
• Diuretics
• Training the bladder to hold more urine for longer periods
• Doing pelvic floor muscle exercises
• Preventing or treating constipation
• Medications
A doctor may prescribe certain medications to treat BPH. These medications can:
stop the growth of the prostate, shrink the prostate, and reduce BPH symptoms. Possible medications for treating BPH include: alpha-blockers, phosphodiesterase-5 inhibitors, 5-alpha reductase inhibitors, and combination medications
• Minimally invasive procedures
Medical professionals may suggest one of several minimally invasive procedures that relieve BPH symptoms when medications do not work. Some of these are transurethral methods, which involve feeding a thin tube through the urethra.
• Surgery
A healthcare professional may suggest that a person with BPH undergo surgery if medications and other treatments do not work. During surgery, a surgeon may remove some enlarged prostate tissue. They may also make cuts in the prostate to widen the urethra to relieve blockages. Surgery may be endoscopic or conventional open surgery, depending on the size of the enlarged prostate. Very large prostate glands may require open surgery.
ENLARGED PROSTATE PREVENTION
Medical professionals do not fully understand how to prevent BPH. If a person has a high risk of BPH, it is best to speak with a doctor. Early diagnosis can be important as early treatment can minimize the effects of BPH.
Experts recommend that people who experience any symptoms of BPH speak with a healthcare professional. This is because early treatment of BPH can be vital in reducing the condition’s effect on a person’s well-being. Symptoms of BPH may also be a sign of a more serious condition, such as prostate cancer.
