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Enlarged Prostate (BPH)


Prostate enlargement (otherwise known as benign prostatic hyperplasia, or BPH) is one of the most common health problems faced by men over 40 years old. In fact, about 50% of men will experience prostate problems in their 60’s, a number that grows to about 80% of men by the time they reach their 80’s. So if you are experiencing symptoms of enlarged prostate, you’re not alone.

The Prostate: What is it?

The prostate is a gland involved in the male reproductive system. It is located just below the bladder, surrounding the bladder opening (called the urethra) like a doughnut. The prostate is composed mostly of muscular and glandular tissue. Its primary job is to produce fluid for semen, the white fluid that transports sperm.

What Happens As A Man Gets Older?

For most of a man’s life, the prostate is small, about the size and shape of a walnut and weighing only about an ounce. In fact, it only undergoes two main growth periods during its life. The first is during puberty, when the prostate doubles in size. The second growth period begins at around age 25.

This second growth phase is what often results, years later, in the condition known as enlarged prostate, or BPH. It’s important to realize that this condition is a benign growth of the prostate. BPH is not cancer, nor does it lead to cancer.

The cause of BPH isn’t entirely understood. Some researchers believe it may be related to hormonal changes that occur later in a man’s life.

How An Enlarged Prostate Affects You:

Prostate enlargement usually starts at the innermost part of the prostate, the part closest to the urethra. It’s easy to imagine what happens-as the prostate grows, it gradually begins to squeeze the urethra, like a clamp on a garden hose. Urination becomes more difficult, and the bladder may not be able to empty completely, keeping small amounts of urine behind. This combination of blocked urethra and irritated bladder, if left untreated, can lead to more serious problems, including infection and damage to the kidneys and bladder.

The Most Common Symptoms:

Most symptoms of an enlarged prostate involve urination, and they can range from mild to bothersome to severe, when a man isn’t able to urinate at all. It’s important to check with your doctor as soon as you notice anything unusual with regard to urination.

The symptoms of an enlarge prostate may vary, but typical symptoms include:

  • Weak urine stream
  • Nighttime urination
  • Urgent urination
  • Starting and stopping of urination
  • Hesitancy of stream
  • Frequent urination
  • Sensation of incomplete bladder emptying
  • Painful or burning urination

Often, the severity of symptoms is related to how constricted the urethra is by the prostate. Without treatment, these symptoms may continue to worsen as the condition progresses.

Tests Used to Diagnose Prostate Enlargement:

You may, especially if you’re over 60 years old, first notice symptoms yourself. Or, your doctor may find that your prostate is enlarged during a routine physical exam. During this exam your doctor will take your medical history and check your urine. He or she will also perform a digital rectal exam (or DRE), which is a simple, painless test in which the doctor feels inside the rectum to check the size and consistency of your prostate.

When prostate enlargement is suspected, you may be referred to a urologist, a physician who specializes in problems of the urinary tract and male reproductive system. This doctor may want to perform other tests to help determine the best course of treatment. These tests may include:

  • Ultrasound – An image formed with sound waves that helps the doctors assess the prostatic and any obstruction.
  • Urine Flow Study – A test to determine how quickly urine is flowing. A slow flow may suggest an enlarged prostate.
  • Intravenous Pyelogram (IVP) – An x-ray of the urinary tract. For this test, dye is injected into a vein, and an x-ray and any blockage caused by the prostate.
  • Cystoscopy – A test in which the doctor inserts a small telescope through the urethra to see the inside of the urethra and bladder. With this, the doctor can see the size of the gland and the location of the obstruction.
  • Complete AUA Symptom Score Survey – A series of questions the doctor will ask to help better assess your symptoms.

Because enlarged prostate is so common, and so treatable, it’s important to have an annual physical examination that includes a prostate exam after the age of 50 years old (or age 40, if you’re an African-American or have a family history of the disease).

Treatment Options:

The good news about prostate enlargement is that it is treatable. You don’t have to endure its symptoms, and you and your doctor will probably find a treatment option that’s right for you.

If you have prostate enlargement but are experiencing no symptoms or urinary obstruction, you and your doctor may decide that watchful waiting is the best option. This may mean no active treatment, but simply yearly or more frequent checkups to evaluate your condition.

Currently, treatment options for enlarged prostate fall into three categories:

  1. Drug therapy
  2. Surgery
  3. Minimally invasive treatments

Each treatment offers both advantages and disadvantages, and the treatments may vary in terms of their effectiveness. Be sure to discuss all your options with your doctor before reaching a decision.

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