October 1, 2013
A middle aged man, who slept well all his life, now visits the bathroom twice or thrice every night and sometimes more. His other symptoms include straining and trouble starting a stream of urine. In most men, this may be the first sign of an enlarged prostate andis a natural process of getting older.
It is a problem that has several names -- enlarged prostate, benign prostate hyperplasia, or simply BPH. It is the most common problem for men over the age of 50, affecting over 50% of men over 60 years and 90% of men over 85 years.These symptoms become more bothersome if not diagnosed and left untreated and significantly affect their quality of life.
On the occasion of World Elders Day on October 1, we discuss about prostate enlargement and its problems in the elderly with consultant urologist, Dr Nischith D’Souza.
What is prostate gland?
The prostate is a gland found only in males. It is present just below the bladder and in front of the rectum. The size of the prostate varies with age. In younger men, it is about the size of a walnut, but it can be much larger in older men. The urethra is the tube that carries urine and it runs through the center of the prostate. The prostate contains cells that make some of the fluid that protects and nourishes the sperm.
What is prostate enlargement?
The prostate keeps on growing with age under the effect of the male hormones. This causes BPH (benign prostatic hyperplasia) which can lead to problems passing urine because the prostate can press on the urethra. BPH is not cancer and does not change into cancer.
What causes prostate enlargement?
It is not yet fully understood what causes the prostate gland to enlarge. The chances of developing enlarged prostate increases as you get older than 50 years but not all will develop symptoms.The balance of hormones in the body changes as one grows older and this may cause the prostate gland to grow.Men with family history and obesity may be at a higher risk of developing an enlarged prostate.
What are the consequences of prostate enlargement?
In men, urine flows from the bladder through the urethra. BPH is a benign enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra, through which urine exits the body. As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.
Over time, the bladder muscle may gradually become stronger, thicker, and sensitive,and contracts even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra, it becomes weak and urine remains in the bladder and it is not completely emptied.When the bladder does not empty completely, there may be an increased risk for developing urinary tract infections, incontinence and acute urinary retention (an inability to urinate). In rare cases, bladder and/or kidney damage can develop from BPH. A sudden and complete inability to urinate is a medical emergency and necessitates catheterization.
What are the symptoms?
Symptoms of enlarged prostate can include:
• A weak or slow urinary stream
• A feeling of incomplete bladder emptying
• Difficulty starting urination
• Frequent urination
• Urgency to urinate
• Getting up frequently at night to urinate
• A urinary stream that starts and stops
• Straining to urinate
• Dribbling of urine
• Returning to urinate again minutes after completion
How is an enlarged prostate diagnosed?
The severity of symptoms is assessed with the IPSS score. Apart from physical and rectal examination, an ultrasound of the abdomen with post void residue, uroflowmetry, blood andurine tests, and a serum PSA in certain cases is recommended.
What are the treatment options for an enlarged prostate?
Incidental finding of an enlarged prostate gland on ultrasound, without symptoms, need not be treated. It is also important to understand that the larger the prostate size does not mean worse the symptoms. Bothersome symptoms and complications as mentioned earlier, necessitate treatment. A range of treatments can relieve enlarged prostate symptoms – medications, endoscopic surgery i.e. TURP (transurethral resection of prostate) and prostatic stents. The treatment decision depends on the symptoms, their severity and associated medical conditions and is decided by the urologist.
Is a person likely to get prostate cancer if he has an enlarged prostate? If so, what are the symptoms?
No. Having an enlarged prostate does not put one at greater risk of getting prostate cancer. However, it can arise independently and it is possible to have both an enlarged prostate and prostate cancer at the same time. Early prostate cancer does not cause any urinary symptoms. As it progresses, the urinary symptoms are the same as that of benign prostatic enlargement.
What is your message?
The number of ageing population has increased and with it a myriad of health problems peculiar to the elderly. Urinary problems are common with advancing age and many consider it as a part of ageing and suffer in silence. It is important that we be aware of prostate gland and its symptoms, and that it can be diagnosed and treated.
The elderly have a right to health and fulfilling their physical, psychological and emotional needs of elders is the key to provide thema good quality of life.On the occasion of World Elders Day,let usalso say thanks to all the elders for bringing us up, giving us all the knowledge and made us what we are today. Thank you.
Dr Nischith can be contacted at ‘Mangalore Kidney Urology Centre’, Don Bosco Hall Cross Road, Falnir, Mangalore. Ph: 0824-2422166/2422167,9945087949. E mail: firstname.lastname@example.org. Website: www.mangalorekidneyurrologycentre.com