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Prostate enlargement, or hyperplasia, is a benign condition of the prostate. This condition isn't in itself life-threatening and is not cancerous, but can nonetheless cause some unpleasant and inconvenient symptoms. In rare cases it may even lead to dangerous complications. Prostate gland enlargement is very common in older men, and there are many kinds of treatment that can effectively relieve the symptoms of this condition.

What Is The Prostate?

The prostate is a gland that is part of the male reproductive system. Its main function is production of the ejaculation fluid for transporting sperm also supporting their nutrition and survival. The prostate gland needs testosterone - a hormone also necessary for the growth of male sex characteristics - to function normally.

A healthy prostate gland is about the size of a large walnut. In young men, it weighs an average of 11 grams, and it enlarges with ageing. It's situated below the bladder and wraps around the urethra, the tube that conducts urine from the bladder to the penis. When the prostate becomes enlarged, the main effect is a restriction around the urethra reducing urine flow. 

Why Does The Prostate Become Enlarged?

The most common cause of prostate enlargement is called benign prostate hyperplasia, a condition that develops mainly in older men. It’s the most common cause of prostate problems in men over 50, affecting around half of men of this age. In men over the age of 80, around 90% are affected. Medical conditions such as type 2 diabetes, circulatory and heart problems can increase the risk of developing benign prostatic hyperplasia.

benign-prostatic-hyperplasia

This prostate condition is a benign enlargement of the prostate, and develops as a result of the overgrowth of cells called epithelial and stromal cells, and the tissue around them. While the exact cause of the disease is not well understood, it's most likely to be a consequence of ageing. For instance, one hypothesis for developing prostate enlargement is that as men age, their levels of testosterone slowly decrease relative to their levels of oestrogen. The changing hormone balance may lead to conditions in the prostate that promote overgrowth of epithelial and stromal cells which make the prostate tissue grow.

As the epithelial and stromal cells grow in number they form nodules within the prostate gland. The growth of cells and nodules puts pressure on the urethra, which disrupts the flow of urine coming from the bladder. This is why prostate enlargement can eventually cause difficulty urinating.

It's important to note that while prostate cancer can cause the prostate to increase in size and can even cause similar symptoms, benign prostate hyperplasia is an entirely different condition, and by far the most common cause of enlargement of the prostate. Benign prostate hyperplasia is by definition a non-cancerous condition.

Symptoms of Prostate Enlargement

While many men with early-stage prostate enlargement don't have any symptoms, most men do end up experiencing one or more symptoms as the prostate grows progressively larger. Some common symptoms of prostate enlargement include:

  • More frequent urination, especially at night
  • Strong and sudden urges to urinate
  • Difficulty starting urination
  • A weak or dribbling urine stream
  • Inability to fully empty the bladder, or a feeling that the bladder isn't fully empty after urinating
  • Urinary incontinence, with daytime urgency or at night

To diagnose the condition a doctor examines the prostate, and may also perform tests such as urinalysis and urine culture to look for any abnormalities in the urine, and whether there are any bacteria present. On the basis of symptoms and a rectal examination a doctor can typically determine whether benign prostate hyperplasia is present.

What are the Possible Consequences of Prostate Enlargement?

The symptoms of prostate enlargement come from the obstruction that the gland puts on the urethra as it grows larger. This obstruction can result in a considerable increase in pressure generated by the bladder muscle when passing urine. The muscle that controls the bladder must then work harder to empty it, and this over time can lead to weakening of the bladder muscle. As the muscle weakens it becomes more difficult to control, which also makes it more difficult to control urination, and results in failure of the bladder to empty effectively.

Another possible consequence of prostate enlargement is more frequent urinary tract infections. This is the result of chronic blockage of the urinary tract, which makes it easier for bacteria to colonize the area, and lead to urinary infection.

Finally, incomplete bladder emptying can lead to urinary retention, where the bladder never empties effectively. This also includes the possibility of complete obstruction, resulting in an inability to urinate at all. This is a medical emergency that requires immediate treatment, as it can result in damage to the bladder and kidneys.

When To Seek Emergency Medical Treatment

If you experience any of the following symptoms, seek medical treatment immediately.

