Urinary Incontinence in Men
What is an Enlarged Prostate?
The prostate gland is located below the bladder in men and produces fluid components of semen. Over half of men aged 60 and above have enlargement of the prostate gland. This condition is sometimes called benign prostatic hyperplasia or benign prostatic hypertrophy (BPH). It is not known exactly why this enlargement occurs. However, BPH is not cancer and does not cause cancer. Some men have symptoms of BPH while others do not.
Symptom: Frequent Urination
The most common symptom of BPH includes having to urinate more, often at night. The reason is that the enlarged prostate gland presses on the urethra, which carries urine out of the body. Because of this pressure, the bladder muscles have to work harder to excrete urine. The bladder eventually may start to contract even when only a small amount of urine is present, creating the urge to urinate more often.
Symptom: Difficulty Urinating
Pressure on the urethra from the enlarged gland and the additional work required of the bladder muscles lead to other symptoms of BPH as well. These include taking longer to initiate a urine stream and urinating with a weaker flow than before. Urine may dribble, or you may feel that there is still urine inside the bladder even after you have finished urinating.
Symptom: Inability to Urinate
If BPH completely blocks the urethra, inability to urinate may result. This can also happen as a result of infections or if the bladder muscles become excessively weak. The inability to urinate is a serious condition that can permanently damage the kidneys. If this comes on suddenly, go to a hospital emergency department. If you start to have symptoms of BPH, see your doctor right away in order to prevent worsening of the symptoms.
Who Gets an Enlarged Prostate?
The prostate gland grows throughout a man's life, starting at puberty and again from age 25 onward. Typically there are no symptoms from an enlarged prostate before age 40. Up to 90% of men have symptoms of BPH by age 85, but only about one-third of men with BPH symptoms are bothered by the symptoms.
What Causes the Prostate to Grow?
No one knows why the prostate continues to enlarge throughout a man's life. Hormones like testosterone, dihydrotestosterone (DHT), and estrogen may be involved in regulating the growth of the prostate. Having a vasectomy and sexual activity do not increase the risk of getting BPH. It is also not understood why some men have symptoms with BPH while others do not.
Getting Diagnosed Early
The symptoms of BPH may be symptoms of other conditions, including tumors and infections. If you have symptoms, you should see your doctor to rule out other possible causes of the symptoms.
Ruling Out Prostate Cancer
Some of the symptoms of BPH are the same as those of prostate cancer, so many men are fearful of the symptoms. However, BPH is far more common than prostate cancer. Men with BPH are no more likely than other men to develop prostate cancer. However, it's important to have your doctor perform a thorough examination because the two conditions share symptoms and can even coexist.
How Will Your Doctor Diagnose BPH?
Diagnosis of BPH is based upon taking a history of your symptoms. Tests that may be carried out include:
- A rectal examination to assess the size and shape of the prostate
- Ultrasound examination
- Biopsy of the prostate
- Urine flow studies
- Cystoscopy, in which the doctor can see and evaluate the inside of the bladder
When Does BPH Need to Be Treated?
Whether or not BPH must be treated depends on the symptoms and their severity. Recurrent infections, problems urinating, leakage of urine, and kidney damage can all significantly impact your quality of life. Medications or surgical treatments may help if you are having severe symptoms.
Treatment: Watchful Waiting
Your doctor may suggest watching the condition if you have only mild symptoms. You may need to visit the doctor for a checkup once a year or more often. You may never need treatment if the symptoms do not worsen. In fact, symptoms tend to resolve on their own in up to one-third of mild cases of BPH.
Treatment: Lifestyle Changes
Some lifestyle changes may be able to help with symptom relief. These are:
- Reducing consumption of alcohol and caffeine
- Avoid drinking fluids at bedtime, and drinking smaller amounts throughout the day
- Avoid taking decongestant and antihistamine medications
- Getting regular exercise
- Making a habit of going to the bathroom when you have the urge
- Practicing double voiding (empty the bladder, wait a moment, then try again)
- Practicing stress management and relaxation techniques
Treatment: Drugs for Urine Flow
Alpha blockers, drugs often prescribed to treat high blood pressure, can help relax the muscles in the bladder and prostate, allowing urine to flow more freely. Alpha blockers that are FDA-approved to treat BPH include alfuzosin, tamsulosin, doxazosin, and terazosin.
Treatment: Drugs to Slow Prostate Growth
5-alpha reductase inhibitors are drugs that can stop growth of the prostate or even shrink its size. They work by lowering the production of the hormone DHT. Examples of these medications are dutasteride and finasteride. The downside of these drugs is that they can lower sex drive and can cause erectile dysfunction. It can also take up to a year to see benefits with these drugs.
Treatment: Medicine Combos
Sometimes, taking more than one medication is beneficial. Combining a drug that slows prostate growth with one that relaxes bladder muscles may work better than the drugs given alone. Other medications that may be added include drugs to treat an overactive bladder.
Treatment: Complementary Medicine
Saw palmetto is a supplement that showed benefit in some studies in managing BPH symptoms. In other studies, this effect was not seen. Because there is no clear benefit and a risk that supplements may interfere with the action of other drugs, the American Urological Association does not recommend saw palmetto or other herbal supplements for BPH.
Treatment: Less Invasive Procedures
When medicines are not effective for symptom relief, procedures to remove excess prostate tissue can be considered. Two outpatient procedures, transurethral needle ablation (TUNA), also known as radiofrequency ablation, and transurethral microwave therapy (TUMT), are less invasive than surgery and can be done in less than one hour. Other options include laser treatments and stenting of the urethra.
Transurethral resection of the prostate (TURP) is the most common surgical procedure for relief of BPH. In this procedure an instrument is inserted through the penis and into the urethra to remove some of the prostate tissue.
Will BPH Affect My Sex Life?
Some evidence suggests that older men with BPH may have more sexual problems that other men their age, and some drugs used to treat BPH can cause problems with erection and ejaculation. You should talk to your doctor if you develop these problems, since a change in medications may relieve them.
Living with BPH
Many men never know they have BPH, and others are never bothered by its symptoms. But for those who do have troubling symptoms, there are many treatment options available. See your doctor as soon as you notice any symptoms.
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