In males, urine and semen pass through a tube called the urethra. It connects the urinary bladder to the penis. This urethra is surrounded by the prostate gland, which produces a fluid that carries the sperms during ejaculation. An overgrowth of the prostate gland can constrict the urethra and result in various problems related to urination.
An enlarged prostate is a result of over-proliferation of prostate cells. However, the condition is not cancerous and is thought to be a normal result of aging. Enlarged prostate is medically known as benign prostatic hyperplasia (BPH).
The enlargement of the prostate puts pressure on the urethra and constricts its opening. This results in the following symptoms:
- Difficulty in passing out urine. This results in sensations of incomplete emptying of the urinary bladder.
- Incomplete emptying of the bladder is accompanied by rapid refilling with newly formed urine. This causes a sense of urgency and increased frequency of urination. Affected people might have to get up frequently at night to pass urine (a condition called nocturia).
- An inability to control the passage of urine (incontinence) could also occur. There might be dribbling of urine at the end of the urine stream or a starting and stopping of the urine flow.
- Straining to pass urine could rupture the veins surrounding the urethra, resulting in bloody urine (hematuria).
- In most severe cases, the urine flow might get blocked altogether leading to complete urine retention in the bladder.
The cause of benign prostatic hyperplasia is not known. However, it affects about 50% of men over the age of 50 years. Therefore, the hormonal changes associated with aging might have some role to play in the onset of benign prostatic hyperplasia. Also, some factors from the testis might play a causative role because BPH does not occur in men who have had their testicles removed (usually as a treatment of testicular cancer) at an early age. Similarly, removal of testis in men with benign prostatic hyperplasia shrinks the prostate size. No risk factors apart from aging and normally functioning testes have been identified.
The treatment options depend on the severity of the symptoms. Benign prostatic hyperplasia (BPH) may not require any treatment if the condition is not causing severe symptoms or complications.
For mild symptoms, the following conservative measures are recommended:
- Avoid alcohol and caffeine since it has the tendency to increase urination.
- Spread the intake of fluid throughout the day instead of drinking a lot in one sitting.
- Avoid cold medications that contain decongestants and anti-histamines.
- Practice Kegel exercises to strengthen the pelvic muscles.
In case of more severe symptoms requiring medical attention, following options are available:
- α1-blockers (prazosin, terazosin, alfuzosin, tamsulosin, and doxazosin) relax the bladder muscles to allow easy urination.
- 5α-reductase inhibitors (like finasteride and dutasteride) reduce prostate size and improve the symptoms of BPH.
- A combination therapy using both these types of drugs is more effective than using a single drug.
Prostate surgery is an option in cases which do not respond to drugs and in severe cases involving complications such as recurrent hematuria, bladder stones and kidney failure. It usually involves removal of part of or the entire prostate. This procedure is known as a prostatectomy.