  • Unable to urinate at all, despite feeling the need to
  • Fever and chills
  • Blood in urine
  • Strong discomfort or pain in the urinary tract or the lower abdominal region

How Is Prostate Enlargement Treated?

There are a number of different strategies for the treatment of benign prostate hyperplasia. They include prostate surgery, medical (tablet) treatments, lifestyle and home management, fluid adjustments and dietary changes, depending on a urological assessment. If conservative treatments of prostate enlargement don’t provide the desired results, surgery may be necessary to alleviate symptoms or complications.

Lifestyle Changes & Self-Care

The first step in treating mild symptoms of an enlarged prostate is to start practicing some simple self-care techniques. These treatment strategies include lifestyle changes that help take some of the pressure off your bladder and mitigate the early symptoms of prostate enlargement.

  • Reduce your liquid intake in the evening and at night, and when you go out in public places.
  • Reduce your intake of diuretic beverages such as alcohol, tea and coffee, and foods that may irritate the bladder.
  • Don’t hold urine in when you feel the urge to go. Urinate when you feel the need.
  • Go to the bathroom to urinate regularly, even if you don’t feel as though you need to, so that the bladder does not overfill. This can also help bladder emptying.
  • Get more exercise in general. Studies show that men who are more physically active are less likely to develop symptoms from benign prostatic hyperplasia. Aerobic exercise can also improve symptoms of prostatitis in men with this condition.
  • Avoid over-the-counter allergy and decongestant medications. These can make it harder for you to empty your bladder. If you suffer from allergies or other conditions that require these medications, talk to your doctor about alternatives.
  • Try to reduce your stress levels. When you feel nervous and stressed, increased adrenaline makes you feel the urge to urinate more frequently, so if you’re able to stay relaxed, your need to urinate may reduce.
  • Try to stay warm, especially in cold weather. Being cold causes your body to produce more urine and increase your need to urinate, so staying warm helps counteract this.

Medication For Prostate Enlargement

There are several different classes of medication that are used for enlarged prostate treatment, including alpha blockers and enzyme inhibitors.

Alpha Blockers are medications that are most often used to treat high blood pressure, but are also commonly used as a treatment for urinary problems in men. These medications act to relax smooth muscle, and therefore they relax the muscles of the bladder neck and prostate gland. This helps reduce obstruction and improve the flow of urine from the bladder to the penis.Commonly used drugs in this category include Tamsulosin and Alfuzosin.

Phosphodiesterase-5 (PD-5) Inhibitors include medications such as Cialis, which is otherwise prescribed for the treatment of erectile dysfunction. Like alpha blockers, this class of medication relaxes smooth muscle, therefore helping urine to flow more freely. However, they’re not commonly prescribed for prostate enlargement unless the individual also has erectile dysfunction.

5-Alpha Reductase Inhibitors are for hormone-based treatments that reduce the production of a highly active male hormone called dihydrotestosterone (DHT). These can be effective because hormone imbalance may be a cause of prostate enlargement. These medications include dutasteride and finasteride, both of which reduce the amount of DHT produced by the prostate.

While these medications can reduce the size of the prostate and improve urine flow, sometimes they have the side effect of decreased libido. Another consideration is that these medications take longer to become effective than alpha blockers and PD-5 inhibitors. They’re most often used to treat benign prostate hyperplasia when the prostate gland has already become moderately enlarged.

Antibiotics are sometimes prescribed for men with prostate enlargement because chronic urinary problems can lead to urinary tract infection. They can be used also for a usually unrelated infection within the prostate, called bacterial prostatitis.

Urologists often prescribe a combination of two or more of the above classes of medication, depending on an individual’s symptoms and how enlarged their prostate gland is. For instance, a typical treatment might include an alpha blocker and a hormone-based drug to treat the enlarged prostate.These can be used alongside another class of medications that specifically treat bladder over-activity to reduce urgency. The aim of these treatments is principally to reduce bothersome symptoms when surgery is not required.

Diet For Prostate Enlargement

It’s well-known that your diet has a strong influence on your health in general, and most doctors, researchers, and nutritionists agree that a good healthy diet is beneficial for improving symptoms of benign prostate hyperplasia. Therefore, when you have an enlarged prostate, nutrition is an aspect of your well-being that shouldn’t be ignored. However, there are no “quick fix” foods as none will cure prostate enlargement.

