ENLARGED PROSTATE

WHAT MIDDLE AGED MEN NEED TO KNOW

By Dr. Vipul Agarwal

Enlarged Prostate: A majority of elderly gentlemen experience urinary symptoms such as increased frequency of urine, the urgency of going to the washroom to pass urine, slow stream of urine etc. Apart from all these symptoms, Patients can also have recurrent urinary tract infections, which can even be life-threatening in elderly men. It is a disease of men and usually starts after the age of 45 years with the involvement of over 80% of men over the age of 80 years with this prostate disease called “benign prostate enlargement” (BPE).

 “Benign prostatic hyperplasia or enlargement” is the medical term for an enlarged prostate. The prostate is a gland that surrounds the urethra (the tube that carries urine from the bladder out through the penis). This gland often gets bigger as a person gets older. It has nothing to do with prostate cancer. In fact, the word “benign” means “not cancer.”

Many of our elders ignore these symptoms thinking it is a part of old age, which significantly impacts their quality of life. Running looking for a washroom, or sometimes passing some part of urine in pants can be emotionally very stressful for such patients and can adversely affect their mental health. 

It is a curable disease. With appropriate medications, patients can have a healthy prostate and hence, undisturbed bladder habits and can lead completely normal lives.

BPH can present with various symptoms like

1. Frequent urination, especially at night (called as nocturia)
2. Having trouble starting to urinate (this means that you might have to wait or strain before urine will come out)
3. A hesitant, interrupted, or weak stream of urine (hesitancy)
4. The need to urinate frequently (frequency)
5. Leaking or dribbling of urine
6. Urgency of urine – feeling of need to pass urine immediately to avoid leak
7. Feeling as though your bladder is not empty even after you urinate

In rare cases, BPH makes it so a person cannot urinate at all. This is a serious problem. If you cannot urinate at all, report to your doctor right away.

If you or your relatives suffer from any of these symptoms, you should immediately see a physician/ urologist.

Your doctor may ask you to undergo a few blood tests and ultrasound studies to determine the level of prostate enlargement and to rule out prostate cancer. Having BPH does not increase the chance of patient developing prostate cancer. 

How do you treat BPH?

1. Lifestyle modifications like-
   1. Reducing the amount of fluid you drink, especially just before bed
   1. Limiting the amount of alcohol and caffeine you drink. These drinks can make you urinate more often.
   1. Avoiding cold and allergy medicines that contain antihistamines or decongestants. These medicines can make the symptoms of BPH worse.
   1. Doing something called “double voiding.” That means that after you empty your bladder, you wait a moment, relax, and try to urinate again.
2. Medicines- There are 2 types of medicine commonly used to treat BPH. One type relaxes the muscles that surround the urethra. The other type keeps the prostate from growing more or even helps the prostate shrink. In some cases, doctors suggest taking both types of medicine at the same time. Depending on your symptoms, your doctor might also suggest other medicines.
3. Surgery – There are several ways to treat BPH with surgery. They can involve removing some of the prostate, shrinking the prostate, or making the urethra wider so more urine can flow through. 

How do I choose which treatment to have?

The right treatment for you will depend on:

• How much your symptoms bother you
• How you feel about the different treatment options

If your symptoms don’t bother you very much, you might not need any treatment. On the other hand, if your symptoms do bother you, you probably should get treated.

Doctors often suggest trying medicines first to see if they help. If medicines don’t do enough, surgery is also an option. When you’re thinking about which treatment to have, ask your doctor or nurse these questions:

• How likely is it that this treatment will improve my symptoms?
• What are the risks or side effects of this treatment?
• What happens if I don’t have this treatment?

Dr Vipul Agarwal (M.B; B.S  MD(Internal Medicine) Department of Internal Medicine Yenepoya medical college, Mangaluru)