What is it:
An enlarged prostate is a common problem that usually affects men over the age of 50. It can cause symptoms like a weak urine stream, the sensation of a full bladder, the need to strain when urinating or drips and urine at the end of urination.
In most cases, an enlarged prostate is caused by benign prostate hyperplasia (BPH), however it may also be a sign of a more serious problem, like prostatitis or prostate cancer. Increased prostate size can compress the urethra, which is the channel through which urine flows, impeding normal urination.
If you suspect you may have an enlarged prostate, you should consult a urologist for testing and diagnosis. If confirmed, the doctor will direct the most appropriate treatment.
Common symptoms
The most common symptoms of an enlarged prostate are:
- Difficulty urinating
- Weak urine stream
- Interrupted urine stream
- Urinating for prolonged periods
- Drips at the end of urination
- Urinary frequency
- Urinary urgency
- The need to strain to urinate
- The sensation of full bladder
- Urinary retention
- Increased urination at night
These symptoms generally emerge after 50 years of age, and occur in at least half of cases. They occur due to the prostate compressing against the urethra, which is where urine flows through.
Because these symptoms are present in other health conditions, like prostatitis or cancer prostate, it is important to see a urologist for assessment, testing and diagnosis.
Symptoms checker
To assess your risk for a prostate problem, report your symptoms below:
Confirming a diagnosis
An enlarged prostate diagnosis is confirmed by a urologist through assessment of symptoms and health history. The doctor will likely ask the patient questions regarding his health history and if there is a family history of BPH. A rectal prostate check will also be done to evaluate the size of the prostate and to check for nodules or other abnormalities.
From here, the doctor may order a prostate ultrasound, urine tests, a PSA blood test, a urinary flow test and a post-urinary bladder scan. It may also be beneficial for men to record when they urinate and the associated symptoms over 24 hours, as this can help to identify the underlying cause.
If abnormalities are noted during the prostate check or if the PSA level is above the reference range, further testing, like an mRI or biopsy, may be needed to rule out the possibility of prostate cancer.
Possible causes
Cases of benign prostate hyperplasia (which emerges due to aging and presents with slowly progressive symptoms), treatment is usually only indicated if symptoms are interfering with the patient’s quality of life.
However, an enlarged prostate can also be caused by serious health conditions that require treatment, like prostatitis or cancer. Prostatitis usually affects younger men, while cancer is more commonly diagnosed in older age.
Men who have a family history of prostate cancer should have their prostate checked regularly after the age of 45 to prevent complications and to facilitate an early diagnosis.
Treatment options
Treatment for enlarged prostate should be oriented by a urologist, and varies with the underlying cause and intensity of symptoms.
The main treatments indicated for an enlarged prostate are:
1. Medication
Treatment for an en enlarged prostate usually starts off with medications that relieve symptoms and prevent complications like urinary retention or kidney stones. Some of the most-prescribed medications are:
- Medications to relax prostate muscles, like alpha-blockers such as tamsulosin and doxazosin.
- Medications to reduce hormonal action on the prostate, which reduces its volume, such as finasteride and dutasteride.
- Antibiotics to decrease prostate inflammation if present, such as ciprofloxacin.
These medications can be used separately or in combination, depending on the patient’s symptoms and the size of the prostate.
In cases in which men also have prostate cancer, the doctor will recommended surgery to remove the prostate, as well as radiation therapy and/or chemotherapy to destroy malignant tumor cells.
2. Surgery
Prostate removal surgery is recommended in more serious cases, like when a catheter is needed to urinate, if there is abundant blood in the urine, if the condition does not improve with more conservative treatment, if kidney stones are present, or if kidney failure is evident.
The most common surgery techniques include:
- Prostatectomy/adenomectomy: This consists of removing the inner most part of the prostate through abdominal surgery
- Transurethral ressection of the prostate: This involves removal of the prostate with equipment introduced through the urethra
- Transurethral electrovaporization of the prostate: This is similar to the transurethral ressection but it relies on a thermal reaction. Patients tend to be discharged much quicker.
In addition to these surgeries, in many cases, the doctor may just opt to make a small incision on the prostate to facilitate urinary flow through the urethra without removing the prostate.
3. Natural remedies
In addition to treatment with medication, patients can also use natural extracts to help relieve symptoms quicker. This type of treatment should not substitute treatment prescribed by a doctor, and should be used, instead to complement it.
A great natural option is saw palmetto extract, which contains anti-inflammatory and diuretic properties that help to reduce prostate swelling and facilitate urinary flow to reduce symptoms. To use saw palmetto, the recommended dose is 1 capsule at breakfast and at dinner. Another option is to take 1 teaspoon of saw palmetto powder dissolved in water, twice per day.
Another medicinal plant that may be beneficial is Pygeum africanum, which can help to relieve urinary frequency. It can be purchased in capsule form at natural health stores, and should be taken in doses of 25 to 200 mg per day. .
How to relieve discomfort
To reduce discomfort associated with an enlarged prostate, some tips include:
- Urinating even when you don’t have the urge to, to avoid holding your urine.
- Avoid drinking too many fluids at once at the end of the afternoon or before going to bed, particularly if you are not close to a bathroom.
- Exercise regularly or participate in physiotherapy to strengthen the pelvic muscles.
- Urinating every 2 hours, even without the urge.
- Avoid saucy foods and diuretic drinks, like coffee, alcohol, oranges, lemon, limes, pineapple, olives, chocolate or nuts.
- Do not allow urine to drip at the end of urination, and instead squeeze the urethra, as this can prevent infections
- Avoid taking medications that cause urinary retention, like nasal decongestants.
In addition, men who frequently experience constipation should increase their water intake and eat more laxative foods to regulate gut functioning, as constipation and worsen discomfort.