Most men will suffer from an enlarged prostate to some degree after a certain age. It is a part of normal male ageing and Western men suffer from it more than Asian men. What is the prostate anyway? Most people have heard of it, but have little idea what it’s for, and many people don’t know where it is.
The prostate gland lies underneath the bladder. Its main job is to produce a thin, clear fluid that nourishes sperm while they are being stored in the seminal vesicles awaiting release through ejaculation. The prostate needs hormones from the testicles, testosterone and prostaglandin, so it can work properly, and if they are low the prostate shrinks.
Why does the prostate cause trouble?
A man’s prostate usually becomes larger after the age of 50. The fact that the prostate grows isn’t important in itself, and indeed the trouble it causes doesn’t depend on its actual size. However, the prostate surrounds the tube from the bladder called the urethra and as it enlarges it squeezes the urethra and narrows the opening out of the bladder. This is called obstruction and it impedes the flow of urine.
Symptoms of obstruction
As obstruction occurs gradually, many men don’t realize it’s happening. They may notice that their urine stream doesn’t travel as far as it did when they were young and they may be aware that it’s less forceful. Then there may be delay in getting started called hesitancy, and the urine stream tails off at the end, sometimes causing troublesome dribbling.
There may be a feeling that the bladder isn’t quite empty, known as incomplete emptying.
Why does the prostate get bigger?
The main cause is simply age. The benign non-cancerous enlargement is called benign prostatic hyperplasia (BPH).
The exact reason of enlargement is still uncertain, but male hormones are required so it doesn’t occur in men castrated at an early age. Most men over the age of 80 have the condition, and about half will have some symptoms from it.
What is prostatitis?
Inflammation of the prostate from infection or other causes is not uncommon and can occur at most ages, affecting approximately 1 man in 10. Sometimes it causes symptoms like cystitis such as burning pain while passing urine. In older men, it might cause a sudden increase in prostate symptoms. The prostate is very tender when the doctor does an internal rectal examination.
Do I have an enlarged prostate?
If you have read this far and you are a man of the right age for prostate problems, you will probably be wondering whether you need to have your prostate seen to, so ask yourself some questions.
• Do you have difficulty starting to pass urine?
• Does it take longer to pass urine that it did?
• Do you stop and start?
• Do you need to pass urine twice or more during the night?
• Are you sometimes caught short?
If your answer to two or more questions is yes, see your doctor.
Treatment of an Enlarged Prostate
If you have a prostate problem, you doctor will ask you about your symptoms then do a rectal examination to assess the size of your prostate. Tests will be arranged for confirmation and to help plan your treatment.
Until very recently, virtually the only treatment for benign enlargement of the prostate was an operation. Operations on the prostate are usually very successful if a man has severe symptoms, but are sometimes disappointing if symptoms are only mild.
Drug treatment of BPH is usually for mild symptoms where the obstruction isn’t too bad. Drugs may be tried in more severe cases if there are medical reasons to avoid surgery, or for temporary relief when waiting lists are long.
Microwave or thermotherapy, where heat treatment is used to destroy prostate tissue, may help some patients with less severe symptoms.
After the Operation
Postoperative pain is uncommon but the catheter can be uncomfortable and may make the bladder feel full. Sometimes painful spasms occur. If they are severe you will get drugs to control them. You will be asked to drink a lot of water each day to help flush out your bladder.
At the end of sex, a man may have a normal climax but no semen is ejaculated. This is called retrograde ejaculation. “Having a dry run” describes exactly what happens and it’s because semen is leaking back into the bladder rather than coming out normally. A few men do experience difficulty in getting an erection after the operation, so ask your surgeon before having the operation for his opinion.