The best diet that can be used for enlarged prostate treatment is simply a healthy diet that includes plenty of fresh foods and a variety of nutrients. Experts recommend at least five servings a day of vegetables and fruits, along with lean protein, whole grains, and healthy plant-based fats. This also helps avoid constipation that can also aggravate prostate symptoms. Cutting down or avoiding salt, sugar, alcohol, and caffeine is also recommended. And finally, eat fresh whole foods whenever possible, rather than foods that are processed or packaged.

There is also some evidence that certain nutrients might be particularly beneficial in promoting prostate health.

  • The mineral zinc may help protect the prostate, and reduce the risk of developing benign prostate hyperplasia. Foods that are high in zinc include oysters, crab, baked beans, lean beef, lamb, and duck.
  • Vitamin C, when obtained by eating vegetables, may reduce risks with prostate enlargement. Some good vegetable sources of vitamin C include bell peppers, Brussels sprouts, broccoli, kale, tomatoes, and cauliflower.
  • It’s best to avoid caffeinated foods and beverages, as caffeine is a diuretic and causes more frequent urination, and can also irritate the bladder. This also applies todecaffeinated beverages and alcohol.

Natural Prostate Enlargement Remedies

According to the Mayo Clinic, there’s no evidence that any kinds of dietary supplements, including herbal supplements, can effectively treat prostate enlargement. However, it’s still possible that some people might experience symptomatic relief from certain kinds of supplements, such as the following:

  • Green tea is high in plant compounds called polyphenols, which can reduce inflammation in the body. However it does contain caffeine, and even a decaffeinated variety can aggravate symptoms.
  • Lycopene is an antioxidant that can lower prostate-specific antigen levels, and may help with prostate inflammation. The best sources of this compound are canned tomatoes and tomato products, rather than fresh tomatoes. Be sure to choose canned products without added salt or sugar.
  • Stinging nettle may help with urinary flow and post-urination dribbling.
  • Beta-sitosterol is a plant compound that may help with bladder emptying and urine flow.
  • Pygeum is obtained from the bark of an African tree. For some men with an enlarged prostate, it helps with urinary frequency and bladder emptying
  • Rye pollen extract can help some men with dribbling, urinary frequency and urgency, and strength of urine flow.
  • Saw palmetto has been the subject of several research studies, with mixed results, but some men find it helps with urinary frequency, strength of urine flow, and urinary urgency.

Always remember that over-the-counter supplements—herbal or otherwise—should be taken with caution, and natural remedies for prostate enlargement shouldn’t be used in lieu of medical treatment. Always consult with your doctor before trying a natural remedy, and be sure to keep them updated with your progress, or if you experience any new or unusual symptoms.

Minimally-Invasive Prostate Procedures

Some kinds of prostate enlargement treatment can be performed in hospital on an out-patient basis. These treatments are minimally invasive,sometimes performed under sedation rather than general anesthetic, and typically everyday activities can be resumed quickly. Some may have fewer side effects than other standard surgical treatments, and they may be less effective in the longer term or in more severe cases.

In each of the following procedures, a surgical instrument is inserted into the urethra in order to access the prostate gland. This is known as transurethral access. The instrument is then used to deliver a particular kind of energy or treatment to overgrown parts of the prostate gland. These treatments are highly specific: the medical professional can target only the prostate tissue that is overgrown, and leave the remainder of the gland intact.

  • Laser treatment uses laser light
  • Transurethral needle ablation uses radio waves
  • Transurethral microwave therapy uses microwave energy
  • Water-induced thermotherapy uses heated water
  • High-intensity focused ultrasound uses sonic energy
  • Transurethral incision of the prostate: rather than using energy to destroy sections of the prostate gland, in this method one or more incisions are made in the gland so that it puts less pressure on the urethra.

These procedures do cause some minor discomfort, and patients are typically given a sedative and a strong painkiller. Once they’re relaxed and ready for the procedure, local anaesthesia is used to numb the urethra.

Following the procedure, it’s common to have temporary side effects such as blood in the urine, a burning feeling at the tip of the penis, and urgency. These problems typically resolve after a few days, but can take longer.

