Wed 29, May 2019
Most men will be affected by an enlarged prostate at some point in their lives, so it's important they know the symptoms and when to seek help.
As men get older, their prostate glands – much like their ears - get bigger. The male hormone testosterone is responsible for this growth, roughly doubling the prostate’s size between the ages of 20 and 50 years, and doubling it again in the next 30-year stretch to 80.
It’s perfectly normal and there’s nothing that can be done about it.
The prostate is a donut-shaped organ that sits under the bladder, and its main function is to make the fluid that protects and feeds sperm. The urethra (urinary tract) passes through the middle of this organ, and as it enlargens the gap through which the urethra passes reduces, causing urethra to constrict and affecting the urine flow out of the bladder.
This constriction of the urethra is called BPH, which refers to two conditions: benign prostatic hyperplasia (an increase in number of prostate cells) or benign prostatic hypertrophy (increase in prostate cells' size).
BPH is the most common prostate disease in men, often starting around 40 years of age and affecting most men eventually. It’s important to understand that BPH is not linked to prostate cancer.
Some of the symptoms of BPH are:
- having to wait to start urinating
- a weak of poorly directed stream
- straining to urinate
- dribbling after finishing
- some urine retained after finishing
- having to urinate urgently
- having to go often, including overnight
- leakage, even if urination can’t get started
If you have any of these lower urinary tract symptoms, it’s important to see your doctor. You will need to provide a personal and family history, and may also be required to complete a voiding diary, recording your urinating and drinking patterns over a few days. Your doctor will also need details of your current medications and any other medical issues.
The main test when checking for prostate problems is a digital rectal examination, which involves the doctor checking the prostate’s size and shape by placing a gloved finger into the rectum.
If you have BPH, your doctor will talk you through the range of treatments, which include:
There are two main types of tablets; alpha-blockers and 5-alpha reductase inhibitors. The alpha-blockers relax the muscles of the prostate, bladder neck and urinary tract, while the 5-alpha reductase inhibitors block the effect of testosterone, causing the prostate to get smaller. Both types are effective, have few side effects and are often the first treatment option.
This involves taking out part of the prostate gland constricting the urinary tract (a prostatectomy) either telescopically with a special instrument passed through the penis into the urinary tract, or by an open operation.
About 90 per cent of prostatectomies are done telescopically. The most common is a transurethral resection of the prostate (TURP), which involves the cutting and removal of the restricting prostate tissue (referred to colloquially as a rebore). A similar procedure, a transurethral incision of the prostate (TUIP), snips the “ring” of enlarged tissue near the bladder neck to make a larger opening.
The remaining 10 per cent of prostatectomies are done openly through the abdomen, when the prostate gland is too large to be telescopically removed.
Laser and microwave treatments
Some less invasive treatments that destroy the enlarged part of the gland with lasers and microwave treatments may be suggested by your doctor, but they have a greater chance of symptoms reoccurring.
Pelvic floor exercises
Men who have had prostate surgery are often encouraged to do pelvic floor muscle exercise because the urinary sphincter (the muscle ring that shuts off the bladder) can be damaged by the surgery.
It is important they are done correctly, so consult a physiotherapist, continence health professional, or phone the National Continence Helpline 1800 33 00 66 to receive the correct instruction.