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