Some men find that they have trouble holding their urine after a transurethral procedure. This is because the bladder is used to “forcing” urine through a urethra made more narrow by their enlarged prostate. It can be problematic for the first few weeks or months, but does get better with time.

Surgical Procedures To Treat An Enlarged Prostate

The surgery that’s most commonly used to treat benign prostate hyperplasia is called transurethral resection of the prostate. In this procedure, the parts of the prostate that are impairing urine flow are surgically removed. It’s usually performed with a general or spinal anaesthetic, and therefore requires a short stay in hospital, of around 1 to 2 days. After this surgery most people have some blood or clots in their urine; once their urine is clear and free from blood they’re ready to go home.

After this surgery it’s important to avoid strenuous activities and exercise, as well as sexual activity, for 4 to 6 weeks. As well as this it’s important to avoid constipation, as straining to have a bowel movement may cause injury to the prostate as it heals. Most men continue to have symptoms such as frequent or urgent urination for several weeks after this surgery; however this is not due to obstruction of the urethra, but to inflammation and irritation of the urethra and prostate while healing takes place. These symptoms typically subside after around 6 weeks, but in more severe cases may persist for longer.

While transurethral resection is the most common surgical treatment for prostate enlargement, it’s not an option for all men with this condition. For instance, if the prostate is very enlarged, open surgery is required instead. In an open prostatectomy, an incision is made in the lower abdomen to gain access to the prostate and remove the overgrown sections. Open surgery does by its very nature come with greater risks than transurethral surgery, but it is just as effective at transurethral surgery when it comes to treating the symptoms of prostate enlargement. Due to the greater risks involved with this surgery a hospital stay of 4 to 6 days is needed.

Once a patient returns home, their recovery experience is similar to that of someone who has transurethral surgery; however, after open surgery a patient must also be mindful of their incision wound, and should avoid lifting weights of over 10 to 15 pounds for around 4 to 6 weeks. Most people can return to work after a week or two, providing they’re able to follow medical instructions regarding their activity level and avoid strenuous exertion.

What Is Your Best Option For Prostate Enlargement Treatment?

The most common treatments for prostate enlargement include lifestyle changes and self-management, medication, and surgical procedures. The best treatment for any individual depends on several different factors, including the following:

  • Your age
  • Your general state of health
  • The size of your prostate
  • The severity of your symptoms, and their degree of bother
  • Whether or not you’re having complications such as infection or urinary blockage
  • Possible side effects of suitable treatment options

If you’re under the age of 50, are in good health overall, and your prostate is only slightly enlarged, you may wish to put off treatment such as medication, and simply focus on self-care techniques such as fluid, dietary and lifestyle changes. With medications, it’s possible to slow down the progression of symptoms, and keep them at a manageable level.

On the other hand, if you’re over 50 and your symptoms are starting to get worse, you may decide it’s time to consider medication. And if your symptoms become severe, or you experience a medical emergency such as urinary blockage, you may decide to opt for surgery.

Surgery is usually a definitive and permanent treatment. It is however irreversible and can have permanent side effects. Side effects should be discussed carefully with your urologist before deciding on any surgical procedure; the risks may vary between different treatments.

In particular, loss of ejaculation, usually referred to as retrograde ejaculation, is common. The prostate and the bladder neck mechanism next to it are essential for this function, and usually both are disrupted by surgery. Erectile function can be temporarily or permanently impaired in much smaller number of cases, unrelated to ejaculation. Unfortunately, but only in a small proportion overall, prostate symptoms may not be sufficiently relieved, and sometimes can be made worse, for instance difficulties with urinary control.

Further surgery may be required for some, as a result of scar tissue formation at the bladder neck or urethra, or for residual prostate tissue or its regrowth: such situations may arise at any time, and usually can be relieved successfully by prompt surgery.

Your urologist should be able to advise you on all aspects of treatment and those options best suited to your situation, guided by the symptoms you are experiencing and a careful diagnostic assessment. Finally, the possibility of unsuspected prostate cancer should be considered, as it can sometimes be diagnosed before surgery; nevertheless in a small number of cases it may only become evident afterwards, on examining the prostate tissue removed by the operation.

 

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